scholarly journals TMS Seeded Diffusion Tensor Imaging Tractography Predicts Permanent Neurological Deficits

Cancers ◽  
2022 ◽  
Vol 14 (2) ◽  
pp. 340
Author(s):  
Matthew Muir ◽  
Sarah Prinsloo ◽  
Hayley Michener ◽  
Jeffrey I. Traylor ◽  
Rajan Patel ◽  
...  
Keyword(s):  
Diffusion Tensor Imaging ◽  
Transcranial Magnetic Stimulation ◽  
Predictive Value ◽  
Magnetic Stimulation ◽  
Diffusion Tensor ◽  
Neurological Deficits ◽  
Preoperative Imaging ◽  
Imaging Features ◽  
Dti Tractography ◽  
Diffusion Tensor Imaging Tractography

Surgeons must optimize the onco-functional balance by maximizing the extent of resection and minimizing postoperative neurological morbidity. Optimal patient selection and surgical planning requires preoperative identification of nonresectable structures. Transcranial magnetic stimulation is a method of noninvasively mapping the cortical representations of the speech and motor systems. Despite recent promising data, its clinical relevance and appropriate role in a comprehensive mapping approach remains unknown. In this study, we aim to provide direct evidence regarding the clinical utility of transcranial magnetic stimulation by interrogating the eloquence of TMS points. Forty-two glioma patients were included in this retrospective study. We collected motor function outcomes 3 months postoperatively. We overlayed the postoperative MRI onto the preoperative MRI to visualize preoperative TMS points in the context of the surgical cavity. We then generated diffusion tensor imaging tractography to identify meaningful subsets of TMS points. We correlated the resection of preoperative imaging features with clinical outcomes. The resection of TMS-positive points was significantly predictive of permanent deficits (p = 0.05). However, four out of eight patients had TMS-positive points resected without a permanent deficit. DTI tractography at a 75% FA threshold identified which TMS points are essential and which are amenable to surgical resection. TMS combined with DTI tractography shows a significant prediction of postoperative neurological deficits with both a high positive predictive value and negative predictive value.

Navigated Transcranial Magnetic Stimulation for “Somatotopic” Tractography of the Corticospinal Tract

2014 ◽  
Vol 10 (4) ◽  
pp. 542-554 ◽  
Author(s):  
Alfredo Conti ◽  
Giovanni Raffa ◽  
Francesca Granata ◽  
Vincenzo Rizzo ◽  
Antonino Germanò ◽  
...  
Keyword(s):  
Diffusion Tensor Imaging ◽  
Transcranial Magnetic Stimulation ◽  
Motor Cortex ◽  
Magnetic Stimulation ◽  
Corticospinal Tract ◽  
Diffusion Tensor ◽  
Standard Technique ◽  
Navigated Transcranial Magnetic Stimulation ◽  
Subcortical Stimulation ◽  
Diffusion Tensor Imaging Tractography

Abstract BACKGROUND: Diffusion tensor imaging tractography provides 3-dimensional reconstruction of principal white matter tracts, but its spatial accuracy has been questioned. Navigated transcranial magnetic stimulation (nTMS) enables somatotopic mapping of the motor cortex. OBJECTIVE: We used motor maps to reconstruct the corticospinal tract (CST) by integrating elements of its somatotopic organization. We analyzed the accuracy of this method compared with a standard technique and verified its reliability with intraoperative subcortical stimulation. METHODS: We prospectively collected data from patients who underwent surgery between January 2012 and October 2013 for lesions involving the CST. nTMS-based diffusion tensor imaging tractography was compared with a standard technique. The reliability and accuracy between the 2 techniques were analyzed by comparing the number of fibers, the concordance in size, and the location of the cortical end of the CST and the motor area. The accuracy of the technique was assessed by using direct subcortical stimulation. RESULTS: Twenty patients were enrolled in the study. nTMS-based tractography provided a detailed somatotopic reconstruction of the CST. This nTMS-based reconstruction resulted in a decreased number of fibers (305.1 ± 231.7 vs 1024 ± 193, P < .001) and a significantly greater overlap between the motor cortex and the cortical end-region of the CST compared with the standard technique (90.5 ± 8.8% vs 58.3 ± 16.6%, P < .001). Direct subcortical stimulation confirmed the CST location and the somatotopic reconstruction in all cases. CONCLUSION: These results suggest that nTMS-based tractography of the CST is more accurate and less operator dependent than the standard technique and provides a reliable anatomic and functional characterization of the motor pathway.

scholarly journals Diffusion Tensor Imaging Evaluation of Neural Network Development in Patients Undergoing Therapeutic Repetitive Transcranial Magnetic Stimulation following Stroke

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Naoki Yamada ◽  
Ryo Ueda ◽  
Wataru Kakuda ◽  
Ryo Momosaki ◽  
Takahiro Kondo ◽  
...  
Keyword(s):  
Diffusion Tensor Imaging ◽  
Transcranial Magnetic Stimulation ◽  
White Matter ◽  
Fractional Anisotropy ◽  
Motor Function ◽  
Magnetic Stimulation ◽  
Diffusion Tensor ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Cerebral White Matter ◽  
Imaging Evaluation

We aimed to investigate plastic changes in cerebral white matter structures using diffusion tensor imaging following a 15-day stroke rehabilitation program. We compared the detection of cerebral plasticity between generalized fractional anisotropy (GFA), a novel tool for investigating white matter structures, and fractional anisotropy (FA). Low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) of 2400 pulses applied to the nonlesional hemisphere and 240 min intensive occupation therapy (OT) daily over 15 days. Motor function was evaluated using the Fugl-Meyer assessment (FMA) and Wolf Motor Function Test (WMFT). Patients underwent diffusion tensor magnetic resonance imaging (MRI) on admission and discharge, from which bilateral FA and GFA values in Brodmann area (BA) 4 and BA6 were calculated. Motor function improved following treatment (p<0.001). Treatment increased GFA values for both the lesioned and nonlesioned BA4 (p<0.05, p<0.001, resp.). Changes in GFA value for BA4 of the lesioned hemisphere were significantly inversely correlated with changes in WMFT scores (R2=0.363, p<0.05). Our findings indicate that the GFA may have a potentially more useful ability than FA to detect changes in white matter structures in areas of fiber intersection for any such future investigations.

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