Artikel
Preoperative functional MR imaging – tissue hypoxia, perfusion restriction and distortions in vascular architecture are associated with neurovascular uncoupling in the vicinity of brain lesions
Präoperative funktionelle MR-Bildgebung – Gewebshypoxie, Perfusionsrestriktion und Störungen der Gefäßarchitektur sind assoziiert mit neurovaskulärer Entkopplung in der Nähe von Gehirnläsionen
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Autoren
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Sebastian Brandner
- Universitätsklinikum Erlangen, Neurochirurgische Klinik, Erlangen, Deutschland
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Michael Buchfelder
- Universitätsklinikum Erlangen, Neurochirurgische Klinik, Erlangen, Deutschland
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Ilker Eyüpoglu
- Universitätsklinikum Erlangen, Neurochirurgische Klinik, Erlangen, Deutschland
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Arnd Dörfler
- Universitätsklinikum Erlangen, Neuroradiologische Abteilung, Erlangen, Deutschland
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Andreas Stadlbauer
- Universitätsklinikum Erlangen, Neurochirurgische Klinik, Erlangen, Deutschland
| Veröffentlicht: | 26. Juni 2020 |
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Gliederung
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Objective: Functional MR imaging (fMRI) is commonly used for the preoperative localization of eloquent cortical areas. Lesion-induced attenuation of neurovascular coupling (NVC) in the lesion border zone, however, can lead to false-negative fMRI results. The purpose of this study was to investigate physiological factors influencing the NVC.
Methods: Twenty patients suffering from brain lesions were preoperatively examined using a multimodal approach including fMRI and magnetoencephalography (MEG) during language or sensorimotor tasks (depending on lesion location) as well as a novel physiologic MRI method for combined determination of oxygen metabolism (cerebral metabolic rate of oxygen, CMRO2; and mitochondrial oxygen tension, mitoPO2), perfusion (cerebral blood volume, CBV; and microvascular CBV, µCBV), and vascular architecture (microvessel density, MVD; and vessel size index, VSI).
Results: Congruence of brain activity patterns between fMRI and MEG were found in 13 patients (Figure 1 [Fig. 1], upper panel). In 7 patients, however, we observed missing fMRI activity in perilesional brain regions that demonstrated activity in MEG, which was interpreted as lesion-induced attenuation of NVC (Figure 1 [Fig. 1], lower panel). In these brain regions with attenuated NVC, physiologic MRI revealed significantly reduced mitoPO2 (P < 0.001), i.e. significant brain tissue hypoxia, as well as significantly decreased macro- and microvascular perfusion (CBV: P < 0.001; µCBV: P ≤ 0.02) and vascular architecture (MVD: P < 0.05; VSI: P < 0.03) compared to brain regions with intact NVC (Figure 2 [Fig. 2]). CMRO2 was increased but did not reach significance compared to brain regions with intact NVC.
Conclusion: We demonstrated that perilesional hypoxia and reductions in vascular perfusion and architecture are associated with lesion-induced attenuation of NVC, making fMRI unreliable for resection planning. Our physiologic MRI approach is a clinically applicable method for preoperative risk assessment for the presence of false-negative fMRI results and may prevent serve postoperative functional deficits.
