Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Functional Magnetic Resonance Imaging and Diffusion Tensor Imaging for Language Mapping in Brain Tumor Surgery: Validation With Direct Cortical Stimulation and Cortico-Cortical Evoked Potential

  • Koung Mi Kang (Department of Radiology, Seoul National University Hospital) ;
  • Kyung Min Kim (Department of Neurosurgery, Inha University Hospital, Inha University College of Medicine) ;
  • In Seong Kim (Siemens Healthineers Ltd.) ;
  • Joo Hyun Kim (Department of Clinical Science, MR, Philips Healthcare Korea) ;
  • Ho Kang (Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • So Young Ji (Department of Neurosurgery, Seoul National University Bundang Hospital) ;
  • Yun-Sik Dho (Neuro-Oncology Clinic, National Cancer Center) ;
  • Hyongmin Oh (Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Hee-Pyoung Park (Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Han Gil Seo (Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Sung-Min Kim (Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Seung Hong Choi (Department of Radiology, Seoul National University Hospital) ;
  • Chul-Kee Park (Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine)
  • Received : 2022.12.20
  • Accepted : 2023.03.23
  • Published : 2023.06.01
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Abstract

Objective: Functional magnetic resonance imaging (fMRI) and diffusion tensor imaging-derived tractography (DTI-t) contribute to the localization of language areas, but their accuracy remains controversial. This study aimed to investigate the diagnostic performance of preoperative fMRI and DTI-t obtained with a simultaneous multi-slice technique using intraoperative direct cortical stimulation (DCS) or corticocortical evoked potential (CCEP) as reference standards. Materials and Methods: This prospective study included 26 patients (23-74 years; male:female, 13:13) with tumors in the vicinity of Broca's area who underwent preoperative fMRI and DTI-t. A site-by-site comparison between preoperative (fMRI and DTI-t) and intraoperative language mapping (DCS or CCEP) was performed for 226 cortical sites to calculate the sensitivity and specificity of fMRI and DTI-t for mapping Broca's areas. For sites with positive signals on fMRI or DTI-t, the true-positive rate (TPR) was calculated based on the concordance and discordance between fMRI and DTI-t. Results: Among 226 cortical sites, DCS was performed in 100 sites and CCEP was performed in 166 sites. The specificities of fMRI and DTI-t ranged from 72.4% (63/87) to 96.8% (122/126), respectively. The sensitivities of fMRI (except for verb generation) and DTI-t were 69.2% (9/13) to 92.3% (12/13) with DCS as the reference standard, and 40.0% (16/40) or lower with CCEP as the reference standard. For sites with preoperative fMRI or DTI-t positivity (n = 82), the TPR was high when fMRI and DTI-t were concordant (81.2% and 100% using DCS and CCEP, respectively, as the reference standards) and low when fMRI and DTI-t were discordant (≤ 24.2%). Conclusion: fMRI and DTI-t are sensitive and specific for mapping Broca's area compared with DCS and specific but insensitive compared with CCEP. A site with a positive signal on both fMRI and DTI-t represents a high probability of being an essential language area.

Keywords

Acknowledgement

The authors appreciate the statistical advice regarding statistics provided by the Medical Research Collaborating Center at the Seoul National University Hospital. The authors also appreciate Ms. Seong Yeong Lee, Mrs. Chanrim Park, and Mrs. Gyungyhye Jung for their help with data analysis, table and figure preparation.

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