Preoperative Mapping of the Supplementary Motor Area in Patients with Brain Tumor Using Resting-State fMRI with Seed-Based Analysis

Fellows’ Journal Club

Sixty-six patients with brain tumors were evaluated with resting-state fMRI using seed-based analysis of hand and orofacial motor regions. Rates of supplementary motor area localization were compared with those in healthy controls and with localization results by task-based fMRI. Localization of the supplementary motor area using hand motor seed regions was more effective than seeding using orofacial motor regions for both patients with brain tumor and controls. Bilateral hand motor seeding was superior to unilateral hand motor seeding in patients with brain tumor for either side. The authors conclude that in addition to task-based fMRI, seed-based analysis of resting-state fMRI represents an equally effective method for supplementary motor area localization in patients with brain tumors, with the best results obtained with bilateral hand motor region seeding.

Abstract

BACKGROUND AND PURPOSE

preoperative mapping of supplementary motor area of the brain
Mean group correlation maps across different seed locations for patients with brain tumor (bilateral hand motor seed in red, left hand motor in blue, right hand motor in green, left tongue motor in yellow, and right tongue motor in pink; please note that left and right denote the cerebral hemisphere of the seeds and thus represent contralateral functional regions). The greatest correlation in the supplementary motor area (arrow on the axial image) is seen with bilateral hand motor seeds. To a much lesser extent in this group visualization, left hand and right hand motor seeds demonstrate correlation in the SMA; however, neither tongue motor seed does so. R indicates right; L, left.

The supplementary motor area can be a critical region in the preoperative planning of patients undergoing brain tumor resection because it plays a role in both language and motor function. While primary motor regions have been successfully identified using resting-state fMRI, there is variability in the literature regarding the identification of the supplementary motor area for preoperative planning. The purpose of our study was to compare resting-state fMRI to task-based fMRI for localization of the supplementary motor area in a large cohort of patients with brain tumors presenting for preoperative brain mapping.

MATERIALS AND METHODS

Sixty-six patients with brain tumors were evaluated with resting-state fMRI using seed-based analysis of hand and orofacial motor regions. Rates of supplementary motor area localization were compared with those in healthy controls and with localization results by task-based fMRI.

RESULTS

Localization of the supplementary motor area using hand motor seed regions was more effective than seeding using orofacial motor regions for both patients with brain tumor (95.5% versus 34.8%, P < .001) and controls (95.2% versus 45.2%, P < .001). Bilateral hand motor seeding was superior to unilateral hand motor seeding in patients with brain tumor for either side (95.5% versus 75.8%/75.8% for right/left, P < .001). No difference was found in the ability to identify the supplementary motor area between patients with brain tumors and controls.

CONCLUSIONS

In addition to task-based fMRI, seed-based analysis of resting-state fMRI represents an equally effective method for supplementary motor area localization in patients with brain tumors, with the best results obtained with bilateral hand motor region seeding.

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Preoperative Mapping of the Supplementary Motor Area in Patients with Brain Tumor Using Resting-State fMRI with Seed-Based Analysis
Jeffrey Ross
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