Neuroimaging Aids for Treatment of CNS Vision Pathology

描述(申请人提供)：该项目的目标是开发功能性磁共振成像(FMRI)工具，用于评估和治疗患有脑肿瘤或其他涉及视觉或运动系统，特别是大脑皮层的局灶性病变的患者。这种病理的侵入性治疗可能会导致衰弱的神经副作用，包括部分或完全丧失视力或运动功能。根据这笔赠款，在第一阶段开发的视觉映射原型系统将扩展到发动机系统，然后集成到FDA 510K上市批准的商业产品中。拟议的核心技术包括非常高效地获取癌症部位附近雄辩的视觉和/或运动皮质功能的完整脑图，并将其链接到一种独特的显示技术，称为功能场图(FFMap)。后者允许医生立即解释完整的、复杂的fMRI大脑激活模式，根据保留或受损的神经功能，而无需费力地阅读多个大脑图像。这种面向功能的显示器增强了传统的基于切片的脑图像，为临床诊断和手术/放射计划提供了最佳系统。然而，对fMRI脑激活的解释可能会因为潜在的BOLD血流动力学机制本身的破坏而变得复杂。这可能导致神经血管解偶联(NVU)和相关的大胆反应的丧失，尽管潜在的神经活动被保留。这可能会导致无意中手术切除可存活的脑组织。在第一阶段开发的使用FFMap技术检测NVU的技术将与其他基于MRI的方法进行比较，以识别受NVU影响的脑组织。我们将扩大我们对患者的初步测试，以更好地估计NVU的发病率，并确定可能导致NVU的特定病理条件。对fMRI视觉映射和FFMap技术的临床有效性的第一阶段初步测试将扩展到运动系统和更大的患者样本。基于预测值理论的定量分析将用于测试fMRI和FFMap技术正确指示局部病理部位附近脑组织功能状态的能力。白质束扩散张量成像将与功能磁共振成像相结合，以提供有关病理部位附近白质束状态的额外信息，从而对潜在的功能障碍做出更有效的预测。该项目的成功完成将产生一种商业上可行的产品和关键信息，以帮助医生解释与脑癌患者相关的先进的多参数成像数据。与公共健康相关：该项目的成功完成将导致创建一套独特的计算机软件工具、分析和显示算法，以帮助神经外科医生和放射肿瘤学家使用先进的医学成像测试来诊断和指导脑瘤和其他脑部病理的治疗。目前，这样的先进技术只在世界范围内的少数几个精选机构中可用。在这个项目中开发的系统将使这项技术在美国和国外更广泛的医院和诊所使用。

DESCRIPTION (provided by applicant): The goal of this project is to develop functional magnetic resonance imaging (fMRI) tools for assessing and treating human patients with a brain neoplasm or other focal pathology involving the visual or motor systems, especially cerebral cortex. Invasive treatment of the pathology can cause debilitating neurological side-effects involving partial or complete loss of vision or motor function. Under this grant, a prototype system for vision mapping developed in Phase I will be extended to the motor system and then integrated into a commercial product with FDA 510K marketing approval. The proposed core technology includes methods for very efficiently acquiring a complete brain map of eloquent visual and/or motor cortex function near a cancer site and linking this to a unique display technology, termed a Functional Field Map (FFMap). The latter allows the physician to instantly interpret the complete, complex pattern of fMRI brain activation in terms of preserved or compromised neural function without laborious perusal of multiple brain images. This functionally-oriented display augments conventional slice-based brain images to provide an optimal system for clinical diagnosis and surgical/radiation planning. However, interpretation of fMRI brain activation can be complicated by potential disruption of the underlying BOLD hemodynamic mechanism itself. This can cause neurovascular uncoupling (NVU) and associated loss of BOLD response despite preservation of underlying neural activity. This could lead to inadvertent surgical ablation of viable brain tissue. A technique developed in Phase I to detect NVU using the FFMap technology will be compared with other MRI-based methods to identify brain tissue affected by NVU. We will extend our initial tests with patients to provide a better estimate of the incidence of NVU and to identify specific pathological conditions that may cause NVU. Initial Phase I tests of the clinical validity of fMRI vision mapping and the FFMap technology will be extended to the motor system and to a larger sample of patients. A quantitative analysis based on predictive value theory will be used to test the ability of fMRI and the FFMap technology to correctly indicate the functional status of brain tissue near a site of focal pathology. Diffusion tensor imaging of white matter tracts will be combined with fMRI to provide additional information about the status of white matter tracts near a site of pathology and thereby yield a more valid prediction of potential functional disruption. Successful completion of the project will produce a commercially viable product plus key information to assist the physician in interpreting advanced, multiparameter imaging data associated with brain cancer patients. PUBLIC HEALTH RELEVANCE: The successful completion of this project will result in the creation of a unique suite of computer software tools, analyses and display algorithms that will assist neurosurgeons and radiation oncologists in the use of advanced medical imaging tests to diagnose and guide treatment of brain tumors and other brain pathologies. Currently such advanced technology is only available at a small number of select institutions world-wide. The system developed in this project will make this technology accessible to a much wider range of hospitals and clinics throughout the USA and abroad.