Neuroimaging Aids for Treatment of CNS Vision Pathology

描述（由申请人提供）：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）的局灶性病理的人类患者。病理学的侵入性治疗可引起使人衰弱的神经系统副作用，涉及视力或运动功能的部分或完全丧失。根据这项资助，第一阶段开发的视觉映射原型系统将扩展到运动系统，然后集成到FDA 510 K营销批准的商业产品中。所提出的核心技术包括用于非常有效地获取癌症部位附近的功能性视觉和/或运动皮层功能的完整脑图并将其与称为功能场图（FFMap）的独特显示技术相关联的方法。后者允许医生立即解释完整的，复杂的fMRI大脑激活模式，保留或受损的神经功能，而无需费力地仔细阅读多个大脑图像。这种面向功能的显示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，潜在的BOLD血流动力学机制本身的破坏可能会使fMRI大脑激活的解释变得复杂。这可能导致神经血管解偶联（NVU）和相关的BOLD反应丧失，尽管保留了潜在的神经活动。这可能会导致无意中手术消融存活的脑组织。在第一阶段开发的一种使用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。功能磁共振成像视觉映射和FFMap技术的临床有效性的初步I期测试将扩展到运动系统和更大样本的患者。基于预测值理论的定量分析将用于测试fMRI和FFMap技术正确指示局灶性病理部位附近脑组织功能状态的能力。白色物质束的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色物质束状态的额外信息，从而产生对潜在功能破坏的更有效预测。该项目的成功完成将产生一个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。公共卫生相关性：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，这将有助于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肿瘤和其他脑部病变的治疗。目前，这种先进的技术只在世界范围内少数选定的机构中提供。该项目中开发的系统将使这项技术在美国和国外的更广泛的医院和诊所中使用。

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.