Identification of Essential Areas of the Brain in Pre-Operative Brain Tumor Patients Using BOLD fMRI and Independent Physiological Parameters

使用 BOLD fMRI 和独立生理参数识别术前脑肿瘤患者的大脑重要区域

• 批准号: 9381979
• 负责人: ANDREI I HOLODNY
• 金额: $ 15.22万
• 依托单位: SLOAN-KETTERING INST CAN RESEARCH
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-01 至 2020-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9381979
• 关键词: Affect; Anatomy; Area; Arteriovenous malformation; Beds; Blood Vessels; Brain; Brain Neoplasms; Calibration; Clinical Research; Collaborations; Country; Data; Enrollment; Excision; Exhibits; Functional Imaging; Functional Magnetic Resonance Imaging; Glioma; Grant; Health; Hypercapnia; Hypoxia; Institutes; Institution; Location; Magnetic Resonance Imaging; Malignant Neoplasms; Malignant neoplasm of brain; Maps; Measurement; Measures; Methods; Microvascular Dysfunction; Moscow; Neoplasm Metastasis; Neurologic; Neurons; Neurosurgeon; New York; Operating Rooms; Operative Surgical Procedures; Outcome; Paper; Pathologic; Patients; Perfusion; Physiological; Russia; Signal Transduction; Span 20; Stenosis; Stimulus; Stroke; Techniques; blood oxygen level dependent; blood oxygenation level dependent response; brain parenchyma; brain tumor resection; cerebrovascular; imaging study; improved; innovation; lectures; meetings; meningioma; neovasculature; neurosurgery; neurovascular; neurovascular coupling; normal aging; prospective; response; treatment planning; tumor

Project Summary: Surgical resection remains the mainstay of the treatment of neurological malignancies. Blood oxygen level dependent functional MRI (BOLD fMRI) can identify essential functional areas of the brain (eloquent cortices) adjacent to brain tumors. BOLD fMRI does not directly detect neuronal activity. Rather, it measures the vascular response that results from increased neuronal activity (neurovascular coupling). It is known that tumor neovasculature reacts to stimuli in a diminished manner. Also, the blood vessels may already be maximally dilated in the setting of a hypoxic malignant tumor. Thus, due to the muted vascular response, the contrast necessary for a reliable fMRI signal appears to be compromised. Therefore, BOLD fMRI appears to be less accurate in the most important location for neurosurgical treatment planning – the area directly adjacent to the tumor. We hypothesize that the location of an abnormal BOLD response (false negative) adjacent to malignant brain tumors can be identified by MRI measurements of abnormal tumor neovasculature, defined by routine MRI data (including perfusion) and vascular reactivity maps, quantified by breath-holding MRI (BH MRI). We further hypothesize that the accuracy of BOLD fMRI in the vicinity of brain tumors can be improved by calibrating the BOLD response by incorporation of BH MRI. The innovation of this grant is to incorporate an independent measurement of cerebrovascular reactivity (BH MRI) into the BOLD fMRI analysis to overcome the false negative activation due to neurovascular uncoupling by tumor neovasculature. Specific Aims: SA1. Determine the relationship between fMRI accuracy and the presence of abnormal tumor neovasculature as defined by anatomical MRI parameters and measurements of vascular reactivity (BH MRI). SA2. Use calibration of the BOLD fMRI data by measurements of vascular reactivity (BH) to compensate for neurovascular uncoupling and increase the accuracy of BOLD fMRI adjacent to tumors. SA3. Determine when independent measurements of vascular reactivity can provide additional information and should be performed to improve the accuracy of BOLD fMRI. Expected outcomes: 1. The accuracy of BOLD fMRI will decrease in the presence of abnormal tumor neovasculature that affects the brain parenchyma. 2. Incorporation of BH MRI into the BOLD fMRI calculations will significantly improve the accuracy of identifying eloquent cortices adjacent to brain tumors with abnormal neovasculature. 3. Patients with tumors which exhibit abnormal parenchyma brain enhancement and perfusion will benefit from incorporation of BH MR into BOLD fMRI calculations. Health relatedness: improve the identification of eloquent cortices adjacent to brain tumors by fMRI, which will have an immediate, positive impact on brain tumor resections. The broad, long-term objectives of the current proposal is not limited to brain tumors, but will extend to other conditions, which affect vascular reactivity and consequently, the accuracy of fMRI, including normal aging and pathological conditions such as arteriovenous malformations, strokes, vascular stenosis, or microvascular disease.

项目概述：手术切除仍然是治疗神经系统恶性肿瘤的主要手段。 血氧水平依赖性功能磁共振成像（BOLD fMRI）可以识别大脑的重要功能区域 （功能皮质）邻近脑肿瘤。BOLD fMRI并不直接检测神经元的活动。而是 测量由增加的神经元活动（神经血管耦合）引起的血管反应。是 已知肿瘤新生血管以减弱的方式对刺激作出反应。同时，血管可能已经 在低氧恶性肿瘤的情况下最大程度地扩张。因此，由于减弱的血管反应， 可靠的功能磁共振成像信号所需的对比度似乎受到了损害。因此，BOLD fMRI显示 在神经外科治疗计划的最重要位置-直接 靠近肿瘤。我们假设异常BOLD反应（假阴性）的位置 可以通过MRI测量异常肿瘤新生血管来识别恶性脑肿瘤附近， 通过常规MRI数据（包括灌注）和血管反应性图定义，通过屏气定量 MRI（BH MRI）。我们进一步假设，BOLD功能磁共振成像在脑肿瘤附近的准确性， 通过结合BH MRI校准BOLD响应得到改善。这项补助金的创新之处在于 将脑血管反应性的独立测量（BH MRI）纳入BOLD fMRI分析 以克服由于肿瘤新血管系统的神经血管解偶联而引起的假阴性激活。具体 目标：SA 1。确定功能磁共振成像准确性与异常肿瘤存在之间的关系 通过解剖MRI参数和血管反应性测量（BH MRI）定义的新生血管。 SA 2.通过测量血管反应性（BH）来校准BOLD fMRI数据， 神经血管解偶联，并增加肿瘤附近BOLD fMRI的准确性。SA 3.确定何时 血管反应性的独立测量可以提供额外的信息， 来提高BOLD功能磁共振成像的准确性预期成果：1. BOLD功能磁共振成像的准确性将下降， 影响脑实质的异常肿瘤新生血管的存在。2.加入BH MRI BOLD功能磁共振成像计算将显着提高识别功能皮层相邻的准确性， 有异常新生血管的脑肿瘤3.肿瘤实质异常的患者 脑增强和灌注将受益于BH MR结合到BOLD fMRI计算中。 健康相关性：通过功能磁共振成像提高对脑肿瘤附近功能皮层的识别， 对脑肿瘤切除术有直接的积极影响。广泛的长期目标， 目前的提案不仅限于脑肿瘤，还将扩展到影响血管的其他疾病 反应性，因此，功能磁共振成像的准确性，包括正常老化和病理条件，如 动静脉畸形、中风、血管狭窄或微血管疾病。