Presurgical brain mapping with functional connectivity MRI

描述(申请人提供)：脑肿瘤和其他疾病患者的诊断和治疗通常严重依赖于功能神经成像(例如功能磁共振成像)来识别健康的脑组织，而在侵入性手术或放射治疗中必须避免这些组织。但是，传统的功能磁共振成像经常失败(高达30%)，或者不能用于无法充分执行所需行为任务的患者。静息状态功能连接磁共振成像(FcMRI)为基于任务的功能磁共振成像提供了一种潜在的替代方法。FcMRI最早是由比斯瓦尔及其同事在威斯康星医学院开发的，他们观察到，在行为“休息”期间，fMRI信号的波动在功能相关的皮质网络(如运动系统)内具有时间相关性，但在功能无关的网络之间没有时间相关性。实际上，这意味着当患者除了在核磁共振扫描仪中安静地休息外，只需5-10分钟的fMRI数据样本，就可以同时绘制出大约20个不同的大脑系统的图谱。这种方法在临床应用中具有特殊的实用价值，例如在脑癌手术前的脑成像。与更传统的基于任务的功能磁共振成像相比，功能磁共振成像更快、更简单、对行为的要求更低，因为它不依赖于准确的任务表现。因此，它可以用于麻醉或太年轻、太老、太虚弱或 太不合作，无法执行具有挑战性的行为任务。此外，理论连通性概念提供了与功能连通性病理变化相关的脑功能障碍的潜在指标。尽管fcMRI具有潜在的临床实用价值，但其临床应用尚未得到优化，其作为脑功能指标的有效性也没有得到充分的表征。 尤其是在存在可手术的脑部病变的情况下。尽管在为基础研究开发连通性方法方面有重大举措，但在促进其临床应用方面做的工作要少得多。事实上，在这个关键时刻，用于获取、分析和显示fcMRI数据的临床优化工具是不可用的。因此，这个多机构项目的总体目标是开发一套用于常规临床使用的软件工具 并验证其在患有脑癌和其他可手术的脑部疾病患者中的应用。在这个第一阶段的项目中，我们将重点开发一个原型系统，安装 在合适的医院地点，并用小样本患者进行测试，以证明其可行性。这将导致一个更广泛的第二阶段项目，在该项目中，该系统将经过改进，最终用于商业发布，并在更广泛的患者中进行测试，以充分表征fcMRI在特定临床应用中的有效性。预计该项目的成功完成将提供一种广泛可用的专业产品，有助于消除目前在临床上使用功能磁共振成像的障碍，促进其在医疗保健和保险行业中的接受，并将先进的神经成像的好处扩展到更广泛的脑部疾病患者的治疗中。

DESCRIPTION (provided by applicant): The diagnosis and treatment of patients with brain tumors and other diseases is often critically dependent on functional neuroimaging (e.g. fMRI) to identify healthy brain tissue that must be avoided during invasive surgery or radiation treatment. But, conventional fMRI often fails (up to 30 percent) or cannot be used with patients who are unable to adequately perform the required behavioral tasks. Resting-state, functional connectivity MRI (fcMRI) provides a potential alternative to task-based fMRI for mapping the brain. fcMRI was first developed at the Medical College of Wisconsin by Biswal and colleagues1 who observed that fluctuations in fMRI signals during behavioral "rest" are temporally correlated within functionally related cortical networks such as the motor system but not between functionally unrelated networks. Practically, this means that approximately 20 functionally distinct brain systems can be mapped simultaneously with a single 5-10 minute sample of fMRI data obtained while the patient does nothing but rest quietly in the MRI scanner. This approach has exceptional practical utility for clinical applications such as brain mapping prior to brain cancer surgery. Compared to more conventional task-based fMRI, fcMRI is faster, simpler, and less behaviorally demanding since it does not depend on accurate task performance. As a result, it can be used with patients who are anesthetized or too young, too old, too debilitated or too uncooperative to perform a challenging behavioral task. In addition, theoretical connectivity concepts provide potential indicators of brain dysfunction related to pathological changes in functional connectivity. Despite its potential clinical utility, fcMRI has not been optimized for clinical use, nor has its validity as an indicator of brain function been adequately characterized, especially in the presence of operable brain pathologies. Although there are significant initiatives to develop connectivity methods for basic research, far less is being done to promote its use for clinical applications. Indeed, at this juncture, clinically optimized tools for the acquisition, analysis and display of fcMRI data are not available. Thus, the overall goal of this multi-institutional project is to develop a suite of software tools for the routine clinical use of fcMRI and to validate their use with patients suffering from brain cancer, and other operable brain diseases. In this Phase I project, we will focus on developing a prototype system, installing it at suitable hospital sites, and testing it with a small sample of patients in order to demonstrae feasibility. This will lead to a more extensive Phase II project in which the system will be refine for eventual commercial release and tested with a wider range of patients to fully characterize the validity of fcMRI for specific clinical applications. It is anticipated that the successful completion of this project will provide a widely available, professional product, help remove current impediments to use of fcMRI clinically, promote its acceptance within the health care and insurance industries, and extend the benefits of advanced neuroimaging to the treatment of a much wider population of patients with brain disease.