fMRI Improves Patient Outcomes with Brain Tumor Resection

Incorporating functional MRI (fMRI) into brain tumor resection planning can help reduce the possibility of negative outcomes patients might experience after surgery.

In a study published in the June 1 Radiology, investigators from Johns Hopkins Hospital showed that using fMRI is an effective way to safeguard brain cancer patients health.

“Our result suggests that pre-operative functional (fMRI) mapping results in a lower risk for delayed or permanent neurologic deficits that persists after a two-month follow-up period when compared with surgery without pre-operative fMRI,” said the team led by Licia Luna, M.D., Ph.D., a nuclear medicine fellow with Johns Hopkins Medicine. “It should be considered as the standard-of-care for brain tumor surgery, even with small tumor volumes.”

Currently, fMRI is gaining traction as an effective way to pinpoint tumors and structures in the brain before a patient goes in for surgery, but there is still considerable disagreement over how it’s being used now and what it could potentially do.

MRI scans and direct cortical stimulation technique in a 32-year-old woman with a grade II astrocytoma. Preoperative MRI shows a well-delineated mass within the left frontal lobe on, A, three-dimensional fluid-attenuated inversion recovery and, B, precontrast three-dimensional T1-weighted scan. C, Patchy and faint contrast enhancement is observed on postcontrast three-dimensional T1-weighted MRI scan. D, Cerebral blood volume map shows a globally hypoperfused tumor with hyperperfused foci.

Credit: RSNA

To get a better idea of the role fMRI plays, the team examined post-operative morbidity in patients who have pre-operative fMRI, comparing it to patients who did not have the scan. To do so, they pulled information from 68 studies conducted between 1946 and 2020, involving 3,280 participants. Examined studies focused on four key areas: patients with brain tumors, individuals who had pre-operative fMRI, the usefulness of pre-operative and intra-operative fMRI with resecting cerebral tumors, and report outcomes after a two-month follow-up timeframe.

Based on their assessment, the team determined that patients who underwent pre-operative fMRI mapping were less likely to have neurologic, motor, or language problems post-surgery, and they were also more likely to have higher Karnofsky scores – a 0-to-100 measurement where lower scores indicate a lower chance of surviving a major illness.

In addition, Luna’s team saw that the adverse event rate linked to pre-operative fMRI was nearly half of what occurred in patients who had surgery without it – 11 percent and 21 percent, respectively.

However, the team said, their results should be interpreted with caution, stressing that more work is still needed to move fMRI closer to widespread use.

“Future studies should include clearly defined outcome measures by using objective measurements and scales and standardizing the definition of permanent neurologic deficits,” they said. “A critical next step toward clinical acceptance of fMRI will be to develop a comprehensive set of guidelines that specifies where and when to implement fMRI in the preoperative planning of neurosurgical oncology.”

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