New fMRI technology allows better preparation for brain surgery

Wednesday, October 31, 2012 | 2:20 p.m. CDT
University Hospital has begun using an fMRI machine to scan patient’s brains. This latest version of MRI technology scans for activity in the brain based on oxygen levels, instead of just the brain itself. The advancement is particularly useful because the specific areas that are activated for certain functions, such as seeing or hearing, are unique to every individual.

The diagram below depicts a fMRI scan of a brain with a tumor. The red areas indicate active areas of the brain for vision. Because of the new techonology, surgeons would be able to take out the majority of the tumor without damaging any of the actively used part of the brain. This would keep the person’s vision as intact as possible.

COLUMBIA —Tap your fingers. Wiggle your toes. Move your tongue. Rhyme words with cat.

These tasks are protocols known as paradigms, and though they may seem simple, the brain works hard to complete them. 

That’s what the new functional magnetic resonance imaging system at University Hospital is able to detect. The fMRI system uses paradigms to determine the location of different functional parts of the brain — in addition to the brain's anatomy and problem areas, visible on an MRI — and create a three-dimensional picture of a patient's brain.

The hospital's is the only fMRI machine in mid-Missouri; the next closest is in St. Louis.

"An MRI scan shows the brain's anatomy and any abnormalities, but not the function of those abnormalities," said Dr. N. Scott Litofsky, chief neurosurgeon at University Hospital. "The fMRI shows the anatomy and abnormalities and the areas of eloquent functions in the anatomy."

Twenty-five years ago, while still in training to become a neurological surgeon, Litofsky assisted a surgeon who was performing a procedure to remove a tumor that was near the speech region of the patient's brain. Because fMRI wasn't available at the time to determine the exact location of the speech area of the brain, the person's ability to speak was affected. Today, fMRI technology could determine the precise location of the speech region and help preserve its function, he said.

How it works

Before a patient is evaluated in the fMRI machine, he or she will have already had an MRI scan of the brain to detect the problem area, said Mark Burton, MRI supervisor of University Hospital. 

During an fMRI scan, the patient lies inside the MRI device and performs certain paradigms, such as reading words or moving fingers, which lets the fMRI determine where the functional parts of the brain are located. The paradigms include motor, visual, language and picture naming tests. Which tasks a patient performs is determined by the problem area in his or her brain.

After the fMRI scan has been performed, the computer system creates a 3-D map of the patient's entire head and brain. That image is displayed on a monitor so a technologist and the patient's physician can look through every millimeter of the brain, Burton said. The colors in the map indicate increased oxygen levels, which shows the active areas of the brain that were stimulated by the paradigms: red indicates high activity; green, no activity; and pink indicates parts of the brain that do not control particular functions, such as speech or movement.

The regions of the brain that control movement, speech, sight and other functions are generally in the same areas for most people; however, most people aren't aware that the areas' size, shape and exact location may vary from person to person, Litofsky said.

"The brain is pretty complicated," he said. "Each technological tool we have helps us understand how the brain works and helps us treat patients based on their specific problem."

Although fMRI and MRI scans show physicians different things, they both operate from the same machine. University Hospital acquired a new MRI machine that has fMRI capabilities in May. Although the equipment and software for the fMRI arrived during the summer, it has only been in use for approximately eight weeks because physicians and MRI technologists had to receive specialized fMRI training before it could be used, Litofsky said.

Technology makes the difference

The fMRI will be used to evaluate conditions such as brain tumors, brain cysts, arteriovenous malformation and other vascular malformations in the brain, Litofsky said. It will also benefit patients who may need epilepsy surgery or movement disorder surgery.

With the new technology, Litofsky will be able to ensure that surgery on a patient's brain will not result in the loss of a major function, because the fMRI technology can localize that function and help preserve it. The fMRI software helps guarantee a patient's safety, ultimately creating better results.

"It's a luxury to be able to plan what we're going to remove," he said. "It's like the Boy Scout motto, 'Be prepared.' Because of this new technology, we can be more prepared going into surgery."

Supervising editor is Simina Mistreanu.

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