Goals of Presurgical Planning

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Goals of Presurgical Planning

• Identify focus (epilepsy surgery)
• Maximize surgical resection
• Avoid functionally eloquent cortex and white
  matter tracts
• INDISPENABLE FOR FUNCTION
• IF INJURED OR REMOVED- FUNCTIONAL DEFICIT

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Functionally Eloquent Cortex
Essentials of Anatomy Physiology, Seeley
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Functional MRI

• Color Overlay of Statistical Maps on Anatomical
  Images

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Readouts

• Location of activation
• 3D extent of activation
• Distance of border of activation cluster to
  lesion
• Laterality index of language (Lt vs Rt)
• Based upon signal magnitude change

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QIBA fMRI Subcommittee

• New Claims
• A. On a test-retest basis, fMRI can be performed
  reproducibly to a level such that the center of
  mass of activation of a focus of interest is
  within 5mm of itself, with at least 90 overlap
  of the activation clusters.
• B. On a test-retest basis, fMRI can be performed
  reproducibly to a level such that the relative
  magnitude of activation in homologous regions
  across hemispheres should be within 10.
• C. Quantitative measures of risk to eloquent
  brain structures distance metrics etc.

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Where do we go from here?

• Create a roadmap to refine claims
• Assess test-retest reprod multisite by using
  ASFNR to develop a harmonized approach across
  institutions
• Level stratification of claims
• Ideal may require additional info
• Target - majority
• Acceptable - min competency

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Next Steps

• Mine FBIRN, ADNI, QIBA FDG-PET in conf calls
• Develop phantom to calibrate T2 change and fSNR.
• Assess geometric spatial accuracy with B Field
  mapping to correct geometric distortion
• Enroll our customers in telecon or stand alone
  meeting
• Extending readouts to other contexts for use such
  as neuropsychiatric, neurodegenerative,
  pharmacologic

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Thanks!

• Dan Sullivan
• Jeff Evelhoch
• Madeline McCoy