Goals of Presurgical Goals of Presurgical PlanningPlanning

Identify focus (epilepsy surgery)Identify focus (epilepsy surgery) Maximize surgical resectionMaximize surgical resection Avoid functionally eloquent cortex and Avoid functionally eloquent cortex and

white matter tractswhite matter tracts– INDISPENABLE FOR FUNCTIONINDISPENABLE FOR FUNCTION– IF INJURED OR REMOVED- FUNCTIONAL IF INJURED OR REMOVED- FUNCTIONAL

DEFICITDEFICIT

Functionally Eloquent Cortex

Essentials of Anatomy & Physiology, Seeley

Functional MRIFunctional MRI Color Overlay of Statistical Maps on Color Overlay of Statistical Maps on

Anatomical ImagesAnatomical Images

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

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.

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

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

Thanks! Dan Sullivan Jeff Evelhoch Madeline McCoy