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<meta name="DC.Title" content="Impact of Brain Tumor Location on Morbidity and Mortality: A Retrospective Functional MR Imaging Study" />
<meta name="DC.Identifier" content="10.3174/ajnr.A2679" />
<meta name="DC.Date" content="2011-09-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2011 by American Journal of Neuroradiology. 
Indicates open access to non-subscribers at www.ajnr.org" />
<meta name="DC.AccessRights" content="open-access" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: fMRI is increasingly used in neurosurgery to preoperatively identify areas of eloquent cortex. Our study evaluated the efficacy of clinical fMRI by analyzing the relationship between the distance from the tumor border to the area of functional activation (LAD) and patient pre- and postoperative morbidity and mortality.

MATERIALS AND METHODS: The study included patients with diagnosis of primary or metastatic brain tumor who underwent preoperative fMRI-based motor mapping ( n =74) and/or language mapping ( n =77). The impact of LAD and other variables collected from patient records was analyzed with respect to functional deficits in terms of morbidity (paresis and aphasia) and mortality.

RESULTS: Significant relationships were found between motor and language LAD and the existence of either pre- or postoperative motor ( P &lt; .001) and language deficits ( P =.009). Increasing age was associated with motor and language deficits ( P =.02 and P =.04 respectively). Right-handedness was related to language deficits ( P =.05). Survival analysis revealed that pre- and postoperative deficits, grade, tumor location, and LAD predicted mortality. Motor deficits increased linearly as the distance from the tumor to the primary sensorimotor cortex decreased. Language deficits increased exponentially as the distance from the tumor to the language areas decreased below 1 cm. Postoperative mortality analysis showed an interaction effect between motor or language LAD and mortality predictors (grade and tumor location, respectively).

CONCLUSIONS: These findings indicate that tumors may affect language and motor function differently depending on tumor LAD. Overall, the data support the use of fMRI as a tool to evaluate patient prognosis and are directly applicable to neurosurgical planning.

BOLD
:   blood oxygen level–dependent
CI
:   confidence Interval
EPI
:   echo-planar imaging
fMRI
:   functional MR imaging
HR
:   hazard ratio
LAD
:   lesion to activation distance
OR
:   odds ratio
SE
:   standard error
SMC
:   sensorimotor cortex
SSDI
:   Social Security Death Index
WHO
:   World Health Organization" />
<meta name="DC.Contributor" content="J.M. Wood" />
<meta name="DC.Contributor" content="B. Kundu" />
<meta name="DC.Contributor" content="A. Utter" />
<meta name="DC.Contributor" content="T.A. Gallagher" />
<meta name="DC.Contributor" content="J. Voss" />
<meta name="DC.Contributor" content="V.A. Nair" />
<meta name="DC.Contributor" content="J.S. Kuo" />
<meta name="DC.Contributor" content="A.S. Field" />
<meta name="DC.Contributor" content="C.H. Moritz" />
<meta name="DC.Contributor" content="M.E. Meyerand" />
<meta name="DC.Contributor" content="V. Prabhakaran" />
<meta name="article:published_time" content="2011-09-01" />
<meta name="article:section" content="Functional" />
<meta name="citation_title" content="Impact of Brain Tumor Location on Morbidity and Mortality: A Retrospective Functional MR Imaging Study" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;fMRI is increasingly used in neurosurgery to preoperatively identify areas of eloquent cortex. Our study evaluated the efficacy of clinical fMRI by analyzing the relationship between the distance from the tumor border to the area of functional activation (LAD) and patient pre- and postoperative morbidity and mortality.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;The study included patients with diagnosis of primary or metastatic brain tumor who underwent preoperative fMRI-based motor mapping (&lt;i&gt;n&lt;/i&gt;=74) and/or language mapping (&lt;i&gt;n&lt;/i&gt;=77). The impact of LAD and other variables collected from patient records was analyzed with respect to functional deficits in terms of morbidity (paresis and aphasia) and mortality.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Significant relationships were found between motor and language LAD and the existence of either pre- or postoperative motor (&lt;i&gt;P&lt;/i&gt; &amp;lt; .001) and language deficits (&lt;i&gt;P&lt;/i&gt;=.009). Increasing age was associated with motor and language deficits (&lt;i&gt;P&lt;/i&gt;=.02 and &lt;i&gt;P&lt;/i&gt;=.04 respectively). Right-handedness was related to language deficits (&lt;i&gt;P&lt;/i&gt;=.05). Survival analysis revealed that pre- and postoperative deficits, grade, tumor location, and LAD predicted mortality. Motor deficits increased linearly as the distance from the tumor to the primary sensorimotor cortex decreased. Language deficits increased exponentially as the distance from the tumor to the language areas decreased below 1 cm. Postoperative mortality analysis showed an interaction effect between motor or language LAD and mortality predictors (grade and tumor location, respectively).&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;These findings indicate that tumors may affect language and motor function differently depending on tumor LAD. Overall, the data support the use of fMRI as a tool to evaluate patient prognosis and are directly applicable to neurosurgical planning.&lt;/p&gt;" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: fMRI is increasingly used in neurosurgery to preoperatively identify areas of eloquent cortex. Our study evaluated the efficacy of clinical fMRI by analyzing the relationship between the distance from the tumor border to the area of functional activation (LAD) and patient pre- and postoperative morbidity and mortality.

MATERIALS AND METHODS: The study included patients with diagnosis of primary or metastatic brain tumor who underwent preoperative fMRI-based motor mapping ( n =74) and/or language mapping ( n =77). The impact of LAD and other variables collected from patient records was analyzed with respect to functional deficits in terms of morbidity (paresis and aphasia) and mortality.

RESULTS: Significant relationships were found between motor and language LAD and the existence of either pre- or postoperative motor ( P &lt; .001) and language deficits ( P =.009). Increasing age was associated with motor and language deficits ( P =.02 and P =.04 respectively). Right-handedness was related to language deficits ( P =.05). Survival analysis revealed that pre- and postoperative deficits, grade, tumor location, and LAD predicted mortality. Motor deficits increased linearly as the distance from the tumor to the primary sensorimotor cortex decreased. Language deficits increased exponentially as the distance from the tumor to the language areas decreased below 1 cm. Postoperative mortality analysis showed an interaction effect between motor or language LAD and mortality predictors (grade and tumor location, respectively).

CONCLUSIONS: These findings indicate that tumors may affect language and motor function differently depending on tumor LAD. Overall, the data support the use of fMRI as a tool to evaluate patient prognosis and are directly applicable to neurosurgical planning.

BOLD
:   blood oxygen level–dependent
CI
:   confidence Interval
EPI
:   echo-planar imaging
fMRI
:   functional MR imaging
HR
:   hazard ratio
LAD
:   lesion to activation distance
OR
:   odds ratio
SE
:   standard error
SMC
:   sensorimotor cortex
SSDI
:   Social Security Death Index
WHO
:   World Health Organization" />
<meta name="og-title" property="og:title" content="Impact of Brain Tumor Location on Morbidity and Mortality: A Retrospective Functional MR Imaging Study" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/32/8/1420" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: fMRI is increasingly used in neurosurgery to preoperatively identify areas of eloquent cortex. Our study evaluated the efficacy of clinical fMRI by analyzing the relationship between the distance from the tumor border to the area of functional activation (LAD) and patient pre- and postoperative morbidity and mortality.

MATERIALS AND METHODS: The study included patients with diagnosis of primary or metastatic brain tumor who underwent preoperative fMRI-based motor mapping ( n =74) and/or language mapping ( n =77). The impact of LAD and other variables collected from patient records was analyzed with respect to functional deficits in terms of morbidity (paresis and aphasia) and mortality.

RESULTS: Significant relationships were found between motor and language LAD and the existence of either pre- or postoperative motor ( P &lt; .001) and language deficits ( P =.009). Increasing age was associated with motor and language deficits ( P =.02 and P =.04 respectively). Right-handedness was related to language deficits ( P =.05). Survival analysis revealed that pre- and postoperative deficits, grade, tumor location, and LAD predicted mortality. Motor deficits increased linearly as the distance from the tumor to the primary sensorimotor cortex decreased. Language deficits increased exponentially as the distance from the tumor to the language areas decreased below 1 cm. Postoperative mortality analysis showed an interaction effect between motor or language LAD and mortality predictors (grade and tumor location, respectively).

CONCLUSIONS: These findings indicate that tumors may affect language and motor function differently depending on tumor LAD. Overall, the data support the use of fMRI as a tool to evaluate patient prognosis and are directly applicable to neurosurgical planning.

BOLD
:   blood oxygen level–dependent
CI
:   confidence Interval
EPI
:   echo-planar imaging
fMRI
:   functional MR imaging
HR
:   hazard ratio
LAD
:   lesion to activation distance
OR
:   odds ratio
SE
:   standard error
SMC
:   sensorimotor cortex
SSDI
:   Social Security Death Index
WHO
:   World Health Organization" />
<meta name="og-type" property="og:type" content="article" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node12161--5" data-node-nid="12161" id="top-node-12161--61363895368" data-pisa="ajnr;32/8/1420" data-pisa-master="ajnr;ajnr.A2679" data-apath="/ajnr/32/8/1420.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">J.M. Wood</span>, <span class="highwire-citation-author" data-delta="1">B. Kundu</span>, <span class="highwire-citation-author" data-delta="2">A. Utter</span>, <span class="highwire-citation-author" data-delta="3">T.A. Gallagher</span>, <span class="highwire-citation-author" data-delta="4">J. Voss</span>, <span class="highwire-citation-author" data-delta="5">V.A. Nair</span>, <span class="highwire-citation-author" data-delta="6">J.S. Kuo</span>, <span class="highwire-citation-author" data-delta="7">A.S. Field</span>, <span class="highwire-citation-author" data-delta="8">C.H. Moritz</span>, <span class="highwire-citation-author" data-delta="9">M.E. Meyerand</span> and <span class="highwire-citation-author" data-delta="10">V. Prabhakaran</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">September 2011,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">32 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(8) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1420-1425; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A2679 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-12161--61363895368" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">J.M. Wood </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.M.%2BWood%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Wood%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AJ.M.%2BWood%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">B. 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<p id="p-6"><strong>BACKGROUND AND PURPOSE:</strong> fMRI is increasingly used in neurosurgery to preoperatively identify areas of eloquent cortex. Our study evaluated the efficacy of clinical fMRI by analyzing the relationship between the distance from the tumor border to the area of functional activation (LAD) and patient pre- and postoperative morbidity and mortality.</p>
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<p id="p-7"><strong>MATERIALS AND METHODS:</strong> The study included patients with diagnosis of primary or metastatic brain tumor who underwent preoperative fMRI-based motor mapping (<em>n</em>=74) and/or language mapping (<em>n</em>=77). The impact of LAD and other variables collected from patient records was analyzed with respect to functional deficits in terms of morbidity (paresis and aphasia) and mortality.</p>
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<p id="p-8"><strong>RESULTS:</strong> Significant relationships were found between motor and language LAD and the existence of either pre- or postoperative motor (<em>P</em> &lt; .001) and language deficits (<em>P</em>=.009). Increasing age was associated with motor and language deficits (<em>P</em>=.02 and <em>P</em>=.04 respectively). Right-handedness was related to language deficits (<em>P</em>=.05). Survival analysis revealed that pre- and postoperative deficits, grade, tumor location, and LAD predicted mortality. Motor deficits increased linearly as the distance from the tumor to the primary sensorimotor cortex decreased. Language deficits increased exponentially as the distance from the tumor to the language areas decreased below 1 cm. Postoperative mortality analysis showed an interaction effect between motor or language LAD and mortality predictors (grade and tumor location, respectively).</p>
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<p id="p-9"><strong>CONCLUSIONS:</strong> These findings indicate that tumors may affect language and motor function differently depending on tumor LAD. Overall, the data support the use of fMRI as a tool to evaluate patient prognosis and are directly applicable to neurosurgical planning.</p>
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</div><div class="section glossary" id="glossary-1"><h2>Abbreviations</h2><dl id="def-list-1"><dt id="def-item-1">BOLD<span class="def-item-dt-sep"></span></dt><dd>blood oxygen level–dependent<span class="def-item-dd-sep"></span></dd><dt id="def-item-2">CI<span class="def-item-dt-sep"></span></dt><dd>confidence Interval<span class="def-item-dd-sep"></span></dd><dt id="def-item-3">EPI<span class="def-item-dt-sep"></span></dt><dd>echo-planar imaging<span class="def-item-dd-sep"></span></dd><dt id="def-item-4">fMRI<span class="def-item-dt-sep"></span></dt><dd>functional MR imaging<span class="def-item-dd-sep"></span></dd><dt id="def-item-5">HR<span class="def-item-dt-sep"></span></dt><dd>hazard ratio<span class="def-item-dd-sep"></span></dd><dt id="def-item-6">LAD<span class="def-item-dt-sep"></span></dt><dd>lesion to activation distance<span class="def-item-dd-sep"></span></dd><dt id="def-item-7">OR<span class="def-item-dt-sep"></span></dt><dd>odds ratio<span class="def-item-dd-sep"></span></dd><dt id="def-item-8">SE<span class="def-item-dt-sep"></span></dt><dd>standard error<span class="def-item-dd-sep"></span></dd><dt id="def-item-9">SMC<span class="def-item-dt-sep"></span></dt><dd>sensorimotor cortex<span class="def-item-dd-sep"></span></dd><dt id="def-item-10">SSDI<span class="def-item-dt-sep"></span></dt><dd>Social Security Death Index<span class="def-item-dd-sep"></span></dd><dt id="def-item-11">WHO<span class="def-item-dt-sep"></span></dt><dd>World Health Organization</dd></dl></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">© 2011 by American Journal of Neuroradiology</li></ul><div class="license" id="license-1"><p id="p-4">Indicates open access to non-subscribers at <a href="http://www.ajnr.org">www.ajnr.org</a></p></div><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div><a href="http://ajnr-stage2.stage.highwire.org/content/32/8/1420.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 32</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 8 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Sep 2011 </div></div>
      
      
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">J.M.</span> <span class="nlm-surname">Wood</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">B.</span> <span class="nlm-surname">Kundu</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">A.</span> <span class="nlm-surname">Utter</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">T.A.</span> <span class="nlm-surname">Gallagher</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Voss</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">V.A.</span> <span class="nlm-surname">Nair</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">J.S.</span> <span class="nlm-surname">Kuo</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">A.S.</span> <span class="nlm-surname">Field</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">C.H.</span> <span class="nlm-surname">Moritz</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">M.E.</span> <span class="nlm-surname">Meyerand</span></span>, <span class="highwire-citation-author" data-delta="10"><span class="nlm-given-names">V.</span> <span class="nlm-surname">Prabhakaran</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-oa-ind highwire-cite-metadata"><i class="highwire-oa-indicator"></i> </span><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Sep 2011, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">32 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(8) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1420-1425; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A2679 </span></div>
  
  
  
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