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<meta name="DC.Title" content="Multimodal Imaging in Malignant Brain Tumors: Enhancing the Preoperative Risk Evaluation for Motor Deficits with a Combined Hybrid MRI-PET and Navigated Transcranial Magnetic Stimulation Approach" />
<meta name="DC.Identifier" content="10.3174/ajnr.A4536" />
<meta name="DC.Date" content="2016-02-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2016 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: Motor deficits in patients with brain tumors are caused mainly by irreversible infiltration of the motor network or by indirect mass effects; these deficits are potentially reversible on tumor removal. Here we used a novel multimodal imaging approach consisting of structural, functional, and metabolic neuroimaging to better distinguish these underlying causes in a preoperative setting and determine the predictive value of this approach.

MATERIALS AND METHODS: Thirty patients with malignant brain tumors involving the central region underwent a hybrid O-(2-[18F]fluoroethyl)-L-tyrosine–PET-MR imaging and motor mapping by neuronavigated transcranial magnetic stimulation. The functional maps served as localizers for DTI tractography of the corticospinal tract. The spatial relationship between functional tissue (motor cortex and corticospinal tract) and lesion volumes as depicted by structural and metabolic imaging was analyzed.

RESULTS: Motor impairment was found in nearly all patients in whom the contrast-enhanced T1WI or PET lesion overlapped functional tissue. All patients who functionally deteriorated after the operation showed such overlap on presurgical maps, while the absence of overlap predicted a favorable motor outcome. PET was superior to contrast-enhanced T1WI for revealing a motor deficit before the operation. However, the best correlation with clinical impairment was found for T2WI lesion overlap with functional tissue maps, but the prognostic value for motor recovery was not significant.

CONCLUSIONS: Overlapping contrast-enhanced T1WI or PET-positive signals with motor functional tissue were highly indicative of motor impairment and predictive for surgery-associated functional outcome. Such a multimodal diagnostic approach may contribute to the risk evaluation of operation-associated motor deficits in patients with brain tumors.

CE
:   contrast-enhanced
CST
:   corticospinal tract
FA
:   fractional anisotropy
FET
:   O-(2-[18F]fluoroethyl)-L-tyrosine
KPS
:   Karnofsky Performance Scale
M1
:   primary motor area
nTMS
:   navigated transcranial magnetic stimulation
SPACE
:   T2-weighted sampling perfection with application-optimized contrasts using different flip angle evolution" />
<meta name="DC.Contributor" content="V. Neuschmelting" />
<meta name="DC.Contributor" content="C. Weiss Lucas" />
<meta name="DC.Contributor" content="G. Stoffels" />
<meta name="DC.Contributor" content="A.-M. Oros-Peusquens" />
<meta name="DC.Contributor" content="H. Lockau" />
<meta name="DC.Contributor" content="N.J. Shah" />
<meta name="DC.Contributor" content="K.-J. Langen" />
<meta name="DC.Contributor" content="R. Goldbrunner" />
<meta name="DC.Contributor" content="C. Grefkes" />
<meta name="article:published_time" content="2016-02-01" />
<meta name="article:section" content="ADULT BRAIN" />
<meta name="citation_title" content="Multimodal Imaging in Malignant Brain Tumors: Enhancing the Preoperative Risk Evaluation for Motor Deficits with a Combined Hybrid MRI-PET and Navigated Transcranial Magnetic Stimulation Approach" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Motor deficits in patients with brain tumors are caused mainly by irreversible infiltration of the motor network or by indirect mass effects; these deficits are potentially reversible on tumor removal. Here we used a novel multimodal imaging approach consisting of structural, functional, and metabolic neuroimaging to better distinguish these underlying causes in a preoperative setting and determine the predictive value of this approach.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Thirty patients with malignant brain tumors involving the central region underwent a hybrid O-(2-[&lt;sup&gt;18&lt;/sup&gt;F]fluoroethyl)-L-tyrosine–PET-MR imaging and motor mapping by neuronavigated transcranial magnetic stimulation. The functional maps served as localizers for DTI tractography of the corticospinal tract. The spatial relationship between functional tissue (motor cortex and corticospinal tract) and lesion volumes as depicted by structural and metabolic imaging was analyzed.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Motor impairment was found in nearly all patients in whom the contrast-enhanced T1WI or PET lesion overlapped functional tissue. All patients who functionally deteriorated after the operation showed such overlap on presurgical maps, while the absence of overlap predicted a favorable motor outcome. PET was superior to contrast-enhanced T1WI for revealing a motor deficit before the operation. However, the best correlation with clinical impairment was found for T2WI lesion overlap with functional tissue maps, but the prognostic value for motor recovery was not significant.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Overlapping contrast-enhanced T1WI or PET-positive signals with motor functional tissue were highly indicative of motor impairment and predictive for surgery-associated functional outcome. Such a multimodal diagnostic approach may contribute to the risk evaluation of operation-associated motor deficits in patients with brain tumors.&lt;/p&gt;" />
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<meta name="twitter:title" content="Multimodal Imaging in Malignant Brain Tumors: Enhancing the Preoperative Risk Evaluation for Motor Deficits with a Combined Hybrid MRI-PET and Navigated Transcranial Magnetic Stimulation Approach" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Motor deficits in patients with brain tumors are caused mainly by irreversible infiltration of the motor network or by indirect mass effects; these deficits are potentially reversible on tumor removal. Here we used a novel multimodal imaging approach consisting of structural, functional, and metabolic neuroimaging to better distinguish these underlying causes in a preoperative setting and determine the predictive value of this approach.

MATERIALS AND METHODS: Thirty patients with malignant brain tumors involving the central region underwent a hybrid O-(2-[18F]fluoroethyl)-L-tyrosine–PET-MR imaging and motor mapping by neuronavigated transcranial magnetic stimulation. The functional maps served as localizers for DTI tractography of the corticospinal tract. The spatial relationship between functional tissue (motor cortex and corticospinal tract) and lesion volumes as depicted by structural and metabolic imaging was analyzed.

RESULTS: Motor impairment was found in nearly all patients in whom the contrast-enhanced T1WI or PET lesion overlapped functional tissue. All patients who functionally deteriorated after the operation showed such overlap on presurgical maps, while the absence of overlap predicted a favorable motor outcome. PET was superior to contrast-enhanced T1WI for revealing a motor deficit before the operation. However, the best correlation with clinical impairment was found for T2WI lesion overlap with functional tissue maps, but the prognostic value for motor recovery was not significant.

CONCLUSIONS: Overlapping contrast-enhanced T1WI or PET-positive signals with motor functional tissue were highly indicative of motor impairment and predictive for surgery-associated functional outcome. Such a multimodal diagnostic approach may contribute to the risk evaluation of operation-associated motor deficits in patients with brain tumors.

CE
:   contrast-enhanced
CST
:   corticospinal tract
FA
:   fractional anisotropy
FET
:   O-(2-[18F]fluoroethyl)-L-tyrosine
KPS
:   Karnofsky Performance Scale
M1
:   primary motor area
nTMS
:   navigated transcranial magnetic stimulation
SPACE
:   T2-weighted sampling perfection with application-optimized contrasts using different flip angle evolution" />
<meta name="og-title" property="og:title" content="Multimodal Imaging in Malignant Brain Tumors: Enhancing the Preoperative Risk Evaluation for Motor Deficits with a Combined Hybrid MRI-PET and Navigated Transcranial Magnetic Stimulation Approach" />
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<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: Motor deficits in patients with brain tumors are caused mainly by irreversible infiltration of the motor network or by indirect mass effects; these deficits are potentially reversible on tumor removal. Here we used a novel multimodal imaging approach consisting of structural, functional, and metabolic neuroimaging to better distinguish these underlying causes in a preoperative setting and determine the predictive value of this approach.

MATERIALS AND METHODS: Thirty patients with malignant brain tumors involving the central region underwent a hybrid O-(2-[18F]fluoroethyl)-L-tyrosine–PET-MR imaging and motor mapping by neuronavigated transcranial magnetic stimulation. The functional maps served as localizers for DTI tractography of the corticospinal tract. The spatial relationship between functional tissue (motor cortex and corticospinal tract) and lesion volumes as depicted by structural and metabolic imaging was analyzed.

RESULTS: Motor impairment was found in nearly all patients in whom the contrast-enhanced T1WI or PET lesion overlapped functional tissue. All patients who functionally deteriorated after the operation showed such overlap on presurgical maps, while the absence of overlap predicted a favorable motor outcome. PET was superior to contrast-enhanced T1WI for revealing a motor deficit before the operation. However, the best correlation with clinical impairment was found for T2WI lesion overlap with functional tissue maps, but the prognostic value for motor recovery was not significant.

CONCLUSIONS: Overlapping contrast-enhanced T1WI or PET-positive signals with motor functional tissue were highly indicative of motor impairment and predictive for surgery-associated functional outcome. Such a multimodal diagnostic approach may contribute to the risk evaluation of operation-associated motor deficits in patients with brain tumors.

CE
:   contrast-enhanced
CST
:   corticospinal tract
FA
:   fractional anisotropy
FET
:   O-(2-[18F]fluoroethyl)-L-tyrosine
KPS
:   Karnofsky Performance Scale
M1
:   primary motor area
nTMS
:   navigated transcranial magnetic stimulation
SPACE
:   T2-weighted sampling perfection with application-optimized contrasts using different flip angle evolution" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node14279--5" data-node-nid="14279" id="top-node-14279--61912318969" data-pisa="ajnr;37/2/266" data-pisa-master="ajnr;ajnr.A4536" data-apath="/ajnr/37/2/266.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">
  
  
      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">ADULT BRAIN</span></span></div>
  
      <div class="highwire-cite-access"><span class="highwire-citation-access"><i class="highwire-access-icon highwire-access-icon-open-access open-access hw-icon-open-access" title="Open Access" aria-hidden="true"></i><span  class="element-invisible highwire-access-icon highwire-access-icon-open-access" style="">Open Access</span></span></div>
  
      <h1 class="highwire-cite-title" id="page-title">Multimodal Imaging in Malignant Brain Tumors: Enhancing the Preoperative Risk Evaluation for Motor Deficits with a Combined Hybrid MRI-PET and Navigated Transcranial Magnetic Stimulation Approach</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">V. Neuschmelting</span>, <span class="highwire-citation-author" data-delta="1">C. Weiss Lucas</span>, <span class="highwire-citation-author" data-delta="2">G. Stoffels</span>, <span class="highwire-citation-author" data-delta="3">A.-M. Oros-Peusquens</span>, <span class="highwire-citation-author" data-delta="4">H. Lockau</span>, <span class="highwire-citation-author" data-delta="5">N.J. Shah</span>, <span class="highwire-citation-author" data-delta="6">K.-J. Langen</span>, <span class="highwire-citation-author" data-delta="7">R. Goldbrunner</span> and <span class="highwire-citation-author" data-delta="8">C. Grefkes</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">February 2016,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">37 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(2) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">266-273; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A4536 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-14279--61912318969" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">V. Neuschmelting </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Neurosurgery (V.N., C.W.L., R.G.)</div><div class='author-affiliation'><span class='nlm-sup'>d</span>Department of Radiology (V.N., H.L.), Memorial Sloan Kettering Cancer Center, New York, New York</div></span></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=V.%2BNeuschmelting%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=Neuschmelting%20V&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"><a href="/search/author1%3AV.%2BNeuschmelting%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0001-7527-6990" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for V. Neuschmelting</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">C. Weiss Lucas </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Neurosurgery (V.N., C.W.L., R.G.)</div></span></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=C.%2BWeiss%2BLucas%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=Weiss%20Lucas%20C&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"><a href="/search/author1%3AC.%2BWeiss%2BLucas%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0001-6463-0034" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for C. Weiss Lucas</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">G. Stoffels </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>e</span>Institute for Neuroscience and Medicine (G.S., A.-M.O.-P., N.J.S., K.-J.L., C.G.), Forschungszentrum Jülich, (Institute for Neuroscience and Medicine [INM]-2, INM-3, INM-4), Juelich, Germany</div></span></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=G.%2BStoffels%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=Stoffels%20G&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"><a href="/search/author1%3AG.%2BStoffels%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0001-7114-1941" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for G. Stoffels</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">A.-M. Oros-Peusquens </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>e</span>Institute for Neuroscience and Medicine (G.S., A.-M.O.-P., N.J.S., K.-J.L., C.G.), Forschungszentrum Jülich, (Institute for Neuroscience and Medicine [INM]-2, INM-3, INM-4), Juelich, Germany</div></span></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=A.-M.%2BOros-Peusquens%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=Oros-Peusquens%20A&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"><a href="/search/author1%3AA.-M.%2BOros-Peusquens%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-8536-8044" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for A.-M. Oros-Peusquens</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">H. Lockau </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Radiology (H.L.)</div><div class='author-affiliation'><span class='nlm-sup'>d</span>Department of Radiology (V.N., H.L.), Memorial Sloan Kettering Cancer Center, New York, New York</div></span></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=H.%2BLockau%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=Lockau%20H&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"><a href="/search/author1%3AH.%2BLockau%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-3610-3074" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for H. Lockau</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">N.J. Shah </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>e</span>Institute for Neuroscience and Medicine (G.S., A.-M.O.-P., N.J.S., K.-J.L., C.G.), Forschungszentrum Jülich, (Institute for Neuroscience and Medicine [INM]-2, INM-3, INM-4), Juelich, Germany</div><div class='author-affiliation'><span class='nlm-sup'>f</span>Departments of Neurology (N.J.S.)</div></span></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=N.J.%2BShah%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=Shah%20N&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"><a href="/search/author1%3AN.J.%2BShah%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-8151-6169" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for N.J. Shah</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">K.-J. Langen </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>e</span>Institute for Neuroscience and Medicine (G.S., A.-M.O.-P., N.J.S., K.-J.L., C.G.), Forschungszentrum Jülich, (Institute for Neuroscience and Medicine [INM]-2, INM-3, INM-4), Juelich, Germany</div><div class='author-affiliation'><span class='nlm-sup'>g</span>Nuclear Medicine (K.-J.L.), Rheinisch-Westfälische Technische Hochschule Aachen University, Aachen, Germany.</div></span></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=K.-J.%2BLangen%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=Langen%20K&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"><a href="/search/author1%3AK.-J.%2BLangen%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0003-1101-5075" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for K.-J. Langen</a></li></ul></div><div class="author-tooltip-7"><div class="author-tooltip-name">R. Goldbrunner </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Neurosurgery (V.N., C.W.L., R.G.)</div></span></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=R.%2BGoldbrunner%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=Goldbrunner%20R&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"><a href="/search/author1%3AR.%2BGoldbrunner%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-1927-0022" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for R. Goldbrunner</a></li></ul></div><div class="author-tooltip-8"><div class="author-tooltip-name">C. Grefkes </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Neurology (C.G.), University of Cologne, Cologne, Germany</div><div class='author-affiliation'><span class='nlm-sup'>e</span>Institute for Neuroscience and Medicine (G.S., A.-M.O.-P., N.J.S., K.-J.L., C.G.), Forschungszentrum Jülich, (Institute for Neuroscience and Medicine [INM]-2, INM-3, INM-4), Juelich, Germany</div></span></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=C.%2BGrefkes%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=Grefkes%20C&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"><a href="/search/author1%3AC.%2BGrefkes%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-1656-720X" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for C. 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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 37</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 2 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Feb 2016 </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">V.</span> <span class="nlm-surname">Neuschmelting</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">C.</span> <span class="nlm-surname">Weiss Lucas</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">G.</span> <span class="nlm-surname">Stoffels</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">A.-M.</span> <span class="nlm-surname">Oros-Peusquens</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">H.</span> <span class="nlm-surname">Lockau</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">N.J.</span> <span class="nlm-surname">Shah</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">K.-J.</span> <span class="nlm-surname">Langen</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">R.</span> <span class="nlm-surname">Goldbrunner</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">C.</span> <span class="nlm-surname">Grefkes</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">Feb 2016, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">37 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(2) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">266-273; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A4536 </span></div>
  
  
  
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      <div class="highwire-cite-title">Multimodal Imaging in Malignant Brain Tumors: Enhancing the Preoperative Risk Evaluation for Motor Deficits with a Combined Hybrid MRI-PET and Navigated Transcranial Magnetic Stimulation Approach</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">V.</span> <span class="nlm-surname">Neuschmelting</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">C.</span> <span class="nlm-surname">Weiss Lucas</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">G.</span> <span class="nlm-surname">Stoffels</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">A.-M.</span> <span class="nlm-surname">Oros-Peusquens</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">H.</span> <span class="nlm-surname">Lockau</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">N.J.</span> <span class="nlm-surname">Shah</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">K.-J.</span> <span class="nlm-surname">Langen</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">R.</span> <span class="nlm-surname">Goldbrunner</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">C.</span> <span class="nlm-surname">Grefkes</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">Feb 2016, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">37 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(2) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">266-273; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A4536 </span></div>
  
  
  
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