Neuroimaging Aids for Treatment of CNS Vision Pathology

DESCRIPTION (provided by applicant): The goal of this project is to develop functional magnetic resonance imaging (fMRI) tools for assessing and treating human patients with a brain neoplasm or other focal pathology involving the visual or motor systems, especially cerebral cortex. Invasive treatment of the pathology can cause debilitating neurological side-effects involving partial or complete loss of vision or motor function. Under this grant, a prototype system for vision mapping developed in Phase I will be extended to the motor system and then integrated into a commercial product with FDA 510K marketing approval. The proposed core technology includes methods for very efficiently acquiring a complete brain map of eloquent visual and/or motor cortex function near a cancer site and linking this to a unique display technology, termed a Functional Field Map (FFMap). The latter allows the physician to instantly interpret the complete, complex pattern of fMRI brain activation in terms of preserved or compromised neural function without laborious perusal of multiple brain images. This functionally-oriented display augments conventional slice-based brain images to provide an optimal system for clinical diagnosis and surgical/radiation planning. However, interpretation of fMRI brain activation can be complicated by potential disruption of the underlying BOLD hemodynamic mechanism itself. This can cause neurovascular uncoupling (NVU) and associated loss of BOLD response despite preservation of underlying neural activity. This could lead to inadvertent surgical ablation of viable brain tissue. A technique developed in Phase I to detect NVU using the FFMap technology will be compared with other MRI-based methods to identify brain tissue affected by NVU. We will extend our initial tests with patients to provide a better estimate of the incidence of NVU and to identify specific pathological conditions that may cause NVU. Initial Phase I tests of the clinical validity of fMRI vision mapping and the FFMap technology will be extended to the motor system and to a larger sample of patients. A quantitative analysis based on predictive value theory will be used to test the ability of fMRI and the FFMap technology to correctly indicate the functional status of brain tissue near a site of focal pathology. Diffusion tensor imaging of white matter tracts will be combined with fMRI to provide additional information about the status of white matter tracts near a site of pathology and thereby yield a more valid prediction of potential functional disruption. Successful completion of the project will produce a commercially viable product plus key information to assist the physician in interpreting advanced, multiparameter imaging data associated with brain cancer patients. PUBLIC HEALTH RELEVANCE: The successful completion of this project will result in the creation of a unique suite of computer software tools, analyses and display algorithms that will assist neurosurgeons and radiation oncologists in the use of advanced medical imaging tests to diagnose and guide treatment of brain tumors and other brain pathologies. Currently such advanced technology is only available at a small number of select institutions world-wide. The system developed in this project will make this technology accessible to a much wider range of hospitals and clinics throughout the USA and abroad.