Greater surgical precision possible with fMRI requires team approach

A neuroradiologist, a neurosurgeon, and a radiological technologist explained to an RSNA audience how working together to analyze fMR scans has significantly helped them pinpoint hard-to-reach brain tumors and plan delicate surgery, resulting in improved surgical outcomes.

The trio, all based at the University of Wisconsin School of Medicine and Public Health in Madison, gave a detailed overview of fMRI, including reimbursement codes, hardware and software recommendations, and the need for specialized training to accurately read the elaborately detailed scans.

The radiological technologist needs special training, and patients need special coaching to be focused and relaxed. For maximum effectiveness, one person needs to communicate with the patient while the technologist runs the software. For the neuroradiologist, selecting the appropriate paradigm is one of the most important roles.

Twenty-second block duration scans are most advantageous, they said.

When patients tapped their fingers during the scan, the image revealed red and gold ovals, reflecting blood oxygen level-dependent activity. For language mapping, patients are shown words and told to think of an opposite word.

Prior to most brain surgeries, an fMRI and an ultrasound scan are done. Patients are awake during the surgery, which allows surgeons to test the person's functioning while removing the tumor.

The technique has become an important aid in neurosurgery. A survey showed that in 19 of 39 cases, surgeons significantly altered their surgical plans after seeing fMRI results, and the subsequent surgical times were greatly reduced, said Dr. Wade Mueller, a professor of neurosurgery at the University of Wisconsin's Translational Brain Tumor Program who does hundreds of brain surgeries annually.

"Our outcomes are so much better with it," he said.

Future issues for fMRI include developing a standardized practice and economic justification.