Strategic goals take shape in functional brain MR imaging

December 1, 2005

Although neurosurgeons depend on preoperative functional MRI to map eloquent brain areas, technique standards need strengthening and reimbursement is nonexistent. The recent formation of a dedicated fMRI society is serving to galvanize interest and search for solutions to these and other issues, according to a Wednesday panel discussion.

Although neurosurgeons depend on preoperative functional MRI to map eloquent brain areas, technique standards need strengthening and reimbursement is nonexistent. The recent formation of a dedicated fMRI society is serving to galvanize interest and search for solutions to these and other issues, according to a Wednesday panel discussion.

Preoperative functional brain mapping is primarily performed and interpreted by radiologists, said Dr. Andrei Holodny, a neuroradiologist at Memorial Sloan-Kettering Cancer Center. Turf is not an issue here.

One problem, however, is that the technique is not as accessible as it could be. Radiologists still need the support of a physicist to help analyze the data. An informal query of panel attendees revealed that most use a physicist and perform 50 or fewer fMR scans per month.

"The impediment right now to moving fMRI to the clinical arena is the lack of user-friendly software," Holodny said. "There is little doubt that fMRI is a good tool to the surgeon. But physicians in private practice don't have the ability or the time to install the right software."

The American Society of Functional Neuroradiology (ASFNR), formed in 2004, plans to help convince vendors to standardize programs and to make these programs more accessible, said Holodny, president of the new group. The society will also focus on developing practice standards and training guidelines, and it wants to help quickly bring research into clinical practice.

Audience member Arthur Wunderlich, Ph.D., a physicist at University Hospital Ulm in Germany, encouraged attendees to use the standard software that comes with certain MR packages. While these generally are not as sensitive as dedicated programs, they do enable radiologists to view in real-time preliminary online fMRI data. This approach can help determine whether the patient understands and executes the tasks correctly.

A poll of the audience revealed that very few use the standard programs for preliminary reads.

Lack of payment for these scans is another problem. The ASFNR is spearheading efforts to get CPT codes issued for fMR brain scans. The next step would be producing enough credible data to convince the Centers for Medicare and Medicaid Services to reimburse for the procedure, Holodny said.

ASFNR officials had expected to have about 50 members enrolled in the new society at this point, but membership is already triple that figure.

"People are knocking down the doors to join," Holodny told Diagnostic Imaging. "These are important issues, and people are very interested in them."

The ASFNR met during the annual American Society of Neuroradiology meeting, but the group expects to have a separate meeting in 2007.

Panel member Dr. John Ulmer, a neuroradiologist at the Medical College of Wisconsin and vice president of the ASFNR, noted that CPT codes will bring about an explosion of functional neurosurgery and surgeons will demand the technique in private practice. He encouraged neuroradiologists to use diffusion tensor imaging as a complement to fMRI.

"DTI so easy to perform. All neuroradiologists who serve neurosurgeons will be required to do DTI, and fMRI powers that," Ulmer said.