Patients with brain tumors and their physicians alike soon may have more confidence in surgical treatment recommendations, thanks to the effects of preoperative functional MRI of language and motor areas in the brain. Scientists from Duke University Medical Center in Durham, N.C., have conducted a study to determine whether functional MRI influenced a physician’s original surgical approach for 39 patients with various diagnoses.

The imaging, performed with a GE Medical Systems 1.5-T MR imager, was conducted while patients performed sentence completion and alternating hand-squeezing tasks. Image analysis revealed the active areas of the brain during language and motor function and the proximity of these areas to a tumor. Not only did these images affect which surgical procedure was chosen, but they also affected the length and extent of the surgery.

As a result of the images, surgeons opted for a more aggressive approach than the original therapeutic plan in 18 patients and a less aggressive approach in one; they recommended surgery for seven out of nine patients for whom it originally had not been planned. Functional MRI allowed physicians to avoid the use of other, more invasive diagnostic approaches, helped to shorten surgical time by up to an hour in 22 patients and enabled a more complete resection of the tumor in six patients.

Although the technique still has several limitations, its advantages are significant and indicate that it has potential for full implementation in regular clinical use. The entire process, conducted in real time, can be completed within one hour, with 30 minutes reserved for actual imaging. Neurosurgeons gain confidence in choosing and performing particular procedures, especially in cases when such procedures previously were considered too risky. The study concluded that functional MRI can help patients with brain tumors receive more beneficial treatment.