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Sensorimotor Cortex Localization: Comparison of Magnetoencephalography, Functional MR Imaging, and Intraoperative Cortical Mapping¹

¹ From the Functional Brain Imaging Unit, Helsinki Brain Research Center, Medical Imaging Center, University of Helsinki, Helsinki, Finland (A.K., H.J.A., E.S.); Brain Research Unit, Low Temperature Laboratory, Helsinki University of Technology, Espoo, Finland (E.K., S.A., J.P.M., M.S.); BioMag Laboratory, Helsinki Brain Research Center, Engineering Centre (A.K., R.J.I.) and Department of Clinical Neurophysiology (E.K., J.H., T.K.), Helsinki University Central Hospital, Helsinki, Finland; Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland (J.E.J.); and Department of Radiology, Hyvinkää Hospital, Hospital District of Helsinki and Uusimaa, Hyvinkää, Finland (A.B.). From the 2000 RSNA Annual Meeting. Received May 10, 2005; revision requested July 8; revision received September 8; accepted October 14; final version accepted November 23. Supported by grants from the Finnish Radiological Society, Maire Taponen Foundation, Maud Kuistila Foundation, Finnish Cancer Organization, Helsinki University Central Hospital, Academy of Finland, Nordic Cancer Union, Sigrid Juselius Foundation, and Helsinki University Hospital Clinical Research Institute. Address correspondence to A.K., Radiology Department, Biomedicum Helsinki, PO Box 700, FI-00029 HUS, Helsinki, Finland (e-mail: antti.korvenoja{at}helsinki.fi).

Purpose: To prospectively evaluate magnetoencephalography (MEG) and functional magnetic resonance (MR) imaging, as compared with intraoperative cortical mapping, for identification of the central sulcus.

Materials and Methods: Fifteen patients (six men, nine women; age range, 25–58 years) with a lesion near the primary sensorimotor cortex (13 gliomas, one cavernous hemangioma, and one meningioma) were examined after institutional review board approval and written informed consent from each patient were obtained. At MEG, evoked magnetic fields to median nerve stimulation were recorded; at functional MR imaging, hemodynamic responses to self-paced palmar flexion of the wrist were imaged. General linear model analysis with contextual clustering (P < .01) was used to analyze functional MR imaging data, and dipole modeling was used to analyze MEG data. MEG and functional MR localizations were compared with intraoperative cortical mappings. The distance from the area of functional MR imaging activation to the tumor margin was compared between the patients with discordant and those with concordant intraoperative mapping findings by using unpaired t testing.

Results: MEG depicted the central sulcus correctly in all 15 patients, as verified at intraoperative mapping. The functional MR imaging localization results agreed with the intraoperative mappings in 11 patients. In all four patients with a false localization, the primary activation was in the postcentral sulcus region, but it did not differ significantly from the primary activation in the patients with correct localization with respect to proximity to the tumor (P = .38). Furthermore, at functional MR imaging, multiple nonprimary areas were activated, with considerable interindividual variation.

Conclusion: Although both MEG and functional MR imaging can provide useful information for neurosurgical planning, in the present study, MEG proved to be superior for locating the central sulcus. Activation of multiple nonprimary cerebral areas may confound the interpretation of functional MR imaging results.

© RSNA, 2006

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