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Oct. 24, 2013 Volume 35, No. 10

Brain imaging device enhances neurosurgery at University Hospital

The precision of the fMRI allows doctors to fine-tune treatment

University Hospital has acquired central Missouri’s first functional magnetic resonance imaging (fMRI) system for diagnosing and treating patients with complex neurological conditions.

The fMRI produces 3-D images of a patient’s brain that show not only the physical structure of the brain, but also detect neurological activity and illustrate which portions of the brain control specific activities. The system, which uses advanced electromagnetic and radiofrequency technology to create the images, has only been utilized by medical doctors for less than a decade.

The technology is used by the Missouri Neurosciences Center, a 28-bed hospital unit dedicated to the comprehensive treatment of neurological conditions. The center is the home of mid-Missouri’s largest team of specialists in neurosurgery and neurology.

“Functional MRI gives us an image of a patient’s brain while also showing us precisely which areas control activity — such as speech, hearing and movement — with those areas ‘lighting up’ on the images,” said Ajay Aggarwal, a radiologist at MU Health Care trained in fMRI use. 

“Locating specific regions of activity is especially important when treating patients with certain neurological conditions, such as brain tumors, epilepsy and arteriovenous malformation.”

Scott Litofsky, chief of the neurosurgery division in the School of Medicine and director of neuro-oncology and radiosurgery at MU Health Care, uses fMRI images when determining treatment plans for patients with tumors in certain areas of the brain. Based on existing science, neurosurgeons know generally which areas of the brain control which activities; for example, the occipital lobe at the back of the brain processes vision. However, the exact locations of those regions vary from person to person.

“If I have a patient with a tumor that I know is near the part of the brain that controls speech, then I want to know exactly how close it is,” Litofsky said. “It could be a quarter-inch away, or the tumor might be invading that area. 

“If the tumor is very close, I may remove part of it surgically and treat the remaining portion with radiation therapy,” he continued. “But if there is enough space between them, I may remove the entire tumor through surgery. Functional MRI can tell me exactly where the tumor is located and exactly where the speech area is located. That helps me achieve my goal of removing as much of the tumor as possible without affecting my patient’s speech.”

The technology can also detect changes in blood flow. When a patient speaks inside an fMRI machine, for example, the device detects the extra blood sent to that region of the brain. A computer system illustrates this additional information on the MRI image by highlighting the active portion of the patient’s brain using different colors, such as red and yellow, which indicate the amount of activity in that portion of the brain.