Functional and diffusion-weighted magnetic resonance images of space-occupying lesions affecting the motor system: imaging the motor cortex and pyramidal tracts

Object. During neurosurgical interventions, preservation of subcortical axons is as important as preservation of cortical neurons. The goal of this study was to assess the combined use of functional (f) and diffusion-weighted (DW) magnetic resonance (MR) imaging to assist in the preservation of the structure and function of the motor system. Methods. The authors evaluated the combination of fMR imaging and DW MR imaging to detect cortical motor areas with their corresponding pyramidal tracts in 12 healthy volunteers and in 10 consecutive patients with various space-occupying lesions affecting the central motor system. Activation within the primary motor cortex (MI) and white matter bundles originating from this cortical region was demonstrated in 21 of the 22 individuals examined. Additional activation was exhibited along the course of white matter tracts at the level of the pons and, in the contralateral hemisphere, in the MI. Fiber tract displacement was visualized in all patients in white matter that had appeared normal on routine T-1- and T-2-weighted MR images. Conclusions. The combination of DW MR and fMR imaging allows visualization of the origin, direction, and functionality of large white matter tracts. This will prove helpful for imaging structural connectivity within the brain during functional imaging. Moreover, local relationships of cerebral tumors that encroach upon M I and subcortical fiber tracts can be defined. Tl is promises to decrease patient morbidity and to broaden the clinical applications of functional imaging.