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Functional Magnetic Resonance Imaging-Guided Stereotactic Radiosurgery to Avoid Symptomatic Radionecrosis.

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Functional magnetic resonance imaging (fMRI) helps identify brain areas for safer stereotactic radiosurgery (SRS). Novel fMRI-guided SRS planning reduces radiation dose to nearby eloquent areas, potentially lowering the risk of radionecrosis symptoms.

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Area of Science:

  • Neurosurgery
  • Radiology
  • Neuro-oncology

Background:

  • Functional magnetic resonance imaging (fMRI) offers superior localization of eloquent brain areas compared to structural imaging, aiding in neurosurgical planning.
  • Despite its benefits, fMRI is underutilized in stereotactic radiosurgery (SRS) for brain metastases (BM).
  • This study investigates the relationship between SRS dose to fMRI-identified eloquent areas and radionecrosis (RN) symptoms.

Purpose of the Study:

  • To assess the neuroanatomic relationship between SRS for BM, nearby eloquent areas identified by fMRI, and symptoms of radionecrosis (RN).
  • To evaluate the efficacy of a novel fMRI-guided SRS (fMRI-SRS) planning approach in minimizing dose to eloquent areas.

Main Methods:

  • Patients with fMRI within three months of SRS for BM were included.
  • The nearest eloquent area (NEA) was defined as the closest motor, language, or visual area on fMRI to the irradiated BM.
  • Logistic regression analyzed the relationship between dose to the NEA and focal symptomatic RN (FSRN); cases were replanned using fMRI-SRS to maximize NEA avoidance.

Main Results:

  • Among 93 patients, 12 developed FSRN. Higher V14Gy (single-fraction equivalent dose) to the NEA predicted increased FSRN risk (OR 6.8/mL, p=0.05) in patients receiving 5-fraction SRS.
  • fMRI-SRS replanning reduced NEA V14Gy by a mean of 22.5% across all cases.
  • The most common NEA was motor (76%), followed by language (19%).

Conclusions:

  • Focal neurologic symptoms of RN are linked to SRS dose delivered to eloquent brain areas identified by fMRI.
  • fMRI-SRS planning effectively minimizes radiation dose to critical eloquent areas.
  • This approach holds potential for mitigating neurological toxicity in patients undergoing SRS for brain metastases.