Language Mapping Using T2-Prepared BOLD Functional MRI in the Presence of Large Susceptibility Artifacts—Initial Results in Patients With Brain Tumor and Epilepsy

At present, presurgical functional mapping is the most prevalent clinical application of functional magnetic resonance imaging (fMRI). Signal dropouts and distortions caused by susceptibility effects in the current standard echo planar imaging (EPI)-based fMRI images are well-known problems and pose a major hurdle for the application of fMRI in several brain regions, many of which are related to language mapping in presurgical planning. Such artifacts are particularly problematic in patients with previous surgical resection cavities, craniotomy hardware, hemorrhage, and vascular malformation. A recently developed T2-prepared (T2prep) fMRI approach showed negligible distortion and dropouts in the entire brain even in the presence of large susceptibility effects. Here, we present initial results comparing T2prep- and multiband EPI-fMRI scans for presurgical language mapping using a sentence completion task in patients with brain tumor and epilepsy. In all patients scanned, T2prep-fMRI showed minimal image artifacts (distortion and dropout) and greater functional sensitivity than EPI-fMRI around the lesions containing blood products and in air-filled cavities. This enhanced sensitivity in T2prep-fMRI was also evidenced by the fact that functional activation during the sentence completion task was detected with T2prep-fMRI but not with EPI-fMRI in the affected areas with the same statistical threshold, whereas cerebrovascular reactivity during a breath-hold task was preserved in these same regions, implying intact neurovascular coupling in these patients. Although further investigations are required to validate these findings with invasive methods such as direct cortical stimulation mapping as the gold standard, this approach provides an alternative method for performing fMRI in brain regions with large susceptibility effects.