College of Medicine, Room 2117
Title: Advanced Neuroimaging for Presurgical Planning
Speaker: Michelle Miller-Thomas, MD
The Department of Medical Imaging is pleased to have Michelle Miller-Thomas, MD presenting at our Grand Rounds on Wednesday, March 21st, in the College of Medicine, Room 2117 at 12:00 pm.
Dr. Miller-Thomas completed her medical degree at Saint Louis University, her Diagnostic Radiology residency at University of Texas Houston, and her Neuroradiology fellowship at Mallinckrodt Institute of Radiology (MIR). At the completion of her fellowship in 2008, she joined the faculty in the Neuroradiology section at MIR. Dr. Miller-Thomas became the director of the Advanced Neuroimaging clinical service in 2013, overseeing the growth of the service and development of a streamlined pipeline for translating resting-state fMRI into routine clinical care. Her clinical research focuses on examining the clinical utility of resting-state fMRI. She also serves as Program Director of the Neuroradiology fellowship, Associate Program Director of the Diagnostic Radiology residency, and Director of Medical Student Education.
Abstract: Intraoperative electrophysiological mapping of eloquent cortex and vital fiber tracts was developed in the 20th century by neurosurgeons to help them to maximize their surgical resection of brain tumors while minimizing permanent neurological deficit. In the 1990s, blood oxygen level dependent (BOLD) imaging was developed, allowing for noninvasive preoperative mapping of eloquent cortex with fMRI. In parallel, the field of tractography developed, allowing for the noninvasive representation of eloquent fiber tracts. fMRI and tractography have been applied to the preoperative evaluation of adults and children undergoing surgical resection of brain tumors, vascular malformations, and epileptogenic foci, either obviating the need for complex intraoperative mapping or reducing the time necessary for performing the mapping. Presurgical mapping reduces the risk and favors a more aggressive resection of tumor, it may shorten surgery, and it allows the surgeon to reduce the size of craniotomy.
Resting-state fMRI is a technique based on BOLD imaging which identifies networks and maps eloquent cortical functions without requiring the patient to perform a task. This technique has been validated against both task-based fMRI and intraoperative cortical stimulation mapping, showing excellent correlation. It is gaining acceptance as a method for mapping eloquent cortex in patients, including those who could not traditionally cooperate with task-based fMRI. This technique has been put in to routine use at our medical center on all adults and many pediatric patients undergoing craniotomy for lesion resection, for biopsy planning, for stereotactic radiosurgery planning, and prior to invasive epilepsy monitoring planning. This novel imaging service is supported by a collaboration between the neuroimaging research lab, the neuroradiology service, and the neurosurgery service.