Integration of fMRI and MEG functional maps into a CyberKnife planning system: feasibility study for motor activity localization and dose planning.

World Neurosurg. 2017 Sep 20;:

Authors: De Martin E, Duran D, Ghielmetti F, Visani E, Aquino D, Marchetti M, Rossi Sebastiano D, Cusumano D, Bruzzone MG, Panzica F, Fariselli L

Abstract
OBJECTIVE: Magnetoencephalography (MEG) and functional magnetic resonance imaging (fMRI) provide non-invasive localization of eloquent brain areas for pre-surgical planning. The aim of this study is the integration of MEG and fMRI maps into a CyberKnife (CK) system to optimize dose planning.
METHODS: Four patients with brain metastases in the motor area underwent functional imaging study of the hand motor cortex prior radiosurgery. MEG data were acquired during a visually cued hand motor-task. Motor activations were identified also using an fMRI block-designed paradigm. MEG and fMRI maps were then integrated into a CK system and contoured as organs at risk (OARs) for treatment planning optimization.
RESULTS: The integration of fMRI data into the CK system was achieved for all patients by means of a standardized protocol. We also implemented an ad hoc pipeline to convert the MEG signal into DICOM standard, to make sure that it was readable by our CyberKnife treatment planning system. Inclusion of the activation areas into the optimization plan allowed the creation of treatment plans which reduced the irradiation of the motor cortex while not affecting the brain peripheral dose.
CONCLUSIONS: The availability of advanced neuroimaging techniques is playing a more and more important role in radiosurgical planning strategy. We successfully imported MEG and fMRI activations into a CyberKnife system. This additional information can improve dose sparing of eloquent areas, allowing a more comprehensive investigation of the related dose-volume constraints which in theory could translate into a gain in tumor local control and reduction of neurological complications.

PMID: 28942018 [PubMed - as supplied by publisher]