Biomedical subjects

T Krings

Publications and source records attributed to T Krings.

79 records · Page 5Linked to original sources

PubMed1999

Determination of cognitive hemispheric lateralization by "functional" transcranial Doppler cross-validated by functional MRI.

BACKGROUND AND PURPOSE: Changes of blood flow velocity in the right and left middle cerebral artery (MCA) induced by cognitive demands are detectable by means of "functional" transcranial Doppler sonography (fTCD). Functional MRI (fMRI) is an alternative method for mapping brain activity. The purpose of this study was to determine whether fTCD can detect hemispheric lateralization and to cross-validate fTCD with fMRI. METHODS: Bilateral continuous MCA monitoring of 14 healthy, right-handed subjects with TCD was performed while the subjects underwent a visuospatial task, and the hemispheric blood flow velocity shift was calculated. Identical stimulus and response patterns were used in fMRI. Blood oxygenation level-dependent fMRI was performed with the use of a gradient-echo echo-planar sequence on a 1.5-T scanner. Statistical maps were computed on a voxel-by-voxel basis, hemispheric ratios for activated pixels were computed, and a group study was performed separately for the male and female subgroups. RESULTS: Statistical analyses (t test) showed a significantly higher mean peak blood flow velocity increase (P<0.05) of the right MCA (111.3+/-7.0%) compared with the left MCA (107.1+/-6.1%). fMRI demonstrated bilateral activation in the superior parietal lobulus (Brodmann area 7) with a right/left ratio of 1.95. Concordant differences between the female and male subgroups could be visualized with both methods. CONCLUSIONS: Both methods succeeded in discriminating a blood flow shift to the right hemisphere induced by a complex cognitive visuospatial task. fMRI cross-validates the findings of fTCD. Our study suggests that fTCD can investigate the close relationship between brain activity and blood flow and lateralize higher cognitive functions reliably.

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PubMed1998

Accuracy of electroencephalographic dipole localization of epileptiform activities associated with focal brain lesions.

We evaluated the accuracy of an electroencephalographic (EEG) localization technique (dipole inverse solution) in a consecutive series of 12 focal intracerebral lesions of diverse etiologies whose EEGs showed interictal spike activity or rhythmic activity at seizure onset. The calculated equivalent dipole was plotted on three axes in the patients' magnetic resonance image, and the distance between the dipole and the lesion margin was measured assuming that the shell of the lesion constituted an epileptogenic region. In all cases the dipole localized closer than 0.8 cm to the nearest lesion margin. In addition, we compared the postsurgical outcome of 6 patients to the dipole localization and the resection margins. In all 6 patients in whom the dipole, and hence the estimated seizure generator, was removed the surgical outcome was favorable. We conclude that the inverse solution algorithm is a promising method for using the scalp EEG to localize the sources of electrical activity in the human brain in routine clinical electroencephalography and provides three-dimensional data not available from conventional analysis.

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PubMed1998

Functional magnetic resonance mapping of sensory motor cortex for image-guided neurosurgical intervention.

PURPOSE: This paper describes the potentials of functional magnetic resonance imaging (fMRI) to map sensory motor cortex in patients with mass lesions near primary motor cortex and to guide neurosurgical procedures located close to eloquent brain regions. MATERIAL AND METHODS: 7 patients with mass lesions near the central sulcus and 10 healthy volunteers were studied using a blood oxygenation level dependent 2D multislice multishot T2* weighted gradient echo EPI sequence on a 1.5T Phillips Gyroscan during alternating epochs of rest and motor activation of hand, foot and tongue. Sites of neuronal activation were identified by statistical analysis of the signal time course using Kolmogorov Smirnov statistics. RESULTS: Neuronal activation following motor tasks consistently localised to the contralateral precentral gyrus and the supplementary motor area, even in the presence of local brain pathology. Additionally we could observe activation in primary sensory areas (post-central gyrus) and supplementary motor area (SMA) in some cases. CONCLUSION: fMRI is capable of mapping sensory motor cortex even in the presence of distorting brain lesions. Since this information will provide valuable information to the neurosurgeon during pre-operative planning, we consider this method for neurosurgical navigation a valuable tool in the routine diagnostic of intracerebral interventions.

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PubMed1998

Representation of cortical motor function as revealed by stereotactic transcranial magnetic stimulation.

Cortical motor representation of 12 muscles of the trunk and the upper and lower extremity was investigated in 18 healthy subjects using focal transcranial magnetic stimulation (TMS) in conjunction with a frameless stereotactic system (FSS). This combination allowed us to orientate stimulation sites to the individual central sulcus rather than to bony landmarks. Distinct but overlapping areas of muscle representation were identified and the 3-dimensional representation of those 12 muscles along the course of the central sulcus was obtained. With increasing stimulus intensity, the cortical output maps changed in that more muscles became excitable, motor evoked potential (MEP) amplitude and size of the responsive area increased and latency of the MEP decreased. These effects were more pronounced for proximal than for distal muscles, indicating a more widespread organization of corticospinal motor projection related to proximal muscles. The combination of TMS and FSS represents a method with which functional information can be directly related to underlying cortical anatomy. This correlation will be useful in the assessment of higher brain functions with TMS.

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PubMed1997

Stereotactic transcranial magnetic stimulation: correlation with direct electrical cortical stimulation.

OBJECTIVE: To evaluate stereotactic transcranial magnetic stimulation (TMS) as a tool for presurgical functional mapping of human motor cortex. METHODS: Transcranial magnetic stimulation using a frameless stereotactic system was performed in two patients with tumors near the central sulcus. TMS motor function maps were plotted on the patients' three-dimensional volumetric magnetic resonance imaging data and compared with direct electrical cortical stimulation at surgery with the patient under local anesthesia. RESULTS: Stereotactic TMS was well tolerated by both patients and was consistent with known somatotopic representation of human motor cortex. The results demonstrated a good correlation between the TMS and electrical cortical stimulation maps, with all TMS responses eliciting more than 75% of the maximum motor evoked potential falling within 1 cm of the electrical cortical stimulation site. CONCLUSIONS: Our findings indicate that stereotactic TMS is feasible and can provide accurate noninvasive localization of cortical motor function. It may prove to be a useful method for presurgical planning.

Adult↗

PubMed1997

Functional magnetic resonance imaging and transcranial magnetic stimulation: complementary approaches in the evaluation of cortical motor function.

Functional magnetic resonance imaging (fMRI) and transcranial magnetic stimulation (TMS) represent different approaches to mapping the motor cortex. fMRI identifies areas of hemodynamic changes during task performance while TMS provides electrophysiologic data concerning the localization and density of cortical motoneurons. Here we define the spatial correlation between fMRI and TMS maps and compared them with direct electrical cortical stimulation (ECS). We performed fMRI at 1.5 T on 3 normal subjects and 2 patients with mass lesions near the central sulcus using a multislice, asymmetric, spin-echo, echo-planar pulse sequence during the performance of a motor task. We also performed focal TMS with surface EMG recordings from the muscles primarily involved in the fMRI task. We coregistered the stimulation sites in real time with the fMRI maps using a frameless stereotactic system. In both patients we also performed ECS of the cortex during surgery under local anesthesia. fMRI maps were validated by the electrophysiologic data both pre- and intraoperatively. Our results suggest that regions of fMRI activation correspond spatially to areas of highest motoneuron density as demonstrated by electrophysiologic techniques.

Adult↗

PubMedDate not supplied

MR blood oxygenation level-dependent signal differences in parenchymal and large draining vessels: implications for functional MR imaging.

BACKGROUND AND PURPOSE: One major limitation of current functional MR (fMR) imaging is its inability to clarify the relationship between sites of cortical neuronal activation, small parenchymal venules that are in close proximity to these sites, and large draining veins distant from the active parenchyma. We propose to use gradient-echo blood oxygenation level-dependent (BOLD) fMR time courses to differentiate large draining veins from parenchymal microvasculature. METHODS: In eight research subjects, five of whom presented with space-occupying lesions near the central sulcus, gradient-echo fMR imaging was performed during alternating periods of rest and motor activation. MR signal time courses from parenchymal regions and draining veins of different diameters, which were identified using contrast-enhanced T1-weighted scans, were evaluated. Percent signal changes (deltaS) and the time to the onset of MR signal rise (T0) were calculated. RESULTS: Mean delta(S) for all subjects was 2.3% (SD+/-0.7%) for parenchymal activation, 4.3% (SD +1.0%) for sulcal macrovasculature, and 7.3 (SD+/-1.1%) for large superficial bridging veins. The mean time to onset of MR signal increase was 4.4 seconds for parenchymal task-related hemodynamic changes and 6.6 seconds for venous hemodynamic changes, regardless of vessel size. Both the differences in delta(S) and T0 were statistically significant between venous and parenchymal activation (P < .0001). CONCLUSION: Gradient-echo fMR imaging reveals hemodynamic task-related changes regardless of vessel size and therefore might show macrovascular changes distal to the site of neuronal activity. MR-signal time-course characteristics (delta(S) and T0) can be used to differentiate between small parenchymal and larger pial draining vessels, which is especially important in presurgical planning of neurosurgical procedures involving functionally important brain regions. The knowledge about the differences in (delta)S and T0 between micro- and macrovasculature might lead to a more accurate description of the spatial distribution of underlying neuronal activity.

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