Does Functional Imaging Play a Role in Pre-Operative Diagnosis of Brain Tumours?

Although there is a large variability in the neural organization of language function between individuals, there is an ongoing debate about functional imaging as a standard procedure in the preoperative setting of brain tumors. Brain mapping of the language centers differs from individual to individual in multilingual patients and changes in its architecture may occur as a result of neuroplasticity induced by a mass lesion. This article discusses the role of functional imaging in the preoperative setting.

Endoscopic and Computed Tomography Evaluation of Posterior Glottic Closure During Phonation.

OBJECTIVES/HYPOTHESIS: The anatomy of the posterior glottis, specifically the states of the posterior glottis during phonation, has not been thoroughly explored in laryngology. Conventional wisdom about the posterior glottis indicates that it tends to be completely closed in men but may be open in women. Furthermore, professional singers are expected to have a completely closed posterior glottis. The aim of this study was to investigate whether these generalizations are true by comparing rigid videolaryngostroboscopy results with high-resolution computed tomography (HRCT) and three-dimensional (3D) reconstruction findings. STUDY DESIGN: Prospective study. METHODS: Of the 90 volunteers (58 women, 32 men) examined, 48 were female professional singers, 10 were female nonsingers, 22 were male professional singers, and 10 were male nonsingers. Rigid videolaryngostroboscopy as well as HRCT scans were performed during singing at the average singing fundamental frequency. HRCT images of the larynx and air-column were 3D visualized using the software MIMICS®. The states of the posterior glottis were assessed in both examinations and compared among participants. RESULTS: The sensitivity of endoscopy was 67.5%. Complete closure of the posterior glottis was observed in 62.5% men and 52% women (P = .33). Complete closure of the posterior glottis was observed in 35% nonsingers and 61% professional singers (P = .036). CONCLUSIONS: The closure of the posterior glottis seen on videolaryngostroboscopy does not always correlate with actual closure. There seems to be no link between sex and complete closure of the glottis. However, there is strong evidence that posterior glottis closure can be influenced, to some degree, by vocal training. LEVEL OF EVIDENCE: 4 Laryngoscope, 132:124-129, 2022.

Imaging of Primary Brain Tumors and Metastases with Fast Quantitative 3-Dimensional Magnetization Transfer.

BACKGROUND AND PURPOSE: This study assesses whether magnetization transfer (MT) imaging provides additive information to conventional MRI in brain tumors. METHODS: MT data of 26 patients with neoplastic and metastatic brain tumors were analyzed at 1.5 T. For the 3 largest tumor groups investigated in this study--glioblastoma multiforme (GBM), meningiomas, and metastases-statistical comparisons were performed. Analyzed MT parameters included the magnetization transfer ratio (MTR) and 4 quantitative MT parameters (qMT): Relaxation times (T1, T2), exchange rate (kf), and macromolecular content (F). Total imaging time of high-resolution whole brain MTR and qMT imaging with balanced steady-state free precession required 9 minutes. Five ROIs were chosen: Contrast-enhancing (T1W-CE), noncontrast-enhancing (T1W-non-CE), proximal hyperintensity (T2W-pSI), distal hyperintensity (T2W-dSI), and a reference (ref). RESULTS: Pathologies showed significant (P < .05) MT changes (MTR and qMT) compared to the reference. The T1W-CE, T1W-non-CE, and T2W-pSI ROIs of GBMs, meningiomas, and metastases showed significant differences in MTR and qMT estimates. Similar MTR with significant different qMT values were observed in several ROIs among different lesions. MT maps (MTR and qMT) indicated changes in tissue appearing unaffected on MRI in most glial tumors. CONCLUSIONS: MTR and qMT imaging enables a better differentiation between brain tumors and provides additive information to MRI.