• Elena De Martin, Dunja Duran, Francesco Ghielmetti, Elisa Visani, Domenico Aquino, Marcello Marchetti, Sebastiano Davide Rossi DR Department of Neurophysiology, Foundation Carlo Besta Neurological Institute IRCCS, Milan, Italy., Davide Cusumano, Maria Grazia Bruzzone, Ferruccio Panzica, and Laura Fariselli.
• Health Department, Foundation Carlo Besta Neurological Institute IRCCS, Milan, Italy.
• World Neurosurg. 2017 Dec 1; 108: 756-762.

ObjectiveMagnetoencephalography (MEG) and functional magnetic resonance imaging (fMRI) provide noninvasive localization of eloquent brain areas for presurgical planning. The aim of this study is the integration of MEG and fMRI maps into a CyberKnife (CK) system to optimize dose planning.MethodsFour patients with brain metastases in the motor area underwent functional imaging study of the hand motor cortex before 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 for treatment planning optimization.ResultsThe 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 a DICOM standard, to make sure that it was readable by our CK treatment planning system. Inclusion of the activation areas into the optimization plan allowed the creation of treatment plans that reduced the irradiation of the motor cortex yet not affecting the brain peripheral dose.ConclusionsThe availability of advanced neuroimaging techniques is playing an increasingly important role in radiosurgical planning strategy. We successfully imported MEG and fMRI activations into a CK system. This additional information can improve dose sparing of eloquent areas, allowing a more comprehensive investigation of the related dose-volume constraints that in theory could translate into a gain in tumor local control, and a reduction of neurological complications.Copyright © 2017 Elsevier Inc. All rights reserved.

31 keywords...

hide…