Male, 54 years old, left handed, with history of progressive brain tumor, presenting with weakness and headache, functional MRI and Stealth MRI requested for surgical planning. Motor cortical activation of the hand is weakly visualized bilaterally along the precentral gyri. On the right, this area of activation falls between two areas of pathologic enhancement which straddle the central sulcus involving both the pre- and postcentral gyri.Motor cortical activation of the feet maps as expected at the medial aspect of the central sulci. Likewise, facial motor cortical activation maps as expected along the inferior lateral extent of the central sulci. Please note that on the hand motor and foot motor paradigms, there is a band of likely artifactual activation centered on the left post central sulcus.On passive visual stimulation, cortical activation is seen along the calcarine sulcus on the left, but is conspicuously absent on the right. This may reflect tumor related disruption of the right optic radiations. Given the patient's left handedness, several language paradigms were also employed. Language is left dominant with Broca's and Wernicke's areas identified in their customary locations.Stealth MRI findings:Evidence of prior right parietotemporal craniotomy is again seen. An irregularly marginated rim-enhancing lesion is present centered on the right mesial temporal lobe. This lesion shows no significant interval change from the immediate prior study. More superiorly, and discontiguous with the mesial temporal lesion, there is a large irregularly marginated enhancing lesion centered on the right parietal white matter with extension into the pre- and postcentral gyri and more posteriorly into the superior parietal lobule. This lesion has increased very slightly in size. Extensive T2 hyperintensity and associated mass effect are again seen involving the right parietal and right temporal lobes showing some slight progression as well.Please note that the size of any given region of activation on BOLD fMRI is dependent upon the specific task performed and statistical thresholding. The size of the actual functional domain may be larger or smaller than that shown on color map images.
1. Weak motor cortical activation of the left hand is visualized along the right central sulcus, situated in between two projections of presumed infiltrative tumor which straddle the central sulcus and involve both the precentral and postcentral gyri. Foot motor cortical activation is situated at the medial extent of the T2 signal abnormality. Language is left dominant.2. Stealth MRI imaging demonstrates interval stability of the enhancing lesion centered on the right mesial temporal lobe. However, the irregularly marginated enhancing lesion centered on the right parietal white matter has slightly increased in size.