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Identifying the Central Sulcus in Patients With Intra-axial Lesions: A Multicenter Study Comparing Conventional Presurgical MRI to Topographical Analysis and BOLD-fMRI

Due-Tonnessen, Paulina MD*†; Rasmussen, Inge MD, PhD†‡; Berntsen, Erik Magnus MD, PhD§; Bjornerud, Atle PhD†∥; Emblem, Kyrre E. PhD

Journal of Computer Assisted Tomography:
doi: 10.1097/RCT.0b013e3182a589e0

Objectives: Identification of eloquent brain areas in patients with intra-axial lesions is important to minimize the risk of neurological deficit. We performed a multicenter study comparing conventional 2-dimensional magnetic resonance imaging (MRI) for identification of the central sulcus to topographical MRI and blood-oxygenation-level-dependent functional MRI (BOLD-fMRI).

Methods: Seventy-seven unoperated patients with brain lesions were imaged at 1.5 or 3 T. The central sulcus was identified by an experienced neuroradiologist on 2-dimensional MRI, by topographic analysis of 3-dimensional MRI in BrainVoyager, and by BOLD-fMRI analysis in BrainVoyager or SPM5.

Results: The central sulcus in the affected hemisphere was readily identified in a significantly higher percentage of patients by 2-dimensional MRI and topographical analysis (77/77 patients) compared to BOLD-fMRI (57 patients; P < 0.001). The topographical analysis identified a significantly larger portion of the total central sulcus than 2-dimensional MRI (P < 0.05). No differences were found between institutions, histological versus radiological diagnoses, MRI sequence parameters, age, or sex.

Conclusions: Identification of the central sulcus is best performed using topographical analysis; however, 2-dimensional analysis may suffice for daily routine work.

Author Information

From the *Department of Radiology, and †Intervention Centre, Clinic for Imaging and Intervention, Oslo University Hospital, Rikshospitalet; ‡Institute of Psychology, University of Oslo, Oslo; §Department of Radiology, Clinic of Radiology and Nuclear Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim; and ∥Institute of Physics, University of Oslo, Oslo, Norway.

Received for publication April 24, 2013; accepted July 16, 2013.

Reprints: Paulina Due-Tonnessen, MD, Department of Radiology, Clinic for Imaging and Intervention, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, N-0027 Oslo, Norway (e-mail:

This work was funded by South-Eastern Norway Regional Health Authority Grant 2336 (P.D.T. and I.R.), Norwegian Research Council Grant 177867/V50 (A.B. and K.E.E.), and Norwegian Research Council Grant 191088/F20 (A.B. and K.E.E.).

© 2014 by Lippincott Williams & Wilkins