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