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RESEARCH PERSPECTIVES

Brain Mapping Project: Clinical Aspects and Role of

L.M. Levy

ABSTRACT SUMMARY: As experts in the realm of applying imaging technology for meaningful information on an individual patient’s medical care, neuroradiologists can provide a physiologic, pathophysiologic, and clinical context for the advances achieved from brain-mapping. Precise identification of the abnormalities involved in brain conditions resulting from a multidisciplinary effort including neuroradiology will help to further define the nature of the pathology, evaluate the results of therapy, and improve health care.

rain mapping generally involves the study of the and diagnosis, and clinical management of normal brain function and Bfunction of the brain and with imaging. It incor- neurologic conditions, with studies extending from the macro to porates many approaches, ranging from , neuro- the micro and nano levels. surgical intraoperative procedures (microscopic, endoscopic, and Alterations of brain function levels have already been related multitechnique imaging), immunohistochemistry, molecular to the pathophysiology of a number of neurologic conditions, and ontogenetic studies, and cellular biology, engineer- including tumors, stroke, dementias, trauma, , ing disciplines (material, electrical, and biomedical), and neuro- movement disorders, epilepsy, demyelinating , neuro- to .1 The synergy of these disciplines metabolic , migraine, abuse, and neuroendocrine will provide improved understanding of the as diseases. Conventional anatomic imaging methods such as CT or viewed from each of these complementary perspectives. MR imaging have not proved sufficient in the evaluation of these The mechanisms by which the brain functions and neurons disorders. The corollary goals of this project include the develop- are interconnected are of paramount importance and usefulness ment, improvement, and validation of novel treatment and imag- both for clinical applications and as inspiration for novel technol- ing techniques. ogies. To date, advances in brain mapping have considerably Brain mapping information can provide clinicians with a aided in understanding, diagnosing, and treating various neuro- powerful tool to evaluate and serially follow diseases. Measure- logic conditions. For example, mapping the location of important ments of certain cerebral markers, such as the neurotransmit- brain regions such as language and motor function by using neu- ters that mediate brain function, can permit quantitative as- roimaging can help neurosurgeons accurately pinpoint important sessment of disease progression with time and drug-mediated and diseased regions of the brain to minimize resection of vital, effects. These markers can also be used to detect specific dis- functioning regions during . Knowledge of how the eases such as Alzheimer disease and to evaluate disease pro- brain is wired and can become rewired is still evolving and can be gression and treatment response. They may also allow the de- of use in understanding how it functions and recovers following velopment of entirely novel approaches to treatment that are disease, injury, or surgery. rational, on the basis of the findings of these studies. Early However, mapping brain function only is not enough; we need detection of these neurologic conditions would provide a to define the normal and abnormal functions and include the greater chance for appropriate and timely treatment of patients related or potential therapeutic aspects. The clinical goal of brain and for delivery of better health care. These methods should mapping is to develop and use methods for the understanding, encompass new techniques for the detection, mapping, and treatment of diseases. Recent advances have the potential to From the Department of Radiology, George Washington University Medical Cen- dramatically enhance the detection of neurologic diseases with ter, Washington, DC. targeted contrast agents, for example, and to deliver focused Please address correspondence to L.M. Levy, MD, PhD, Professor of Radiology and Director of Neuroradiology, George Washington University Medical Center, Wash- therapies to the central nervous system. These developments ington, DC 20037; e-mail: [email protected] will greatly impact diagnostics and therapeutics across many http://dx.doi.org/10.3174/ajnr.A3587 medical specialties in the coming age of personalized and tar-

942 Levy May 2013 www.ajnr.org geted medicine. These effects will likely be seen in many areas, nautical), and neuroradiology, will be needed. A systematic including stem cell therapy, immunoimaging and immuno- team approach and the sharing of information and experience therapy, and will enhance pre- and intraoperative brain tumor will lead to a more efficient use of our collaboration across the characterization, nanoneurosurgery, and targeted therapeutic biologic and physical sciences and the funding of resources. As payload delivery to the nervous system. experts in the realm of applying brain imaging technology for A brain mapping project or roadmap should include the de- meaningful information on an individual patient’s medical velopment of data bases and methods to evaluate the following: care, neuroradiologists can provide a physiologic, pathophys- 1) How the brain is wired or connected. iologic, and clinical context for the advances achieved from 2) How the brain functions and processes information. brain mapping. Precise identification of the abnormalities in- 3) How different neurologic conditions are related to connec- volved in brain conditions resulting from a multidisciplinary tivity patterns. effort, including neuroradiology, will help to further define the 4) How neurologic conditions are related to brain function nature of the pathology, evaluate the results of therapy, and patterns. improve health care. In addition, the technologies employed 5) How brain structure and function are related to various and the findings of these studies may have applications beyond types of therapies. the clinical realm. 6) How to detect brain disorders. 7) How to evaluate disease progression and results of ACKNOWLEDGMENTS treatment. I thank the members of the Society for Brain Mapping and Ther- Determination of brain connectivity and functional profiles will apeutics (especially Dr B. Kateb) for their effort in building mul- enable us to further evaluate changes associated with pathology or tidisciplinary groups to complement the work already done by treatment and to follow progression of disease or response to other societies and research institutes. therapy. For this endeavor, a systematic organization of effective teams, involving a wide spectrum of specialties, including neu- REFERENCE roscience, , , neurosurgery, engi- 1. Kateb B, Heiss JD, eds. The Textbook of Nanoscience and Nanoneuro- neering (including material, biomedical, electrical, and aero- surgery. CRC Press, Taylor & Francis Group LLC; 2013

AJNR Am J Neuroradiol 34:942–43 May 2013 www.ajnr.org 943