Rater-dependent accuracy in predicting the spatial location of functional centers on anatomical MR images

Objectives The determination of eloquent cortex is essential when planning neurosurgical approaches to brain lesions. This study examined the abilities of medical personnel of various backgrounds to predict the location of functional cortex using anatomical information provided by MR imaging. Patients and methods Neurosurgeons, neuroscientists, neuroradiologists, medical students and MR technologists viewed anatomical MR images acquired from patients with brain tumors and healthy controls. These five groups of raters were then asked to locate the primary motor hand, supplementary motor and primary auditory areas and their predictions were compared to fMRI data acquired from the same subjects. Results The overall mean distance from the center of the fMRI activation was 2.38 cm. The neuroscientists performed the best and MR technologists performed the worst (mean distance from center of 1.83 and 3.04 cm, respectively, p < 0.05). The difference between patients and controls was not significant. The mean distance by ROI was primary motor hand 2.03 cm, auditory area 2.06 cm and supplementary motor area 3.18 cm (p < 0.05). Raters also performed best in the medial–lateral direction, compared to superior–inferior and anterior–posterior directions (mean distances from center 0.42, 1.04 and 1.81 cm, respectively). Finally, the approximate minimum fields of view necessary to capture the entire fMRI activations using the raters’ predictions ranged from 5 to 15 cm, or 3 to 12 cm larger than the fMRI activations. Conclusion Medical personnel of various training perform poorly when using only anatomical information to predict the location of functional areas of cortex.