Treatment planning with corticospinal tract

BOLD fMRI information has been integrated into radiation treatment planning to identify and avoid the eloquent cortices adjacent to a brain tumor. However, BOLD fMRI is essentially restricted to locate the activation in the cortical area. The white matter appears to be more susceptible to damage during the treatment by the radiation. In order to limit consequences of radiation treatment to motor activity, it is important to limit exposure to the corticospinal track. The authors present a novel technique in radiation treatment planning, which utilizes both BOLD fMRI and its corticospinal track maps. This technique allows one to limit exposure to both the motor cortex and the corticospinal tracks during radiation treatment by identifying the former using BOLD fMRI and the latter by diffusion study. It is concluded that, in order to better preserve the motor system, it is essential that both BOLD fMRI and corticospinal track maps be used together. It is hoped that decreased radiation exposure to the corticospinal track will lead to decreased complications in the motor system. The treatment plan may be more difficult to design with both maps, since more restrictions are applied