Clinical functional magnetic resonance imaging for pre-surgical planning--the Singapore General Hospital experience with the first 30 patients

<p><b>INTRODUCTION</b>Functional magnetic resonance imaging (fMRI) is a neuroradiological technique for the localisation of cortical function. FMRI made its debut in cognitive neuroscience and then eventually to other clinical applications. We report our experience with pre-surgical fMRI on a high field scanner, based purely on a clinical platform.</p><p><b>MATERIALS AND METHODS</b>The protocols included motor, auditory, visual and language fMRI. The choice of protocols was dependant on clinical request and lesion locale.</p><p><b>RESULTS</b>Retrospective analysis and audit of the fi rst 30 consecutive patients over a 12-month period revealed that about 85% of patients had a successful examination. In a pictorial essay, we demonstrate that patients with weakness in performing a motor task showed abnormal activations of the pre-motor and supplementary motor areas.</p><p><b>CONCLUSION</b>FMRI data greatly enhances the pre-surgical planning process and the conduct of surgery when it is incorporated into the surgical navigation system in the operating theatre.</p>

Local experience of endorectal magnetic resonance imaging of prostate with correlation to radical prostatectomy specimens

<p><b>INTRODUCTION</b>We evaluated the accuracy of endorectal magnetic resonance imaging (MRI) in the staging of prostate cancer.</p><p><b>MATERIALS AND METHODS</b>We retrospectively reviewed 32 patients who underwent endorectal MR prostate prior to radical prostatectomy. The tumour stage based on MR imaging was compared with the pathologic stage. The sensitivity and specificity of endorectal MR prostate in the evaluation of extracapsular extension (ECE) of the tumour were then determined.</p><p><b>RESULTS</b>MR correctly diagnosed 17 cases of organ-confined prostate carcinoma and 2 cases of locally advanced disease. In the evaluation of ECE, endorectal MR achieved a high specificity of 94.4%, low sensitivity of 14.3% and moderate accuracy of 59.4%.</p><p><b>CONCLUSION</b>Endorectal MR prostate has high specificity for the detection of ECE. It is useful in the local staging of prostate cancer in patients with intermediate risk as this helps to ensure that few patients will be deprived of potentially curative surgery.</p>