of critical brain areas may vary among patients, emphasizing the need for an
individualized presurgical imaging assessment.^44 Functional neuroimaging tech-
niques (FNT) allow for noninvasive brain mapping that visualizes a specific
individual’s localization of areas of eloquence and the accurate proximity of a
nearby tumor.^45 Functional magnetic resonance imaging (fMRI) and diffusion
tensor imaging (DTI) are among the most widely used FNTs. fMRI offers pre-
and intrasurgical prediction of functional cortical areas.^46 Patients who typically
undergo preoperative fMRI can be divided into three groups: (a) patients with
structural brain lesions in close proximity to the eloquent cortex who need preop-
erative risk assessment, (b) patients who need the determination of preoperative
language hemispheric lateralization—this group specifically emphasizes the need
for a personalized approach, and (c) patients with epilepsy needing preoperative
seizure focus localization.^47 DTI is a noninvasive technique that allows in vivo
assessment of white matter tracts (WMTs).^48 The goal of DTI in the case of cerebral
neoplasm resection is to determine the proportion of WMTs alteration due to tumor
invasion. If WMTs are according to DTI measurements only displaced and intact,
such WMTs have to be preserved during resection. In the case of WMTs that are
identified as destroyed or disrupted by using DTI, no special care has to be taken
during resection in order to preserve them.^49 Data obtained from DTI as a technique
for delineation of eloquent WMTs and fMRI for the definition of relevant cortical
areas are nowadays integrated into neuronavigation systems providing distinctive
anatomical details about individual patients. Imaging is also used to guide inter-
ventional procedures. Given frequent histologic heterogeneity of tumors, adequate
sampling provides accurate diagnosis.
Molecular imaging can be used to guide biopsy needle to the specific part of the
tumor with higher concentration of biomarkers. Imaging provides essential
roadmaps for treatment planning and enables minimally invasive image-guided
interventions.^50 Imaging is mandatory when personalized therapy needs to be
delivered at the specific site of the body. Supraselective catheterization of different
vascular networks is well established, enabling delivery of regional chemotherapy/
chemoembolization and gene therapy. When cells are used to deliver a therapeutic
gene, local activation within a specific organ or tissue has to be rigorously con-
trolled. Focal heat deposition via focused ultrasonography as a noninvasive method
to control transgene expression could be monitored by the use of MRI thermome-
try.^51 In the future, rapidly evolving imaging modalities will be more frequently
(^44) Hricak et al. ( 2004 ).
(^45) Burgel et al. ( 2006 ).
(^46) Nicolaidis ( 2013 ).
(^47) Brodbelt ( 2011 ).
(^48) Pillai ( 2010 ).
(^49) Jellison et al. ( 2004 ).
(^50) Abdel Razek et al. ( 2007 ).
(^51) Smits et al. ( 2007 ).
The Role of Radiology in Personalized Medicine 227