Figure 3

A patient known to have breast cancer with a manually dexterous job presented with intermittent left hand and arm weakness and was found (A) to have a solitary ring enhancing lesion in the premotor area on T1W MRI with gadolinium. (B) functional MRI performing a hand tapping and gripping task determined the location of hand function and this was used as the “seed” region of interest on a DTI scan to produce a representation of the motor tracts. (C) these were used to generate a 3D object and fused with an anatomical planning scan (1 mm slices) using commercially available software (StealthViz™ with StealthDTI™ by Medtronic, running on an S7 workstation) to produce images that were used intraoperatively for image guided resection, avoiding the tracts (shown in red, with tumour rendered in green).