Fig. 2 Tumor tracing, modeling, and optimization.

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Fig. 2 Tumor tracing, modeling, and optimization. Tumor tracing, modeling, and optimization. (A) MRI images were manually segmented by two independent investigators. Following the Response Assessment in Neuro-Oncology recommendations, the solid part (red) of the tumor (GBM in this example) as well as the necrotic core (blue) were identified on CET1w images. The edema (green) of the tissue surrounding the tumor was segmented using FLAIR images. In the postsurgery phase, T2 Turbo Spin Echo (TSE) scans were used to correctly identify the vacuum created by the surgical intervention. ROIs were manually segmented on the corresponding anatomical scan using MRIcro software and 3D Slicer. ROIs were concentric, with the edema ROI usually including both solid and necrotic parts, while the solid tumor ROI included the necrotic one, such as currently done for planning of radiation therapy. (B) Top: Conductivity values were assigned to each ROIs as well as to healthy brain tissue according to existing literature: gray matter (GM) and white matter (WM), cerebrospinal fluid (CSF), skin, and skull. Bottom: A multielectrode solution maximizing stimulation over the edema-solid tumor interface was identified for each patient, with the corresponding E-field distribution calculated on patients’ head models. Resulting E-field was overlaid onto individual anatomical T1w scans, showing specificity of the tES solution targeting the solid tumor (C). (D) In detail, the T1w MRI of the participant was segmented into multiple tissue classes using MARS, SPM-8 segmentation toolbox, and FreeSurfer (left). Models of PITRODE electrodes (cylinders, 1-cm radius) were placed on scalp positions corresponding to the international 10/10 electroencephalography (EEG) system (green circles, center). A genetic algorithm [Stimweaver (12)] was then used to estimate the best multielectrode solution among those possible using 32 positions on the scalp (center), with the final personalized tES montage including up to eight electrodes placed over the hemisphere ipsilateral to the tumor (right). Note: All images are presented in neurological convention (right = right). G. Sprugnoli et al. Sci Adv 2019;5:eaau9309 Copyright © 2019 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works. Distributed under a Creative Commons Attribution NonCommercial License 4.0 (CC BY-NC).