Abstract
Functional magnetic resonance imaging (fMRI) is an important tool for pre-surgical evaluation of eloquent cortex. Classic task-based paradigms require patient participation and individual imaging sequence acquisitions for each functional domain that is being assessed. Resting state fMRI (rs-fMRI), however, enables functional localization without patient participation and can evaluate numerous functional domains with a single imaging session. To date, post-processing of this resting state data has been resource intensive, which limits its widespread application for routine clinical use. Through a novel automated algorithm and advanced imaging IT structure, we report the clinical application and the large-scale integration of rs-fMRI into routine neurosurgical practice. One hundred and ninety one consecutive patients underwent a 3T rs-fMRI, 83 of whom also underwent both motor and language task-based fMRI. Data were processed using a novel, automated, multi-layer perceptron algorithm and integrated into stereotactic navigation using a streamlined IT imaging pipeline. One hundred eighty-five studies were performed for intracranial neoplasm, 14 for refractory epilepsy and 33 for vascular malformations or other neurological disorders. Failure rate of rs-fMRI of 13% was significantly better than that for task-based fMRI (38.5%,) (p <0.001). In conclusion, at Washington University in St. Louis, rs-fMRI has become an integral part of standard imaging for neurosurgical planning. Resting state fMRI can be used in all patients, and due to its lower failure rate than task-based fMRI, it is useful for patients who are unable to cooperate with task-based studies.
Highlights
Striking the correct balance between aggressive resection and functional preservation has been an ongoing dynamic in neurosurgery
Task-based Functional magnetic resonance imaging (fMRI) can be associated with a high failure rate in populations that cannot comply with task paradigms
One can generate resting-state correlation maps that are similar to the functional maps obtained from task activations[8]. rsfMRI is highly efficient: multiple resting state networks (RSNs), can be mapped simultaneously with a single imaging session lasting less than fifteen minutes[9]
Summary
Striking the correct balance between aggressive resection and functional preservation has been an ongoing dynamic in neurosurgery. Task-based functional magnetic resonance imaging (fMRI) has become a useful adjunct for pre-surgical planning[5]. Each function must be individually mapped, making the mapping paradigms lengthy. These limitations are eliminated by the use of resting state functional magnetic resonance imaging (rsfMRI). This approach uses the endogenous brain activity detectable with blood oxygen level dependent (BOLD) MRI to identify areas that are interacting at rest[6]. One can generate resting-state correlation maps that are similar to the functional maps obtained from task activations[8]. The imaging can be performed under sedation/anesthesia without compromise of the functional localization[10]
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