Abstract
BackgroundTask-based functional MRI (tb-fMRI) is a well-established technique used to identify eloquent cortex, but has limitations, particularly in cognitively impaired patients who cannot perform language paradigms. Resting-state functional MRI (rs-fMRI) is a potential alternative modality for presurgical mapping of language networks that does not require task performance. The purpose of our study is to determine the utility of rs-fMRI for clinical preoperative language mapping when tb-fMRI is limited.MethodsWe retrospectively reviewed 134 brain tumor patients who underwent preoperative fMRI language mapping. rs-fMRI was post-processed with seed-based correlation (SBC) analysis, when language tb-fMRI was limited. Two neuroradiologists reviewed both the tb-fMRI and rs-fMRI results. Six neurosurgeons retrospectively rated the usefulness of rs-fMRI for language mapping in their patients.ResultsOf the 134 patients, 49 cases had limited tb-fMRI and rs-fMRI was post-processed. Two neuroradiologists found rs-fMRI beneficial for functional language mapping in 41(84%) and 43 (88%) cases respectively; Cohen’s kappa is 0.83, with a 95% confidence interval (0.61, 1.00). The neurosurgeons found rs-fMRI “definitely” useful in 26 cases (60%) and “somewhat” useful in 13 cases (30%) in locating potential eloquent language centers of clinical interest. Six unsuccessful rs-fMRI cases were due to: head motion (2 cases), nonspecific functionality connectivity outside the posterior language network (1 case), and an unknown system instability (3 cases).ConclusionsThis study is a proof of concept that shows SBC rs-fMRI may be a viable alternative for clinical language mapping when tb-fMRI is limited.
Highlights
Task-based functional MRI is a well-established technique used to identify eloquent cortex, but has limitations, in cognitively impaired patients who cannot perform language paradigms
Functional MRI is a well-known modality often used in neurosurgical oncology for preoperative planning to facilitate safe, maximal surgical resection of tumors located in eloquent brain areas, including those in language areas [1, 2]
Causes of limited Task-based functional MRI (tb-Functional MRI (fMRI)) Of the 134 patients with brain tumors who were evaluated for preoperative fMRI language mapping, 85 had successful tb-fMRI results and 49 had limited tb-fMRI results
Summary
Task-based functional MRI (tb-fMRI) is a well-established technique used to identify eloquent cortex, but has limitations, in cognitively impaired patients who cannot perform language paradigms. Restingstate functional MRI (rs-fMRI) is a potential alternative modality for presurgical mapping of language networks that does not require task performance. Tie et al showed in healthy right-handed individuals, that language networks obtained from rs-fMRI revealed highly similar overlap with language networks obtained from tb-fMRI, especially in the left frontal and temporal/ parietal regions [6]. These results were reproduced in patients with brain tumors and epilepsy [7]. Rosazza et al [8] reported a significant correlation of the results of rs-fMRI seed-based correlation (SBC) and independent component analysis (ICA) in 40 healthy individuals
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