Rationale and Objectives
Task-evoked functional MRI (fMRI) has been used successfully in the study of brain function and clinically for presurgical localization of eloquent brain regions prior to the performance of brain surgery. This method requires patient cooperation and is not useful in young children or if the patient has cognitive dysfunction or physical impairment. An alternative method that can overcome some of these disadvantages measures the intrinsic function of the brain using resting-state fMRI. This method does not require any task performance and measures the spontaneous low-frequency (<0.1 Hz) fluctuations of the fMRI signal over time. Our objective in the present work is to provide preliminary information on the possible clinical utility of this technique for presurgical planning and on possible future applications.
Materials and Methods
Data from prior fMRI resting-state studies were reviewed for their potential use in preoperative mapping. Structural and resting-state fMRI data from normal subjects and patients with brain tumors were preprocessed and seed regions were placed in key regions of the brain; the related functional networks were identified using correlation analysis.
Results
Several key functional networks can be identified in patients with brain tumors from resting-state fMRI data.
Conclusion
Resting-state fMRI data can provide valuable presurgical information in many patients who cannot benefit from traditional task-based fMRI. Adoption of this method has the potential to improve individualized patient-centered care.
Blood oxygen level–dependent (BOLD) functional magnetic resonance imaging (fMRI) measures neuronal activity using the ratio of oxyhemoglobin to deoxyhemoglobin as a contrast mechanism. In a typical application, the patient alternates between a passive resting state and performing a task, such as finger tapping, that activates a region of interest in the cerebral cortex. During these periods, the BOLD signal is measured in the magnetic resonance scanner, and the two images are subtracted from each other to reveal areas of the brain that were activated during the prescribed task ( Fig 1 A ). This technique has been an invaluable research tool in the laboratory and has helped increase our understanding of normal and abnormal brain function. Clinical applications of fMRI have focused on localizing areas of critical function for presurgical planning . The accurate localization of eloquent cortex (eg, somatomotor, language) in relation to a tumor mass can help optimize resection and minimize morbidity and mortality. Functional foci identified using fMRI have been shown to correlate well with foci identified using more invasive techniques, such as intraoperative electrophysiology and Wada testing . Furthermore, the distance from an fMRI-identified functional region to the surgical margin has been shown to correlate with loss of function postoperatively . Although there is much accumulated evidence for the benefit of fMRI use in presurgical planning, large-scale studies to demonstrate improved patient outcomes have not been performed.
Open full size image
Figure 1
The blood oxygen level–dependent (BOLD) signal during task-based functional magnetic resonance imaging (fMRI) (a) and during intrinsic resting-state fMRI (b) . (a) The subject focused on a flickering checkerboard pattern that was periodically turned on and off. The measurement was made in the V1 region of the visual cortex (red circle) . Ongoing spontaneous fluctuations can be seen in this task paradigm. (b) Spontaneous fluctuations from two regions of the dorsal attention system. The regions are the intraparietal sulcus (IPS) and the frontal eye fields (FEF) (red circles) . The two time curves demonstrate a high degree of correlation ( r = 0.60).
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Spontaneous bold fluctuation fMRI
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Assessing a new fMRI paradigm
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Conclusions
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Acknowledgment
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