article · Neuroradiology
Presurgical functional mapping helps surgeons maximise tumour removal while protecting essential motor and language capabilities. Standard task-based functional magnetic resonance imaging requires active patient compliance, which is challenging for individuals experiencing aphasia, paresis, or cognitive deficits. Resting-state functional magnetic resonance imaging provides a task-free alternative. A prospective study evaluated twelve patients with confirmed brain tumours using both techniques to map sensorimotor and language regions. Motor assessment used finger tapping, while language evaluation used word generation, rhyming, and synonym paradigms. Resting-state scans showed fair to moderate spatial agreement with task-based mapping, achieving high specificity between 0.93 and 0.94, alongside moderate sensitivity near 0.62. The task-free method also showed superior signal stability, with significantly fewer motion-censored volumes during language assessments. Although moderate sensitivity means some critical functional regions could be missed, resting-state imaging offers a valuable component for multimodal surgical planning.
Brain tumour surgery requires accurate localisation of speech and movement areas to avoid permanent disability. Standard presurgical scans require patients to complete difficult tasks during imaging, excluding many cognitively or physically impaired individuals. Confirming that task-free scanning can reliably identify key functional zones helps expand safe presurgical planning to vulnerable patients who cannot complete traditional active tests.
This approach applies to clinical presurgical planning tools and neuroimaging software used by neurosurgeons, neuro-oncologists, and neuroradiologists. Based on this preliminary single-centre study of twelve patients, the methodology represents early-stage research. Commercial translation requires larger trials and integration into multimodal imaging platforms before it can be adopted safely into clinical practice.
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PURPOSE: Presurgical functional mapping is essential for maximizing tumor resection while preserving motor and language function. While task-based fMRI (tb-fMRI) is the current non-invasive standard, its utility is substantially limited in patients with aphasia, paresis, or cognitive impairment who cannot comply with active paradigms. Resting-state fMRI (rs-fMRI) offers a task-free alternative, yet its spatial fidelity and clinical validity compared to task-based methods remain under rigorous evaluation. METHODS: In this prospective study, we evaluated 12 patients with histologically confirmed brain tumors who underwent rs-fMRI and tb-fMRI for preoperative sensorimotor and language mapping. Motor mapping utilized a bilateral finger tapping block-design paradigm. Language mapping utilized three distinct task paradigms (Silent Word Generation, Rhyming, and Synonym). Spatial concordance was quantified using Dice Similarity Coefficients (DSC), Jaccard Indices, and Receiver Operating Characteristic (ROC) analysis. RESULTS: rs-fMRI demonstrated fair to moderate spatial concordance with tb-fMRI. For motor mapping, the mean DSC was 0.62 ± 0.08 with high specificity (0.93 ± 0.02). In the language domain, rs-fMRI showed the highest concordance with the Silent Word Generation task (DSC 0.63 ± 0.11). Notably, rs-fMRI exhibited superior signal stability, with significantly fewer motion-censored volumes compared to language task paradigms (p < 0.01). While rs-fMRI demonstrated moderate sensitivity (~ 0.62), it achieved high specificity (0.93-0.94) across all domains however the moderate sensitivity indicates that functionally important regions may remain undetected. CONCLUSIONS: In this preliminary single-center study, rs-fMRI demonstrates fair to moderate spatial concordance with tb-fMRI and high specificity in delineating core eloquent cortex, though with moderate sensitivity that may leave functionally important regions undetected. The study provides hypothesis-generating evidence supporting the integration of rs-fMRI into multimodal presurgical workflows for neuro-oncology patients who cannot comply with task-based paradigms.
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DOI: 10.1007/s00234-026-04174-7
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