Real‐time presurgical resting‐state fMRI in patients with brain tumors: Quality control and comparison with task‐fMRI and intraoperative mapping

Resting‐state functional magnetic resonance imaging (rsfMRI) is a promising task‐free functional imaging approach, which may complement or replace task‐based fMRI (tfMRI) in patients who have difficulties performing required tasks. However, rsfMRI is highly sensitive to head movement and physiological noise, and validation relative to tfMRI and intraoperative electrocortical mapping is still necessary. In this study, we investigate (a) the feasibility of real‐time rsfMRI for presurgical mapping of eloquent networks with monitoring of data quality in patients with brain tumors and (b) rsfMRI localization of eloquent cortex compared with tfMRI and intraoperative electrocortical stimulation (ECS) in retrospective analysis. Five brain tumor patients were studied with rsfMRI and tfMRI on a clinical 3T scanner using MultiBand(8)‐echo planar imaging (EPI) with repetition time: 400 ms. Moving‐averaged sliding‐window correlation analysis with regression of motion parameters and signals from white matter and cerebrospinal fluid was used to map sensorimotor and language resting‐state networks. Data quality monitoring enabled rapid optimization of scan protocols, early identification of task noncompliance, and head movement‐related false‐positive connectivity to determine scan continuation or repetition. Sensorimotor and language resting‐state networks were identifiable within 1 min of scan time. The Euclidean distance between ECS and rsfMRI connectivity and task‐activation in motor cortex, Broca's, and Wernicke's areas was 5–10 mm, with the exception of discordant rsfMRI and ECS localization of Wernicke's area in one patient due to possible cortical reorganization and/or altered neurovascular coupling. This study demonstrates the potential of real‐time high‐speed rsfMRI for presurgical mapping of eloquent cortex with real‐time data quality control, and clinically acceptable concordance of rsfMRI with tfMRI and ECS localization.