Integration of resting state functional MRI into clinical practice - A large single institution experience.

PLoS One. 2018;13(6):e0198349

Authors: Leuthardt EC, Guzman G, Bandt SK, Hacker C, Vellimana AK, Limbrick D, Milchenko M, Lamontagne P, Speidel B, Roland J, Miller-Thomas M, Snyder AZ, Marcus D, Shimony J, Benzinger TLS

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.

PMID: 29933375 [PubMed - in process]