Moretto Manuela, Luciani Beatrice Federica, Zigiotto Luca, Saviola Francesca, Tambalo Stefano, Cabalo Donna Gift, Annicchiarico Luciano, Venturini Martina, Jovicich Jorge, Sarubbo Silvio
Center for Mind/Brain Sciences (CIMeC), University of Trento, Trento , Italy.
Department of Neurosurgery, "S. Chiara" University-Hospital, Azienda Provinciale per i Servizi Sanitari, Trento , Italy.
Neurosurgery. 2024 Dec 1;95(6):1358-1368. doi: 10.1227/neu.0000000000003012. Epub 2024 Jun 5.
Precise mapping of functional networks in patients with brain tumor is essential for tailoring personalized treatment strategies. Resting-state functional MRI (rs-fMRI) offers an alternative to task-based fMRI, capable of capturing multiple networks within a single acquisition, without necessitating task engagement. This study demonstrates a strong concordance between preoperative rs-fMRI maps and the gold standard intraoperative direct electric stimulation (DES) mapping during awake surgery.
We conducted an analysis involving 28 patients with glioma who underwent awake surgery with DES mapping. A total of 100 DES recordings were collected to map sensorimotor (SMN), language (LANG), visual (VIS), and speech articulation cognitive domains. Preoperative rs-fMRI maps were generated using an updated version of the ReStNeuMap software, specifically designed for rs-fMRI data preprocessing and automatic detection of 7 resting-state networks (SMN, LANG, VIS, speech articulation, default mode, frontoparietal, and visuospatial). To evaluate the agreement between these networks and those mapped with invasive cortical mapping, we computed patient-specific distances between them and intraoperative DES recordings.
Automatically detected preoperative functional networks exhibited excellent agreement with intraoperative DES recordings. When we spatially compared DES points with their corresponding networks, we found that SMN, VIS, and speech articulatory DES points fell within the corresponding network (median distance = 0 mm), whereas for LANG a median distance of 1.6 mm was reported.
Our findings show the remarkable consistency between key functional networks mapped noninvasively using presurgical rs-fMRI and invasive cortical mapping. This evidence highlights the utility of rs-fMRI for personalized presurgical planning, particularly in scenarios where awake surgery with DES is not feasible to protect eloquent areas during tumor resection. We have made the updated tool for automated functional network estimation publicly available, facilitating broader utilization of rs-fMRI mapping in various clinical contexts, including presurgical planning, functional reorganization over follow-up periods, and informing future treatments such as radiotherapy.
精确绘制脑肿瘤患者的功能网络对于制定个性化治疗策略至关重要。静息态功能磁共振成像（rs-fMRI）为基于任务的功能磁共振成像提供了一种替代方法，能够在单次采集过程中捕获多个网络，而无需任务参与。本研究表明，术前rs-fMRI图谱与清醒手术期间的金标准术中直接电刺激（DES）图谱之间具有高度一致性。
我们对28例接受清醒手术及DES图谱绘制的胶质瘤患者进行了分析。共收集了100次DES记录，以绘制感觉运动（SMN）、语言（LANG）、视觉（VIS）和言语发音认知域。术前rs-fMRI图谱使用ReStNeuMap软件的更新版本生成，该软件专门用于rs-fMRI数据预处理和自动检测7个静息态网络（SMN、LANG、VIS、言语发音、默认模式、额顶叶和视觉空间）。为了评估这些网络与通过侵入性皮层图谱绘制的网络之间的一致性，我们计算了它们与术中DES记录之间的患者特异性距离。
自动检测的术前功能网络与术中DES记录显示出极佳的一致性。当我们在空间上比较DES点与其相应网络时，发现SMN、VIS和言语发音DES点落在相应网络内（中位数距离 = 0毫米），而对于LANG，报告的中位数距离为1.6毫米。
我们的研究结果表明，术前使用rs-fMRI进行无创绘制的关键功能网络与侵入性皮层图谱之间具有显著的一致性。这一证据凸显了rs-fMRI在个性化术前规划中的实用性，特别是在肿瘤切除期间保护明确区域而无法进行清醒手术及DES的情况下。我们已将更新后的自动功能网络估计工具公开提供，便于在各种临床环境中更广泛地使用rs-fMRI图谱，包括术前规划、随访期间的功能重组以及为未来治疗（如放疗）提供信息。
