ReStNeuMap: a tool for automatic extraction of resting-state functional MRI networks in neurosurgical practice

Abstract

OBJECTIVEResting-state functional MRI (rs-fMRI) represents a promising and cost-effective alternative to task-based fMRI for presurgical mapping. However, the lack of clinically streamlined and reliable rs-fMRI analysis tools has prevented wide adoption of this technique. In this work, the authors introduce an rs-fMRI processing pipeline (ReStNeuMap) for automatic single-patient rs-fMRI network analysis.METHODSThe authors provide a description of the rs-fMRI network analysis steps implemented in ReStNeuMap and report their initial experience with this tool after performing presurgical mapping in 6 patients. They verified the spatial agreement between rs-fMRI networks derived by ReStNeuMap and localization of activation with intraoperative direct electrical stimulation (DES).RESULTSThe authors automatically extracted rs-fMRI networks including eloquent cortex in spatial proximity with the resected lesion in all patients. The distance between DES points and corresponding rs-fMRI networks was less than 1 cm in 78% of cases for motor, 100% of cases for visual, 87.5% of cases for language, and 100% of cases for speech articulation mapping.CONCLUSIONSThe authors’ initial experience with ReStNeuMap showed good spatial agreement between presurgical rs-fMRI predictions and DES findings during awake surgery. The availability of the rs-fMRI analysis tools for clinicians aiming to perform noninvasive mapping of brain functional networks may extend its application beyond surgical practice.

Mapping cognitive and emotional networks in neurosurgical patients using resting-state functional magnetic resonance imaging

“…36 In 2018, Zacà et al developed a promising toolbox, ReStNeuMap, to automatically extract the RSNs in neurosurgical patients. 71 This toolbox provides the ICA results of different numbers of components and automatically identifies the motor, primary visual, and language networks. Their initial experience in 6 brain tumor patients indicated good spatial agreement among the eloquent networks using rs-fMRI and DES awake mapping.…”

Presurgical resting‐state functional MRI language mapping with seed selection guided by regional homogeneity

“…However, determining the component number and selecting network‐specific components require additional effort. Recent developments have been aimed at addressing these issues with ICA and have demonstrated its potential for routine presurgical language mapping . The use of both the model‐free and the seed‐based rs‐FMRI, such as the proposed method, needs to be tested in a larger cohort of patients before they can be widely deployed in clinical practice.…”

Editorial. Mapping at rest: translating resting-state functional MRI to clinical practice

“…Advancing that realization is the subject of a paper by Zacà et al in the current issue of the Journal of Neurosurgery. 16 The authors demonstrate the application of an automated method for identifying RSNs in 6 patients prior to neurosurgical resection of intraparenchymal lesions. An automated method such as theirs is useful, and arguably necessary, for the widespread adoption of rs-fMRI in neurosurgical practice.…”

“…Zacà et al build on the ICA method with the addition of an automated step for matching components to a predefined RSN template map. 16 This effectively emulates the process of an expert reviewer assigning an RSN to each component but does so systematically using a goodnessof-fit test. The authors introduce a software package named resting-state neurosurgical mapping, or ReStNeuMap, that implements this step, along with routine preprocessing, in a turn-key pipeline intended for use in presurgical planning.…”

“…The work by Zacà et al and related reports by other groups make a compelling proposal for the future of rs-fMRI in clinical neurosurgery. 16 Future work along similar lines to further validate methodologies and disseminate tools to the neurosurgical masses is eagerly awaited. While there is plenty of work to be done, we expect that neurosurgeons and basic neuroscientists will continue to work together to advance this effort and successfully translate rs-fMRI to a common clinical application.…”