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| EDITORIAL |
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| Year : 2013 | Volume
: 61
| Issue : 2 | Page : 103-104 |
Resting state functional magnetic resonance imaging: An emerging clinical tool
Chandrasekharan Kesavadas
Department of Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| Date of Submission | 02-Apr-2013 |
| Date of Decision | 02-Apr-2013 |
| Date of Acceptance | 04-Apr-2013 |
| Date of Web Publication | 29-Apr-2013 |
Correspondence Address:
Chandrasekharan Kesavadas
Department of Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum - 695 011, Kerala
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0028-3886.111107
How to cite this article:
Kesavadas C. Resting state functional magnetic resonance imaging: An emerging clinical tool. Neurol India 2013;61:103-4 |
In a routine clinical practice, functional magnetic resonance imaging (fMRI) is offered as a non-invasive means of pre-surgical functional mapping of eloquent cortex. [1],[2] The basic approach is to conduct the study while the patient performs a task designed to target a single domain such as language, vision, memory, sensory or motor function. The fMRI images thus obtained are used prior to surgery to identify the closeness of the lesion to regions of functional activity. This approach is now well-established and many centers around the world use the results of this technique for pre-surgical counseling, surgical planning and neurosurgical decision making. However, there are few limitations for this technique. Some patients can have difficulty in performing the required tasks, especially those who have neurological deficits such as weakness of limbs for performing motor function, lower intelligence to perform cognitive tasks and altered levels of consciousness. Infants and children may not be able to perform the task. Thus, if a patient is unable to perform the prescribed task, the presently available task-based functional mapping approaches may be unreliable or prove impossible. Secondly, specific task sets must be performed to target distinct functions. It is difficult to map multiple brain functions simultaneously.
Functional mapping based on spontaneous intrinsic activity, referred to as resting state fMRI, offers an alternative approach to pre-surgical mapping. Resting state fMRI measures spontaneous low-frequency fluctuations (<0.1 Hz) in the blood oxygen level dependent (BOLD) signal to investigate the functional architecture of the brain. In 1995, Biswal and colleagues were the first to present the functional significance of these fluctuations. [3] In their study, they showed that motor areas activated by actual motor movements could also be localized using spontaneous activity correlations. Following this publication, several studies have shown the application of this technique in identification of various resting state networks and functionally-related regions demonstrating synchronous BOLD fluctuations at rest. It has been used to map out brain regions linked to motor function, [3] vision, [4] audition, [5] language, [6] memory, [7] and attention. [8]
Lee et al., reviewed the various methods for analyzing resting-state fMRI data. [9] This includes seed-based approaches, independent component analysis, graph methods, clustering algorithms, neural networks, and pattern classifiers. Their review also describes the emerging clinical applications of this technique. One of the clinical applications that is showing great promise is in the pre-surgical planning for patients with brain tumor. Manglore et al., in their study, published in this issue of the journal, have aimed at establishing the utility of resting state fMRI as a clinical tool for mapping eloquent motor cortex in patients with brain tumors. [10] Their study results show that the findings of resting state fMRI in six patients with brain tumor were comparable to that of task based fMRI mapping of motor cortex. The study also reports disrupted functional connectivity on the side of tumor.
An earlier study by Zhang et al., has shown that resting state fMRI correlation mapping compares well with "gold standard" cortical stimulation mapping in motor cortex mapping in healthy volunteers and patients with brain tumor. [11] The utility of this technique in motor cortex mapping in patients with brain tumors have also been reported in the studies by Liu et al., and Kokkonen et al. [12],[13] These studies concluded that the task-free paradigm in resting state fMRI may provide a powerful approach to map functional anatomy in patients without task compliance and allow multiple brain systems to be determined in a single scanning session. Hence, the technique becomes useful in young children, patients with altered mental status, patients under sedation, sleep or anesthesia, and in patients with paresis or aphasia.
The other clinical application includes pre-surgical planning in patients with epilepsy. Resting state fMRI has been used to localize areas of increased connectivity for detecting the epileptogenic zone in patients with epilepsy. [14],[15] Studies have demonstrated the utility of this technique in identifying patients with Alzheimer disease. [16] Resting state studies have been used to distinguish patients with psychiatric diseases from controls, [17] identify autism spectrum disorder, [18] and attention deficit hyperactivity disorder. [19]
Fox and Greicius, in their review article, have discussed the guidelines for performing resting state research on clinical populations and have also identified the barriers to be addressed to facilitate the translation of resting state fMRI into the clinical realm. [20] Since the methods of resting state fMRI data analysis requires technical expertise, there is a need for close collaboration between the clinician and the biomedical engineer to make this technique clinically useful and feasible.
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