gms | German Medical Science

Objective: To proof feasibility of resting-state functional MRI (RS-fMRI) in an intraoperative setting (iRS-fMRI) and to correlate findings of the sensorimotor networks with the clinical condition of patients pre- and postoperatively.

Method: Twelve patients underwent iMRI-guided resection of lesions in or directly adjacent to the central region and/or pyramidal tract. iRS-fMRI was performed pre- and intraoperatively and correlated with patients' postoperative clinical condition, as well as with intraoperative monitoring (IOM) results. Independent component analysis (ICA) was used to post-process the iRS-fMRI data concerning the sensorimotor networks.

Results: iRS-fMRI with anesthetized patients proved to be feasible and ICA revealed comparable preoperative z-scores. iRS-fMRI showed a significant (p<0.01) decrease of z-scores in patients with new postoperative, compared to patients with no postoperative neurological deficits. A comparable correlation was found for the direct postoperative neurological status, as well as at the point of patients' discharge from hospital (p=0.01). ROC curve analysis demonstrated moderate prognostic value of intraoperative z-score (cut-off value: ≤10.5, sensitivity: 82.4%, specificity: 80%, AUC: 0.84, P<0.0001) for the mid-term paresis score (at patient discharge). The activation of the sensorimotor areas in the contralateral hemisphere did not demonstrate any significant difference before and after operation and was not correlated with the degree of paresis.

Conclusions: The use of iRS-fMRI with ICA is feasible and the results may correlate with clinical parameters demonstrating a significant negative correlation between the intensity of the iRS-fMRI signal and the postoperative neurological changes.