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

Eric C. Leuthardt*, Gloria Guzman, Sarah Kathleen Bandt, Carl Hacker, Ananth K. Vellimana, David Limbrick, Mikhail Milchenko, Pamela Lamontagne, Benjamin Speidel, Jarod Roland, Miller Thomas Michelle, Abraham Z. Snyder, Daniel Marcus, Joshua Shimony, Tammie L.S. Benzinger

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

50 Scopus citations


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.

Original languageEnglish (US)
Article numbere0198349
JournalPloS one
Issue number6
StatePublished - Jun 2018

ASJC Scopus subject areas

  • General


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