Resting-State Functional MRI: Current State, Controversies, Limitations, and Future Directions-<i>AJR</i> Expert Panel Narrative Review.
Authors
Affiliations (8)
Affiliations (8)
- Department of Radiology, UMass Chan Medical School, UMass Memorial Health, 55 Lake Ave N, Worcester, MA 01655.
- Department of Neuroradiology, University of Texas MD Anderson Cancer Center, Houston, TX.
- Department of Radiology, Division of Neuroradiology, Mayo Clinic, Rochester, MN.
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD.
- Department of Radiology, Washington University School of Medicine, St. Louis, MO.
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO.
- Department of Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD.
- The Malone Center for Engineering in Healthcare, The Whiting School of Engineering, Johns Hopkins University, Baltimore, MD.
Abstract
Resting-state functional MRI (rs-fMRI), a promising method for interrogating different brain functional networks from a single MRI acquisition, is increasingly used in clinical presurgical and other pretherapeutic brain mapping. However, challenges in standardization of acquisition, preprocessing, and analysis methods across centers and variability in results interpretation complicate its clinical use. Additionally, inherent problems regarding reliability of language lateralization, interpatient variability of cognitive network representation, dynamic aspects of intranetwork and internetwork connectivity, and effects of neurovascular uncoupling on network detection still must be overcome. Although deep learning solutions and further methodologic standardization will help address these issues, rs-fMRI remains generally considered an adjunct to task-based fMRI (tb-fMRI) for clinical presurgical mapping. Nonetheless, in many clinical instances, rs-fMRI may offer valuable additional information that supplements tb-fMRI, especially if tb-fMRI is inadequate due to patient performance or other limitations. Future growth in clinical applications of rs-fMRI is anticipated as challenges are increasingly addressed. This <i>AJR</i> Expert Panel Narrative Review summarizes the current state and emerging clinical utility of rs-fMRI, focusing on its role in presurgical mapping. Ongoing controversies and limitations in clinical applicability are presented and future directions are discussed, including the developing role of rs-fMRI in neuromodulation treatment of various neurologic disorders.