title: Localizing hand motor area using resting-state fMRI: validated with direct cortical stimulation.
abstract: BACKGROUND
  Resting-state functional magnetic resonance imaging (R-fMRI) is a promising tool in clinical application, especially in presurgical mapping for neurosurgery. This study aimed to investigate the sensitivity and specificity of R-fMRI in the localization of hand motor area in patients with brain tumors validated by direct cortical stimulation (DCS). We also compared this technique to task-based blood oxygenation level-dependent (BOLD) fMRI (T-fMRI).
  
  
  METHODS
  R-fMRI and T-fMRI were acquired from 17 patients with brain tumors. The cortex sites of the hand motor area were recorded by DCS. Site-by-site comparisons between R-fMRI/T-fMRI and DCS were performed to calculate R-fMRI and T-fMRI sensitivity and specificity using DCS as a "gold standard". R-fMRI and T-fMRI performances were compared statistically
  
  
  RESULTS
  A total of 609 cortex sites were tested with DCS and compared with R-fMRI findings in 17 patients. For hand motor area localization, R-fMRI sensitivity and specificity were 90.91 and 89.41 %, respectively. Given that two subjects could not comply with T-fMRI, 520 DCS sites were compared with T-fMRI findings in 15 patients. The sensitivity and specificity of T-fMRI were 78.57 and 84.76 %, respectively. In the 15 patients who successfully underwent both R-fMRI and T-fMRI, there was no statistical difference in sensitivity or specificity between the two methods (p = 0.3198 and p = 0.1431, respectively)
  
  
  CONCLUSIONS
  R-fMRI sensitivity and specificity are high for localizing hand motor area and even equivalent or slightly higher compared with T-fMRI. Given its convenience for patients, R-fMRI is a promising substitute for T-fMRI for presurgical mapping.
authors.affiliation: Neurological Surgery Department, Huashan Hospital, Shanghai Medical College, Fudan University, 12#, Wulumuqi Zhong Road, Shanghai, 200040, People's Republic of China.
authors.forename: Tian-ming
authors.initials: TM
authors.lastname: Qiu
authors.forename: Chao-gan
authors.initials: CG
authors.lastname: Yan
authors.forename: Wei-jun
authors.initials: WJ
authors.lastname: Tang
authors.forename: Jin-song
authors.initials: JS
authors.lastname: Wu
authors.forename: Dong-xiao
authors.initials: DX
authors.lastname: Zhuang
authors.forename: Cheng-jun
authors.initials: CJ
authors.lastname: Yao
authors.forename: Jun-feng
authors.initials: JF
authors.lastname: Lu
authors.forename: Feng-ping
authors.initials: FP
authors.lastname: Zhu
authors.forename: Ying
authors.initials: Y
authors.lastname: Mao
authors.forename: Liang-fu
authors.initials: LF
authors.lastname: Zhou
mesh_terms: D000328:Adult; D001931:Brain Mapping / Q000379:methods*; D001932:Brain Neoplasms / Q000175:diagnosis; D046690:Deep Brain Stimulation; D005260:Female; D005910:Glioma / Q000175:diagnosis; D006225:Hand / Q000294:innervation*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000503:physiopathology*; D012680:Sensitivity and Specificity