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Movie-watching fMRI for presurgical language mapping in patients with brain tumour
  1. Shun Yao1,2,
  2. Laura Rigolo1,
  3. Fuxing Yang1,
  4. Mark G Vangel3,4,
  5. Haijun Wang2,
  6. Alexandra J Golby1,4,
  7. Einat Liebenthal5,
  8. Yanmei Tie1
  1. 1 Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
  2. 2 Department of Neurosurgery, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
  3. 3 Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
  4. 4 Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
  5. 5 McLean Imaging Center, McLean Hospital, Harvard Medical School, Belmont, Massachusetts, USA
  1. Correspondence to Yanmei Tie, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; ytie{at}bwh.harvard.edu

https://doi.org/10.1136/jnnp-2020-325738

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    Introduction

    The primary goal of presurgical language mapping is localising critical language areas with high sensitivity (ie, capturing areas in which resection could lead to language deficits) and specificity (ie, excluding non-language areas) and reliably determining language hemispheric dominance, on an individual basis. Language mapping is challenging due to the widely distributed functional organisation of language in the frontal, temporal and parietal lobes, and in neurosurgical patients the possibility of tumour-induced functional reorganisation.

    A major drawback of conventional task-based functional magnetic resonance imaging (tb-fMRI) recommended for presurgical language mapping1 is the contingency on patient performance of precisely timed tasks (eg, antonym generation—AntGen). Drawbacks of task-free resting-state fMRI (rs-fMRI) include confounding effects of ‘mind wandering’ and sensitivity to motion artefacts. In contrast, movie watching is a rich, stimulating and naturalistic activity, predicted to constrain cognitive processes and engage the distributed, multimodal neural networks supporting language function in real life.2

    Our previous study demonstrated individual language mapping using movie-watching fMRI (mw-fMRI) in neurologically healthy subjects.3 Here, we examine mw-fMRI language mapping in presurgical patients with a brain tumour encroaching on putative language cortex, and varying levels of language disruption. We hypothesise that mw-fMRI versus AntGen tb-fMRI, and rs-fMRI, will provide comprehensive language mapping at reduced burden, as determined by metrics of in-scanner head motion, and mapping specificity, sensitivity and lateralisation.

    Methods

    Mw-fMRI was compared with clinically indicated AntGen tb-fMRI in 34 patients with brain tumour undergoing presurgical language mapping, and with rs-fMRI in 22 of these patients. See online supplemental methods for exclusion criteria, and online supplemental table S1 for demographic and clinical information. Language maps were generated from tb-fMRI using a general linear model, and from mw-fMRI and rs-fMRI using independent …

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    Footnotes

    • Twitter @SHUNYAO11

    • Contributors YT, EL and AJG are responsible for the study conception and design, interpreting the data, and critically revising the manuscript. SY drafted the manuscript, performed imaging data analysis, statistical analysis (with assistance of MGV), and graphical visualisation. LR performed MRI scanning and organised the fMRI dataset. All authors contributed to data interpretation, reviewed and approved the final version of this manuscript.

    • Funding This work is supported by the grants from the National Institutes of Health (NIH) (R21NS075728, R21CA198740, P41EB015898 and R25CA089017), and Jennifer Oppenheimer Cancer Research Initiative. The Chinese Postdoctoral Science Foundation (2019M663271) provided support to SY.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.