Measurements of Functional Network Connectivity Using Resting State Arterial Spin Labeling During Neurosurgery

In neurosurgery, an exact delineation of functional areas is of great interest to spare important regions to ensure the best possible outcome for the patient (i.e., maximum removal while maintaining the highest possible quality of life). Preoperative imaging is routinely performed, including the visualization of not only structural but also functional information. During surgery, however, brain shift can occur, leading to an offset between the previously defined and the real position. Real-time imaging during the procedure is therefore desired to obtain this information while performing surgery. In this study 15 patients suffering from glioblastoma multiforme were included. These patients underwent structural and perfusion imaging using arterial spin labeling during the procedure. The latter has been used for gathering information about tumor residual perfusion. However, special postprocessing of this data allows for additional mapping of resting state networks and is intended to be used to gather deeper insights to aid the surgeon in planning the procedure. The data of each patient could be successfully postprocessed and used to map different resting state networks alongside the default mode network. On the basis of this study, it is feasible to use the information obtained from perfusion imaging to visualize not only vascular signal but also functional activation of resting state networks without acquiring any additional data besides the already available information. This may help guide the neurosurgeon in real time to adjust the surgical plan.