Resting-State Coactivation Patterns of Language Reorganization in Brain Tumors

We investigated the temporal dynamics of resting-state brain activity associated with language reorganization in patients with left-hemisphere brain tumors using coactivation pattern (CAP) analysis of functional MRI. This retrospective study included 106 right-handed patients who underwent both resting-state and task-based fMRI before surgery. Language dominance was determined using a phonemic fluency task, and CAP analysis identified recurring whole-brain activation patterns. Dynamic properties of CAPs, including persistence, transitions, in-degree, and out-degree, were compared between patients with typical and atypical language dominance and between those with and without postoperative aphasia. Six distinct CAPs corresponding to known functional networks were identified. Patients with atypical language dominance showed higher out-degree (p = 0.004) and transitions (p = 0.006) in the dorsal default mode network (DMN; CAP2) and lower persistence in the visuospatial network (VSN; CAP3; p = 0.002) compared with patients with typical dominance. Patients without postoperative aphasia demonstrated higher transitions in VSN CAP6 (p = 0.024). Logistic regression analyses were performed to evaluate the prediction of postoperative aphasia. A model including CAP metrics and the language laterality index (LI) demonstrated good predictive performance (area under the curve [AUC] = 0.851, accuracy = 82.4%, sensitivity = 71.9%, and specificity = 88.1%), outperforming a model based on LI alone (AUC = 0.640 and accuracy = 67.0%). No significant differences were observed by tumor type or volume. These findings indicate that CAP dynamics capture distinct neural states associated with language dominance and postoperative outcomes. Specific CAP metrics may serve as potential imaging biomarkers of functional reorganization, supporting prognostic evaluation and surgical planning in patients with brain tumors.