Clinical-State Validation Should Precede Patient-Level Use of Glioma Connectivity Anomaly Maps

Multimodal anomaly maps can reveal distributed structural and functional connectivity deviations in glioma, but resting-state functional connectivity also reflects scan-day motion, vigilance, symptoms, seizures, and medication exposure. We propose prespecifying whether the target is tumor-associated alteration, all-cause patient-state deviation, or prognosis; recording a compact clinical-state vector; auditing state leakage and repeatability; and externally validating incremental clinical value before patient-level use.