Coarse motor-state structure across paired preoperative fMRI and intraoperative ECoG in patients with brain tumors

Presurgical motor mapping in patients with tumors near eloquent motor cortex is commonly based on task-evoked activation maps, yet local BOLD responses may be difficult to interpret in lesion-affected tissue because of anatomical distortion, altered vascular coupling, and variability in task performance. In this study, we used a four-state motor paradigm spanning Action, kinesthetic motor imagery (IMG), Watch, and recent-action recall (REC) - to test whether coarse task-state relationships are preserved across paired preoperative fMRI and intraoperative ECoG in10 patients with brain tumors. Activation summaries and preoperative task familiarization were used to support task engagement, representational similarity analysis (RSA) was used to characterize within-modality state geometry, and cross-modal RSA was used to assess shared organization. Across modalities, Action and IMG showed relatively similar response patterns, Watch was more distinct, and REC occupied an intermediate position that should be interpreted cautiously because of the fixed task order. Cross-modal RSA showed positive correspondence between fMRI and ECoG representational dissimilarity matrices, supporting a shared coarse state structure rather than fine-grained equivalence between modalities. These findings support a hypothesis-generating, relation-based complementary framework for interpreting functional organization in patients with brain tumors, while the limited state space, clinically determined ECoG coverage, fixed task order, and indirect verification of internally generated states warrant cautious interpretation.