Voets NL, Ashtari M, Beckmann CF, et al. Consensus recommendations for clinical functional MRI applied to language mapping. Aperture Neuro. 2025;5. doi:10.52294/001c.128149 Available at https://apertureneuro.org/article/128149

Summary

This paper presents standardized guidelines for using functional MRI (fMRI) in clinical language mapping, particularly in presurgical planning for epilepsy and brain tumor patients. Developed by an expert panel under the American Society of Functional Neuroradiology (ASFNR), the recommendations aim to ensure consistency, reliability, and clinical validity in fMRI applications.

The consensus emphasizes that language fMRI should complement, not replace, direct cortical stimulation (DCS), which remains the gold standard for identifying eloquent cortex. The document provides detailed guidance on every stage of the fMRI process—patient preparation, paradigm selection, data acquisition, analysis, and interpretation—to minimize variability across clinical sites.

Key points include:

• Task selection: At least two validated language tasks (commonly verb generation, semantic decision, or sentence completion) should be used to engage both expressive and receptive networks.
• Imaging parameters: High-field (≥3T) MRI with optimized echo-planar imaging sequences and motion correction techniques is recommended.
• Analysis: Use of statistical thresholding and careful evaluation of activation in regions like Broca’s and Wernicke’s areas.
• Clinical integration: Results should be interpreted by teams that include neuroradiologists, neuropsychologists, and neurosurgeons, integrating fMRI findings with neuropsychological testing and intraoperative mapping.

The paper also addresses limitations of fMRI, such as susceptibility to motion, variability in patient compliance, and differences in hemodynamic response. It advocates for standardized reporting templates and continuous quality assurance to improve reproducibility and inter-site comparability.

In essence, these recommendations establish a framework for the safe, effective, and evidence-based clinical use of fMRI in language localization, promoting its role as an essential adjunct in neurosurgical decision-making while maintaining alignment with established invasive standards.