[ska]

I thought I was clearer, apologies.

People doing related research are interested in it, and a few teaching hospitals etc., but that’s a really small fraction. it’s not really a factor in most clinical practice.

Thus “transformed medicine” is more than a bit of a stretch.

[lostlogin]

> it’s not really a factor in most clinical practice.

For a nice anecdata point - I’m an MR technologist and clinically I’ve seen it done once, I’ve done it once and I’ve heard a colleague mention doing one. I’ve done them as research scans a hell of a lot of times.

[unsrsly]

fMRI is used to plan procedures that put eloquent cortex at risk. For example, tumor resections. Typically, fMRI is used for initial planning (whether the tumor is in the dominant hemisphere, how to approach the tumor). Then, in the actual surgery, function is confirmed using awake cortical mapping (e.g. stimulating different cortical areas with a bipolar electrode while the patient performs language tasks).

See more: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4966674/

[ska]

> Typically, fMRI is used for initial planning

No, it is not. In my experience it is at best rarely used for planning, i.e. typically planning is done without fMRI. It will probably have DWI but maybe not tensor information (although that is growing).

Awake cortical mapping and/or task based references are very typical (near 1/2 of procedures, iirc). fMRI is not.

I'm not saying it's a bad idea or anything. I have a pretty good understanding of all the tradeoffs for fMRI but I'm not arguing for or against it. I'm reacting to the claim that is commonly deployed in clinical (not research) practice, which just doesn't match my (fairly extensive) experience.

So the articles claims of "transforming medicine" are aspirational.

source: Have worked directly in this market (clinical), hashed this out with many neurosurgeons,seen the procedures, etc. See also MR tech comment in this thread, in my experience very typical.

[unsrsly]

fMRI is used for planning in neurooncology [1] and epilepsy surgery [2].

[1] https://thejns.org/focus/view/journals/neurosurg-focus/48/2/...

[2] https://n.neurology.org/content/88/4/395.long

[ska]

I don't really know what you are responding to here.

As I posited, there is research interest and a few people doing it clinically. Your links support this. What they don't support is the idea that this is typical clinical practice.

[unsrsly]

For those interested, here's a nice Tweet and video from a neurosurgeon at the Mayo clinic in Arizona demonstrating the use of both fMRI and intraoperative motor mapping: "Preoperative and Intraoperative mapping help with selection, safety and strategy."

https://twitter.com/BernardBendokMD/status/13785056756894556...