Introducing the Integrated Clinical FMRI Paradigm

This study introduces and evaluates the “Integrated Functional Mapping” (IFM) clinical fMRI paradigm, a streamlined five-minute sequence designed to concurrently map language, bilateral motor, and visual cortical functions in pediatric patients undergoing presurgical evaluation for epilepsy. Methods: A cohort of 118 children aged 7 - 18 years (mean age 12.8) was scanned between 2018 and 2023 using a Philips Ingenia 1.5 T system. The IFM paradigm incorporated four tasks—semantic decision (words vs. tones), right- and left-hand motor responses, and visual stimulation—within a single block design run modeled with multiple orthogonal regressors. Data processing utilizes FSL with custom scripts, applying standard preprocessing and thresholding protocols. Clinical validity was assessed using a comparator auditory description task (ADT) for language lateralization. Results: The IFM paradigm fully activated receptive and expressive language areas in 97.5% and 85.6% of patients, respectively, while motor and visual activations were achieved in 95.7% and 94.1% of cases. Language lateralization results from the IFM and ADT tasks demonstrated strong concordance (97.3% for receptive and 99% for expressive language). Additionally, IFM maps exhibited reduced noise and motion artifacts compared to conventional single-task paradigms. Conclusions: The IFM fMRI paradigm offers reliable, simultaneous mapping of critical functional domains within a concise five-minute acquisition. It is well-tolerated by pediatric patients, enhances data quality by minimizing motion artifacts, and significantly reduces overall clinical scanning time. This approach promises an efficient screening and planning tool for pediatric presurgical fMRI, particularly in scenarios where motion or time constraints limit the feasibility of multi-run protocols.