Identification of the Language Network from Resting-State fMRI in Patients with Brain Tumors: How Accurate Are Experts?

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FIG 1.
Flow diagram of inclusion and exclusion criteria. SWG indicates Silent Word Generation; SC, Sentence Completion.
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FIG 2.
Correctness percentage by reviewer and ICA target components with their corresponding confidence intervals.
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FIG 3.
Comparison of task- versus rs-fMRI averaged across subjects. Green denotes average task-fMRI activation of the language system across all subjects. Red denotes the average spatial map of the rs-fMRI component correctly selected across subjects by all reviewers. Blue represents the average spatial map of the incorrectly selected rs-fMRI component across subjects by all reviewers. Overlays are additive: Yellow denotes overlapping voxels between green (task-fMRI) and red (correct rs-fMRI component). The white area in the inferior frontal gyrus along the inferior frontal sulcus denotes overlap across task-fMRI, incorrect rs-fMRI, and correct rs-fMRI. While some overlap is noted here, which may be a function of spatial smoothing, there is a clear distinction between the correct rs-fMRI versus incorrect rs-fMRI distribution.

Table 1:

Correctness percentage by reviewer and ICA target component

Reviewer	ICA Component	Top Choices	No. (% Correctness)	95% CIs
1	Overall		72.09%	66.12%–77.39%
1	20	Top 1	28 (65.12%)	49.01%–78.55%
1	20	Top 2	32 (74.42%)	58.53%–85.96%
1	20	Top 3	33 (76.74%)	61.00%–87.72%
1	50	Top 1	25 (58.14%)	42.21%–72.63%
1	50	Top 2	33 (76.74%)	61.00%–87.72%
1	50	Top 3	35 (81.40%)	66.08%–91.08%
2	Overall		50.39%	44.13%–56.63%
2	20	Top 1	16 (37.21%)	23.39%–53.28%
2	20	Top 2	23 (53.49%)	37.83%–68.53%
2	20	Top 3	24 (55.81%)	40.01%–70.59%
2	50	Top 1	15 (34.88%)	21.45%–50.99%
2	50	Top 2	24 (55.81%)	40.01%–70.59%
2	50	Top 3	28 (65.12%)	49.01%–78.55%
3	Overall		55.04%	48.74%–61.18%
3	20	Top 1	22 (51.16%)	35.68%–66.44%
3	20	Top 2	26 (60.47%)	44.45%–74.63%
3	20	Top 3	26 (60.47%)	44.45%–74.63%
3	50	Top 1	18 (41.86%)	27.37%–57.79%
3	50	Top 2	24 (55.81%)	40.01%–70.59%
3	50	Top 3	26 (60.47%)	44.45%–74.63%

Table 2:

Difference in correctness percentages comparing the top choice with the top 2 and 3 choices

Reviewer	ICA	Pair Comparison	Number (Percentage Differences)	P Value^{^a}
1	20	Top 1 vs top 2	4 (8.30%)	.063
	20	Top 1 vs top 3	5 (11.63%)	.031^{^a}
	20	Top 2 vs top 3	1 (2.33%)	.500
1	50	Top 1 vs top 2	8 (18.60%)	.004^{^a}
	50	Top 1 vs top 3	10 (23.26%)	<.001^{^a}
	50	Top 2 vs top 3	2 (4.65%)	.250
2	20	Top 1 vs top 2	7 (16.28%)	.008^{^a}
	20	Top 1 vs top 3	8 (18.60%)	.004^{^a}
	20	Top 2 vs top 3	1 (2.32%)	.500
2	50	Top 1 vs top 2	9 (20.93%)	.002^{^a}
	50	Top 1 vs top 3	13 (30.23%)	<.001^{^a}
	50	Top 2 vs top 3	4 (9.30%)	.063
3	20	Top 1 vs top 2	4 (9.30%)	.063
	20	Top 1 vs top 3	4 (9.30%)	.063
	20	Top 2 vs top 3	0(0.00%)	1.0
3	50	Top 1 vs top 2	6 (13.95%)	.016^{^a}
	50	Top 1 vs top 3	8 (18.60%)	.004^{^a}
	50	Top 2 vs top 3	2 (4.65%)	.250

Table 3:

Interrater (between reviewers) κ statistic by top choice groups

Reviewer	1	2	3
Overall
1	1.0	0.35	0.40
2	0.35	1.0	0.16
3	0.40	0.16	1.0
Top choice
1	1.0	0.47	0.21
2	0.47	1.0	0.028
3	0.21	0.028	1.0
Top 2 choices
1	1.0	0.37	0.37
2	0.37	1.0	0.27
3	0.37	0.27	1.0
Top 3 choices
1	1.0	0.31	0.42
2	0.31	1.0	0.12
3	0.42	0.12	1.0