Purpose: The adoption of functional MRI for presurgical planning in neuro-oncology has been limited by the high degree of patient compliance required to generate accurate activation maps. The purpose of this work was to evaluate the brain activation properties and patient head motion associated with a presurgical fMRI cueing system utilizing complex scene and auditory commands to enhance compliance in patients with cognitive and physical deficits.

Materials and Methods: An fMRI cueing system which delivered simultaneous audio and video task instructions was compared to a simple visual cueing system across 10 healthy volunteers, each performing two different motor tasks (40 total fMRI acquisitions). Statistical differences between the complex and simple cueing systems were evaluated using a mixed effects modeling method which was able to carry up variances from the individual analyses to the group analysis. Differences in relative head motion between the systems were evaluated using a paired t-test.

Results: Both cueing systems demonstrated typical somatotopic activity distributions in the pre- and postcentral gyrus of the left hemisphere. No significant differences were found between the systems in target brain regions. Furthermore, relative head motion using the complex system was found to not differ statistically from the simple method.

Conclusion: The fMRI cueing system using complex scene stimuli produced results comparable to a simple cueing system in target regions of the brain. In patients presenting with deficits that lead to noncompliance with fMRI procedures, the use of complex scene stimuli may provide a good alternative to conventional cueing methods.