自从20世纪90年代初发现以来，功能性磁共振成像（fMRI）已被用于研究人脑功能。临床环境中fMRI的一项成熟应用是对脑肿瘤靠近重要皮层区域的患者进行神经外科规划。临床fMRI旨在术前确定在日常生活中具有重要功能的重要皮层，如手运动和语言。神经外科的首要目标是在最大限度地切除肿瘤的同时保留靠近肿瘤的重要皮层。当病变靠近重要皮层时，外科医生可以使用fMRI来规划他们最佳的手术方法，通过确定病变与激活区域的接近程度，为清醒脑外科手术和术中脑部映射提供指导。获得fMRI需要在成像前对患者进行准备，确定功能范式，监测患者的表现，并进行图像处理和分析。解释fMRI图像需要对功能性神经解剖有深入的了解，并熟悉脑肿瘤成像中常见的技术限制，包括神经血管解耦、患者合作性和数据分析。本综述讨论了在神经肿瘤学中的临床fMRI，相关正在进行的研究课题以及未来前景的发展，构成了这一激动人心学科的一部分。© RSNA, 2023.

Since its discovery in the early 1990s, functional MRI (fMRI) has been used to study human brain function. One well-established application of fMRI in the clinical setting is the neurosurgical planning of patients with brain tumors near eloquent cortical areas. Clinical fMRI aims to preoperatively identify eloquent cortices that serve essential functions in daily life, such as hand movement and language. The primary goal of neurosurgery is to maximize tumor resection while sparing eloquent cortices adjacent to the tumor. When a lesion presents in the vicinity of an eloquent cortex, surgeons may use fMRI to plan their best surgical approach by determining the proximity of the lesion to regions of activation, providing guidance for awake brain surgery and intraoperative brain mapping. The acquisition of fMRI requires patient preparation prior to imaging, determination of functional paradigms, monitoring of patient performance, and both processing and analysis of images. Interpretation of fMRI maps requires a strong understanding of functional neuroanatomy and familiarity with the technical limitations frequently present in brain tumor imaging, including neurovascular uncoupling, patient compliance, and data analysis. This review discusses clinical fMRI in neuro-oncology, relevant ongoing research topics, and prospective future developments in this exciting discipline.© RSNA, 2023.