A Watershed Algorithm GUI for Personalized fMRI-guided rTMS Target

Abstract

Personalized repetitive transcranial magnetic stimulation (rTMS) increasingly relies on resting-state functional magnetic resonance imaging (fMRI) to select stimulation sites, yet most pipelines depend on user-defined thresholds and atlas masks, which can shift individualized targets. We propose a watershed-based approach, implemented in a graphical user interface, that performs threshold-independent segmentation of functional images to support rTMS target localization. As a proof-of-concept, we focused on Alzheimers disease-related circuits within the default mode network, designating the posterior cingulate cortex (PCC) as the deep effective region and the inferior parietal lobule (IPL) as the superficial stimulation target. In a cohort of 21 healthy participants, quantitative comparison with a conventional threshold-based, mask-constrained peak strategy revealed high concordance for PCC peaks but a median spatial displacement of 6.0 mm (95% CI: 0.0-12.7 mm) for IPL targets. Qualitative examples further illustrate that watershed segmentation reduces bias from neighboring functional clusters, truncation by atlas boundaries, and ambiguity among multiple local peaks. By decoupling target definition from user-chosen thresholds and packaging the method in an accessible toolbox, this framework offers a generalizable tool for individualized fMRI-guided rTMS.