Journal of magnetic resonance imaging : JMRI
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Neuroimaging in recent years has greatly contributed to our understanding of a wide range of aspects related to central neurological diseases. These include the classification and localization of disease, such as in headache; the understanding of pathology, such as in Parkinson's disease (PD); the mechanisms of reorganization, such as in stroke and multiple sclerosis (MS); and the subclinical progress of disease, such as in amyotrophic lateral sclerosis (ALS). ⋯ Nevertheless, functional imaging does enable the formulation of neurobiological hypotheses that can be tested clinically, and thus is well suited for testing classic clinical hypotheses about how the brain works. Understanding the mechanisms and sites of pathology, such as has been achieved in cluster headaches, facilitates the development of new therapeutic strategies.
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J Magn Reson Imaging · Jun 2006
ReviewDiagnostic functional MRI: illustrated clinical applications and decision-making.
Functional magnetic resonance imaging (fMRI) has become a popular research tool, yet its use for diagnostic purposes and actual treatment planning has remained less widespread. The literature yields rather sparse evidence-based data on clinical fMRI applications and accordant decision-making. ⋯ Assessment of cochlear implant candidates by fMRI is covered in some detail, and distinct reference is made to particular challenges imposed by brain tumors, other space-occupying lesions, cortical dysplasias, seizure disorders, and vascular malformations. Specific strategies, merits, and pitfalls of analyzing and interpreting diagnostic fMRI studies in individual patients are highlighted.
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J Magn Reson Imaging · Jun 2006
ReviewPrinciples of magnetic resonance assessment of brain function.
MRI has advanced to being one of the major tools for the assessment of brain function. This review article examines the basic principles that underpin these measurements. The main emphasis is on the characteristics and detection of blood oxygen level dependent (BOLD) contrast. ⋯ The second section of the article deals with the imaging characteristics of BOLD in terms of the attainable spatial resolution and linear system characteristics. In the third section, practical BOLD imaging is examined for choice of pulse sequence, resolution, echo time (TE), repetition time (TR), and flip angle. The final section touches on other MRI approaches that are relevant to cognitive neuroimaging, in particular the measurement of blood flow, blood volume, resting state fluctuations in the BOLD signal, and measures of connectivity using diffusion tensor imaging and fiber-tracking.
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J Magn Reson Imaging · Jun 2006
ReviewThe clinical potential of functional magnetic resonance imaging.
Functional magnetic resonance imaging (fMRI) has had a huge impact on understanding the healthy human brain. To date it has had much less impact in clinical neuroscience or clinical practice. ⋯ Nevertheless, there are emerging applications for clinical fMRI, and as the field matures the number of applications is likely to grow. It seems certain that fMRI has an important role to play in helping us understand the mechanisms of neuropsychiatric diseases and in helping to identify effective therapeutic strategies.
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Functional MRI (fMRI) has tremendous clinical potential that is as yet unrealized. There are tremendous unmet medical needs that fMRI could address with significant benefit to human health. However, both medical and technical barriers prevent this benefit from accruing today. ⋯ However, the real challenge lies in the medical realm, and this will require multidisciplinary and interdisciplinary work since the technical aspects of fMRI are ahead of the medical aspects. This can be seen in a range of diseases from Alzheimer's disease to schizophrenia to ischemic stroke: in each case our ability to image changes with fMRI outstrips our ability to do anything useful for the patient with them. Diagnostic imaging will always be linked in the clinic to therapeutic choices, and therefore the most powerful approach to link fMRI more directly to the clinic will be to tie fMRI to therapy development and implementation.