Journal of magnetic resonance imaging : JMRI
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Since the birth of functional magnetic resonance imaging (fMRI)-a noninvasive tool able to visualize brain function-now 15 years ago, several clinical applications have emerged. fMRI follows from the neurovascular coupling between neuronal electrical activity and cerebrovascular physiology that leads to three effects that can contribute to the fMRI signal: an increase in the blood flow velocity, in the blood volume and in the blood oxygenation level. The latter effect, gave the technique the name blood oxygenation level dependent (BOLD) fMRI. One of the major clinical uses is presurgical fMRI in patients with brain abnormalities. ⋯ Unfortunately, randomized trials or outcome studies that definitively show benefits to the final outcome of the patient when applying fMRI presurgically have not been performed. Therefore, fMRI has not yet reached the status of clinical acceptance. The final purpose of this article is to define a roadmap of future research and developments in order to tilt pre-surgical fMRI to the status of clinical validity and acceptance.
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J Magn Reson Imaging · Jun 2006
ReviewDesign and analysis of fMRI studies with neurologically impaired patients.
Functional neuroimaging can be used to characterize two types of abnormality in patients with neurological deficits: abnormal functional segregation and abnormal functional integration. In this paper we consider the factors that influence the experimental design, analysis, and interpretation of such studies. With respect to experimental design, we emphasize that: 1) task selection is constrained to tasks the patient is able to perform correctly, and 2) the most sensitive designs entail presenting stimuli of the same type close together. ⋯ At the second level (between subjects), inference should be based on between-subjects variance. Provided that these and other constraints are met, deficits in functional segregation are indicated when activation in one or a set of regions is higher or lower in patients relative to control subjects. In contrast, deficits in functional integration are implied when the influence of one brain region on another is stronger or weaker in patients relative to control subjects.
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J Magn Reson Imaging · Jun 2006
ReviewRole of fMRI in the decision-making process: epilepsy surgery for children.
Functional MRI (fMRI) is increasingly being used to evaluate children and adolescents who are candidates for surgical treatment of intractable epilepsy. It has the advantage of being noninvasive and well tolerated by young people. By identifying important functional regions within the brain, including unpredictable patterns of functional reorganization, it can aid in surgical decision-making. ⋯ We describe how fMRI, used in conjunction with conventional investigative methods such as neuropsychological assessment, MRI, and electrophysiology, can 1) help to improve functional outcome by enabling resective surgery that spares functional cortex, 2) guide surgical intervention by revealing when reorganization of function has occurred, and 3) show when abnormal cortex is also functionally active, and hence that surgery may not be the best option. Altogether, these roles have reduced the need for invasive procedures that can be both risky and distressing for young people with epilepsy. In our experience, fMRI has significantly contributed to the decision-making process, and improved the counseling and management of young people with intractable epilepsy.
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Over the past dozen years, the use of MRI techniques to map brain function (fMRI) has sparked a great deal of research. The ability of fMRI to image several different physiological processes concurrently (i.e., blood oxygenation, blood flow, metabolism) and noninvasively over large volumes make it the ideal choice for many different areas of neuroscience research in addition to countless applications in clinical settings. ⋯ There seems to be no foreseeable end in sight to the advancement of fMRI techniques and its subsequent use in basic research as well as in clinical settings. In this work, fMRI techniques and the ongoing development of existing techniques are discussed with implications for the future of fMRI.
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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.