3T高场强功能MRI在脑功能区胶质瘤皮质电刺激手术中的应用

目的研究应用3T高场强功能MRI（fMRI）定位脑运动功能区，及在脑胶质瘤直接皮质电刺激手术中的指导作用。方法26例邻近或累及脑运动功能区的胶质瘤患者术前采用双手握拳刺激策略，根据血氧水平依赖（BOLD）原理进行功能成像。经工作站提供的BOLD功能图像分析软件包进行分析，获得脑运动功能区的激活图像，制定手术方案。所有患者均在唤醒麻醉下进行显微外科手术，在术前fMRI指导下利用直接皮质电刺激定位运动区。在保护脑功能不受损的前提下，最大程度地切除胶质瘤。术前、术后均行Karnofsky生活状态（KPS）评分，判断患者的状态。结果26例术前BOLD运动fMRI有23例获得良好的手运动脑功能区激活图像。患者在唤醒麻醉下，在术前fMRI指导下利用直接皮质电刺激快捷、准确定位初级运动皮质区，并且两者具有良好的一致性。同时术前fMRI提供术中未检测到的脑功能区的信息，相互补充。术前KPS评分80．0～90．0分患者21例（平均85．7分）术后恢复至平均95．2分，术前KPS评分40．0～70．0分患者5例（平均68．0分）术后恢复至平均90．0分。结论术前fMRI可活体和无创地描绘出脑运动功能区与肿瘤的功能解剖位置关系，优化手术方案，在唤醒麻醉下指导直接皮质电刺激定位运动区的手术，实现最大程度保护脑功能，并最大程度地切除肿瘤。     

Refining the sensory and motor ratunculus of the rat upper extremity using fMRI and direct nerve stimulation.

It is well understood that the different regions of the body have cortical representations in proportion to the degree of innervation. Our current understanding of the rat upper extremity has been enhanced using functional MRI (fMRI), but these studies are often limited to the rat forepaw. The purpose of this study is to describe a new technique that allows us to refine the sensory and motor representations in the cerebral cortex by surgically implanting electrodes on the major nerves of the rat upper extremity and providing direct electrical nerve stimulation while acquiring fMRI images. This technique was used to stimulate the ulnar, median, radial, and musculocutaneous nerves in the rat upper extremity using four different stimulation sequences that varied in frequency (5 Hz vs. 10 Hz) and current (0.5 mA vs. 1.0 mA). A distinct pattern of cortical activation was found for each nerve. The higher stimulation current resulted in a dramatic increase in the level of cortical activation. The higher stimulation frequency resulted in both increases and attenuation of cortical activation in different regions of the brain, depending on which nerve was stimulated.     

fMRI of the lumbar spinal cord during a lower limb motor task.

This study applied spinal fMRI to the lumbar spinal cord during lower limb motor activity. During active ankle movement, activity was detected in the lumbar spinal cord motor areas and sensory areas bilaterally. During passive ankle movement, activity was detected in the motor and sensory areas in lower lumbar spinal cord segments and motor activity in higher lumbar spinal cord segments. Spinal fMRI detects patterns of activity consistent with known physiology and can be used to reliably assess activity in the lumbar spinal cord during lower limb motor stimulation. This study affirms spinal fMRI as an effective tool for assessing spinal cord function and increases its potential as a clinical tool.     

fMRI for preoperative neurosurgical mapping of motor cortex and language in a clinical setting

PURPOSE: Identification of the precentral gyrus can be difficult in patients with brain tumors. The purpose of the current study was to evaluate the clinical usefulness of functional MRI (fMRI) in identifying motor cortex and speech areas as a part of preoperative neurosurgical planning. METHOD: fMRI was performed using a 1.5 T MR unit in 41 patients with brain tumors. The motor paradigm was finger tapping and foot movement, whereas the language paradigm consisted of a two word semantic test. Statistical analysis of the data was done using the Kolmogorow-Smirnow test. Plots of signal intensities over time were created. RESULTS: The precentral gyrus was identified in 38 of 41 patients. In two patients, fMRI was not of acceptable quality due to motion artifacts. Speech areas were localized in 33 patients. In a typical clinical setting, the value of the method was graded "high." CONCLUSION: fMRI's efficacy in the preoperative localization of language and motor areas is high. The method should become a routine adjunct for preoperative evaluation of brain tumors in the near future.     

Functional magnetic resonance imaging for neurosurgical planning in neurooncology

Functional magnetic resonance imaging (fMRI) is a non-invasive technique that is widely available and can be used to determine the spatial relationships between tumor tissue and eloquent brain areas. Within certain limits, this functional information can be applied in the field of neurosurgery as a pre-operative mapping tool to minimize damage to eloquent brain areas. In this article, we review the literature on the use of fMRI for neurosurgical planning. The issues addressed are: (1) stimulation paradigms, (2) the influence of tumors on the blood oxygenation level-dependent (BOLD) signal, (3) post-processing the fMRI time course, (4) integration of fMRI results into neuronavigation systems, (5) the accuracy of fMRI and (6) fMRI compared to intra-operative mapping (IOM).     

Effects of using different software packages for BOLD analysis in planning a neurosurgical treatment in patients with brain tumours

BackgroundThe authors of the present thesis carried out a comparative analysis of three different computer software packages – FSL, SPM and FuncTool – for the processing of fMRI scans.PurposeThe aim of the thesis was the analysis of the volume of regions functionally active during the stimulation of the centres evaluated as well as the location of those regions in relation to the tumour boundaries, and then the comparison of the results.Material and methodsThirty eight patients with a diagnosed tumour of the left hemisphere, qualified for a neurosurgical operation, underwent fMRI. The functions of speech, motion and sensation were evaluated. Imaging data were processed for all the acquired scans with the use of each of the three software packages assessed.ResultsFor the FuncTool software package the calculated differences in the distances were several times greater than those calculated using FSL and SPM. The differences in the volume of the functionally active regions derived from the calculations with the use of the FSL and SPM software packages were statistically different for four out of the six functions evaluated.ConclusionsThe conclusions of the analysis in question showed that the FSL and SPM packages could be used interchangeably in the functional mapping of the brain with the purpose of the planning of neurosurgical operations. The FuncTool software package is less precise than FSL and SPM.     

An fMRI study of somatosensory-implicated acupuncture points in stable somatosensory stroke patients

PURPOSE: To assess differences in brain responses between stroke patients and controls to tactile and electrical acupuncture stimulation using functional MRI (fMRI). MATERIALS AND METHODS: A total of 12 male, clinically stable stroke patients with left side somatosensory deficits, and 12 age-matched male control subjects were studied. fMRI was performed with two different paradigms; namely, tactile stimuli and electrical stimulation at acupuncture points LI4 and LI11 on the affected side of the body. fMRI data were analyzed using SPM99. RESULTS: Tactile stimulation in both patients and controls produced significant activation in primary and secondary sensory and motor cortical areas and cerebellum. Greater activation was present in patients than controls in the somatosensory cortex with both the tactile task and the acupuncture point (acupoint) stimulation. Activation was greater during the tactile task than the acupuncture stimulation in patients and normal controls. CONCLUSION: Differences observed between patients and controls on both tasks may indicate compensatory over recruitment of neocortical areas involved in somatosensory perception in the stroke patients. The observed differences between patients and controls on the acupoint stimulation task may also indicate that stimulation of acupoints used therapeutically to enhance recovery from stroke, selectively activates areas thought to be involved in mediating recovery from stroke via functional plasticity. fMRI of acupoint stimulation may illustrate the functional substrate of the therapeutically beneficial effect of acupuncture in stroke rehabilitation.     

Functional localization of brainstem and cervical spinal cord nuclei in humans with fMRI

BACKGROUND AND PURPOSE: To our knowledge, no published functional map of the human lower brainstem exists. Our purpose was to use 1.5-T functional MR imaging (fMRI) to visualize the location of cranial nerve (CN) nuclei and other pontine, bulbar, and cervical spinal cord nuclei by using specific sensory stimulation or motor performance. METHODS: We localized nuclei by using cross-correlation analysis of regional blood oxygen level-dependent (BOLD) signal intensity during specific motor and sensory procedures based on known functions of specific nuclei. Statistical parametric mapping (SPM) analysis was used for comparison. Head, cardiac, and respiratory motion artifact correction was applied. Histologic atlases aided localization. RESULTS: We obtained evidence of localization of the following nuclei by using tests, as follows: main trigeminal sensory (CN V), brushing the face; abducens (CN VI), left-right eye movement; facial (CN VII), smiling and lip puckering; hypoglossal (CN XII), pushing the tongue against the hard palate; nucleus ambiguus, swallowing; nucleus tractus solitarii (NTS), tasting a sweet-sour-salty-bitter mixture; nucleus cuneatus, finger tapping; and cervical spinal cord levels C1-C3, tongue movement to activate the strap muscles. Activation of cortical motor and sensory areas and somatosensory thalamus corresponded with the tasks and sites of brainstem activation. Head movement was minimal, typically less than 1 mm in all three axes. CONCLUSION: With 1.5-T fMRI, the CN nuclei of the pons and medulla, and other nuclei of the lower brainstem and cervical spinal cord, can be localized in awake humans with specific sensory stimulation or motor performance.     

Differences in the BOLD fMRI response to direct and indirect cortical stimulation in the rat.

Functional MRI (fMRI) exploits a relationship between neuronal activity, metabolism, and cerebral blood flow to functionally map the brain. We have developed a model of direct cortical stimulation in the rat that can be combined with fMRI and used to compare the hemodynamic responses to direct and indirect cortical stimulation. Unilateral electrical stimulation of the rat hindpaw motor cortex, via stereotaxically positioned carbon-fiber electrodes, yielded blood oxygenation level-dependent (BOLD) fMRI signal changes in both the stimulated and homotypic contralateral motor cortices. The maximal signal intensity change in both cortices was similar (stimulated = 3.7 +/- 1.7%; contralateral = 3.2 +/- 1.0%), although the response duration in the directly stimulated cortex was significantly longer (48.1 +/- 5.7 sec vs. 19.0 +/- 5.3 sec). Activation of the contralateral cortex is likely to occur via stimulation of corticocortical pathways, as distinct from direct electrical stimulation, and the response profile is similar to that observed in remote (e.g., forepaw) stimulation fMRI studies. Differences in the neuronal pool activated, or neurovascular mediators released, may account for the more prolonged BOLD response observed in the directly stimulated cortex. This work demonstrates the combination of direct cortical stimulation in the rat with fMRI and thus extends the scope of rodent fMRI into brain regions inaccessible to peripheral stimulation techniques.     

Clinical applications of functional MRI at 1.0 T: motor and language studies in healthy subjects and patients

In this article we describe clinical applications of functional MRI (fMRI) at 1.0 T. All experiments were performed on a commercially available 1.0-T system (Magnetom Impact Expert, Siemens AG, Erlangen, Germany) using a blood oxygen level-dependent (BOLD)-sensitive multi-slice EPI technique (TE 66 ms, 4 mm slice thickness, 210 mm field of view, 64 × 64 acquisition matrix). Different paradigms for localization of the motor cortex and for language lateralization were tested in healthy subjects and patients. Methodological considerations concerning the development of the paradigms are also described. In all healthy subjects, motor activation elicited BOLD signal changes in the sensorimotor cortex, permitting identification of primary motor and sensory cortical areas. Furthermore, focal activation of different cortical areas by a language task was possible in 6 of 10 subjects. Nineteen motor studies were performed in 18 patients with supratentorial lesions, in most cases prior to neurosurgical procedures. In 14 studies, fMRI results demonstrated the localization of the motor hand areas relative to the lesion. The results proved valuable for preoperative planning and contributed to therapeutical decisions. We conclude that functional MRI for clinically relevant applications, such as localization of motor and language function, is feasible even at a field strength of 1.0 T without dedicated equipment. Received: 5 May 1998; Revision received: 1 July 1998; Accepted: 13 July 1998     

Functional magnetic resonance imaging at 3T as a clinical tool in patients with intracranial tumors

Purpose: To investigate the potential of functional magnetic resonance imaging (fMRI) at 3T as a clinical tool in the preoperative evaluation of patients with intracranial tumors. High magnetic field strength such as 3T is of benefit for fMRI because signal-to-noise ratio and sensitivity to susceptibility changes are field-strength-dependent.

Material and Methods: Twenty patients with tumors close to eloquent sensorimotor or language areas were studied. Motor, sensory, and two language paradigms (word generation, rhyming) were used; their effectiveness was determined as the percentage of patients in whom the functional area of interest was activated. Activation maps were calculated and their quality rated as high, adequate, or insufficient. The influence of fMRI on the neurosurgical decision regarding operability, surgical approach, and extent of the resection, was assessed.

Results: Paradigm effectiveness was 90% for motor and 95% for sensory stimulation, and varied from 79% to 95% for word generation and rhyming in combination. Ninety percent of the activation maps held high or adequate quality. fMRI proved useful: in the decision to operate (9 patients), in the surgical approach (13 patients), and in extent of the resection (12 patients).

Conclusion: fMRI at 3T is a clinically applicable tool in the work-up of patients with intracranial tumors.     

Fusion von MRT-, fMRT- und intraoperativen MRT-Daten Methode und klinische Bedeutung am Beispiel neurochirurgischer Interventionen

The aim of this work was to realize and clinically evaluate an image fusion platform for the integration of preoperative MRI and fMRI data into the intraoperative images of an interventional MRI system with a focus on neurosurgical procedures. A vertically open 0.5 T MRI scanner was equipped with a dedicated navigation system enabling the registration of additional imaging modalities (MRI, fMRI, CT) with the intraoperatively acquired data sets. These merged image data served as the basis for interventional planning and multimodal navigation. So far, the system has been used in 70 neurosurgical interventions (13 of which involved image data fusion--requiring 15 minutes extra time). The augmented navigation system is characterized by a higher frame rate and a higher image quality as compared to the system-integrated navigation based on continuously acquired (near) real time images. Patient movement and tissue shifts can be immediately detected by monitoring the morphological differences between both navigation scenes. The multimodal image fusion allowed a refined navigation planning especially for the resection of deeply seated brain lesions or pathologies close to eloquent areas. Augmented intraoperative orientation and instrument guidance improve the safety and accuracy of neurosurgical interventions.     

Comparison of functional MR imaging guidance to electrical cortical mapping for targeting selective motor cortex areas in neuropathic pain: a study based on intraoperative stereotactic navigation

PURPOSE: To assess the concordance between data from functional MR imaging (fMRI) guidance and the intraoperative electrical cortical mapping (iCM) in targeting selective motor cortex areas in refractory neuropathic pain. METHODS: Twenty-one patients (11 women and 10 men; mean age, 55.6 years) with refractory central (ischemic, 8 cases) and neuropathic pain (trigeminal neuropathy, 6 cases; syrinx/amputation/plexus trauma, 7 cases) underwent surgery for the implantation of an epidural electrode for chronic motor cortex stimulation (MCS) with general anesthesia and a frameless neuronavigation system used for the image-guided targeting procedure. All patients were studied by preoperative fMRI and epidural iCM with somatosensory evoked potentials and motor cortex stimulodetection. fMRI investigated systematically motor tasks of both hands and that related to the somatic area (foot or tongue) affected by pain. fMRI data were analyzed with the Statistical Parametric Mapping99 software (initial analysis threshold [AT] corresponding to P < .001), registered in the neuronavigation system and correlated intraoperatively with iCM. Matching of fMRI and iCM was specifically examined, focusing the study on hand mapping. RESULTS: Concordance between contours of fMRI activation area and iCM in precentral gyrus (mean distance, 3.8 mm) was found in 20/21 patients (95%). Because precision of iCM was suboptimal in 7 patients, concordance for more restrictive values of the AT (P < .0001) was found in only 13 of these 20 patients. Concordance was not found in one patient, as result of image distortion and residual motion artifact. CONCLUSIONS: In this study, fMRI guidance provides information that matches those of an independent functional method. These data illustrate the functional accuracy of fMRI guidance for the operative targeting of selective motor cortex areas in neuropathic pain.     

Influence of fMRI on operative planning of brain tumors: Initial experience in a histopathologically variable subset of tumors

Background and purpose

Conventional MR imaging permits subcategorization of brain tumors; however, assessment of relation of the tumor to eloquent cortical centers is limited. Functional MRI (fMRI) is a promising method for visualizing cortical brain centers and for studying their relation to brain tumors which is an essential factor in proper planning of treatment strategy. The aim of this study is to assess and evaluate the value of fMRI in guiding preoperative decision making in patients with brain tumors.

Materials and methods

Both conventional and functional MRI were analyzed in 21 patients with brain tumors, the decision for treatment strategy for each case was determined twice, first with the data provided by the conventional MRI alone, second with the data provided by conventional and functional MRI.

Results

Accurate localization of eloquent cortical centers and as well as detailed assessment of their relation to the brain tumor were feasible in the majority of the examined patients, the data provided by this new technique modified the treatment strategy in seven of them aiming to avoid damage of eloquent brain areas.

Conclusion

fMRI can provide essential data about cortical centers and their relation with the tumor helping in safer preoperative planning.     

fMRI activation mapping as a percentage of local excitation: Consistent presurgical motor maps without threshold adjustment

Purpose

To evaluate the performance of a relative activation amplitude algorithm, versus standard t‐value thresholding, for reliably establishing the location, amplitude, and spatial extent of functional magnetic resonance imaging (fMRI) brain activation for presurgical planning.

Materials and Methods

Diagnostic fMRI maps from 42 neurosurgical patients performing a simple hand movement task were analyzed. Relative activation maps were made by normalizing statistical t‐value maps to the local peak activation amplitude within each functional brain region. The spatial distribution of activation was quantified and compared across mapping algorithms, subjects, and scan duration.

Results

Whereas the spatial distribution of blood oxygenation level‐dependent (BOLD) t‐value statistical activation maps was highly variable across subjects and scan duration, the spatial distribution of relative activation maps was highly reproducible both within individual subjects and across different subjects. In every case the 40% most active voxels in the cortical hand region were consistently localized to the pre‐ and postcentral gyri of the sensorimotor cortex.

Conclusion

The reproducibility and anatomical specificity of the spatiotemporal pattern of BOLD activation makes relative amplitude fMRI mapping a useful tool for clinical imaging, where accuracy, reproducibility, and quality control are critical concerns. J. Magn. Reson. Imaging 2009;29:751–759. © 2009 Wiley‐Liss, Inc.     

Direct Impact of Motor Cortical Stimulation on the Blood Oxygen-level Dependent Response in Rats

Purpose:Neuropathic pain is a complex and distressing chronic illness in modern medicine. Since 1990s, motor cortex stimulation (MCS) has emerged as a potential treatment for chronic neuropathic pain; however, the precise mechanisms underlying analgesia induced by MCS are not completely understood. The purpose of the present study was to investigate the blood oxygen-level dependent (BOLD) response in the brain during MCS.Methods:We inserted a bipolar tungsten electrode into the primary motor cortex (M1) of adult male Wistar rats. Functional magnetic resonance imaging (fMRI) scans were implemented simultaneously with the electrical stimulation of M1 and the BOLD signals taken from the fMRI were used as an index to reflect the response against MCS.Results:Our results demonstrated that the bilateral M1, ipsilateral caudate-putamen, and ipsilateral primary somatosensory cortex to the stimulation spot were activated after the onset of MCS. The BOLD signal time courses were analysed in these regions and similar temporal characteristics were found.Conclusion:By conducting direct cortical stimulation of the rodent brain to investigate its instant effect using fMRI, we identified encephalic regions directly involved in the instant motor cortical stimulation effects in healthy rat models. This result may be essential in establishing a foundation for further research on the underlying neuropathways associated with the MCS effects.     

Presurgical Assessment of the Sensorimotor Cortex Using Resting-State fMRI

BACKGROUND AND PURPOSE:The functional characterization of the motor cortex is an important issue in the presurgical evaluation of brain lesions. fMRI noninvasively identifies motor areas while patients are asked to move different body parts. This task-based approach has some drawbacks in clinical settings: long scanning times and exclusion of patients with severe functional or neurologic disabilities and children. Resting-state fMRI can avoid these difficulties because patients do not perform any goal-directed tasks.MATERIALS AND METHODS:Nineteen patients with diverse brain pathologies were prospectively evaluated by using task-based and resting-state fMRI to localize sensorimotor function. Independent component analyses were performed to generate spatial independent components reflecting functional brain networks or noise. Three radiologists identified the motor components and 3 portions of the motor cortex corresponding to the hand, foot, and face representations. Selected motor independent components were compared with task-based fMRI activation maps resulting from movements of the corresponding body parts.RESULTS:The motor cortex was successfully and consistently identified by using resting-state fMRI by the 3 radiologists for all patients. When they subdivided the motor cortex into 3 segments, the sensitivities of resting-state and task-based fMRI were comparable. Moreover, we report a good spatial correspondence with the task-based fMRI activity estimates.CONCLUSIONS:Resting-state fMRI can reliably image sensorimotor function in a clinical preoperative routine. It is a promising opportunity for presurgical localization of sensorimotor function and has the potential to benefit a large number of patients affected by a wide range of pathologies.

Mapping of cerebral function in neurosurgery patients aims to predict the efficacy of the neurosurgical treatment, estimate the operation risk, and avoid neurologic deficits. Several techniques have been used to identify brain activity in tissue surrounding the regions planned for resection, including neuronavitaged transcranial magnetic stimulation,¹ magnetoencephalography,² and fMRI,³ each having advantages and drawbacks over the others.The clinical criterion standard for localization of functional brain areas is intraoperative electrical stimulation in the awake patient.⁴ Although electrical stimulation provides unique assistance during surgery, it is an invasive technique that requires expertise of the surgical team and a cooperative and motivated subject. It also adds considerable time to the surgical procedure for an investigation limited to a few cortical areas. Therefore, fMRI has been seen as very promising for clinical applications. However, its integration into preoperative surgical planning has been relatively slow because of several practical constraints: the dedicated experimental setup, long scanning time, and a high cognitive demand on the patient. Moreover, localizing the sensorimotor cortex with fMRI at the individual level can be challenging in some cases when the patient has paresis or paralysis. Furthermore, >1 acquisition is necessary whenever the lesion is bordering on several motor representations.Techniques measuring functional connectivity can address several of the limitations faced by stimulus-driven or task-based fMRI (tb-fMRI). Resting-state fMRI (rs-fMRI) uses slow, spontaneous fluctuations in the blood oxygen level–dependent signal to characterize networks of distant brain regions.⁵ The subject simply “rests” in the scanner without any specific task to perform. rs-fMRI has been successfully applied in groups of healthy volunteers,⁶ provides a means of mapping several functional networks in a single acquisition, appears robust across individuals,⁷ and is less-demanding than tb-fMRI because it requires less cooperation from the patient and can be used in individuals with neurologic deficits or cognitive dysfunction or in children. Additionally, spontaneous activity continues in the primary sensory and motor cortices even when subjects are asleep⁸ or anesthetized.⁹ This feature suggests that complete patient compliance may not be necessary. Resting-state networks have been extensively explored in recent years at the group level in populations of healthy subjects and patients. In the case of neurosurgery patients with brain damage,¹⁰ precise functional network estimation at the individual level is essential for surgery planning and/or intraoperative navigation. The conclusions of previous pioneering studies were limited to the feasibility of rs-fMRI for presurgical mapping by using small patient samples.^11–15In this study, we investigated the sensitivity of extracting the sensorimotor network from rs-fMRI at the individual level in patients with brain damage scheduled for surgery. Because brain lesions can appear at any segment of the motor cortex, we divided our investigations into 3 portions of the somatotypy (foot, hand, and face). rs-fMRI was then compared with tb-fMRI acquired when corresponding body parts were moved.     

Organization of the human motor system as studied by functional magnetic resonance imaging.

Blood oxygenation level dependent functional magnetic resonance imaging (BOLD fMRI), because of its superior resolution and unlimited repeatability, can be particularly useful in studying functional aspects of the human motor system, especially plasticity, and somatotopic and temporal organization. In this survey, while describing studies that have reliably used BOLD fMRI to examine these aspects of the motor system, we also discuss studies that investigate the neural substrates underlying motor skill acquisition, motor imagery, production of motor sequences; effect of rate and force of movement on brain activation and hemispheric control of motor function. In the clinical realm, in addition to the presurgical evaluation of neurosurgical patients, BOLD fMRI has been used to explore the mechanisms underlying motor abnormalities in patients with neuropsychiatric disorders and the mechanisms underlying reorganization or plasticity of the motor system following a cerebral insult.     

Motor cortex brain activity induced by 1-Hz transcranial magnetic stimulation is similar in location and level to that for volitional movement

RATIONALE AND OBJECTIVES: The relatively high temporal and spatial resolution of functional MR imaging was used to compare the blood oxygenation level dependent (BOLD) response associated with movement induced by transcranial magnetic stimulation (TMS) with that for a similar movement executed volitionally (VOL). METHODS: Seven healthy adults were studied in a 1.5-T MR scanner. One hertz TMS at 110% of motor threshold was applied over the motor cortex for the thumb in 21-pulse trains in alternation with VOL every 63 seconds and interleaved with functional MR imaging. RESULTS: BOLD increases in motor cortex associated with TMS and VOL movement were similar (2%-3%). Mean separation of their centers of activity was 3.7 + 1.9 mm (mean displacement: left/right = 0.3 +/- 4.1 mm; superior/inferior = 0.7 +/- 1.9 mm). There was no indication of supraphysiological brain activity. CONCLUSIONS: Motor cortex BOLD response associated with thumb movement induced by 1-Hz TMS at 110% motor threshold is similar in both location and level to that caused by a similar movement executed volitionally.     

Minimum detectable change in motor and prefrontal cortex activity over repeated sessions using 3T functional MRI and a block design

Purpose

To determine the minimum detectable change (MDC) in functional magnetic resonance imaging (fMRI) measurements of brain activity over repeated sessions with 95% confidence using a block design of tasks.

Materials and Methods

Fourteen individuals participated in three sessions on different days during which four scans each of a motor task and working memory task were performed. Using a region‐of‐interest analysis of variance, we calculated the MDC in the volume of activated primary sensorimotor cortex (for motor) and dorsolateral prefrontal cortex (for working memory), as well as the percent increase in MR signal and the center and location of maxima of the activated voxels.

Results

The MDC of activated volume was 5.0–8.8 cm³, and the MDC of percent increase in signal from baseline during tasks was 0.3%–0.6%. The MDC of the center of mass of activity was 3–4 mm, compared to 6–10 mm for the location of maxima.

Conclusion

fMRI measurements that quantify the strength of activity in response to tasks and centers of mass offer sensitive measurements of change over repeated imaging sessions. fMRI can be used for serial investigations of individual participants using simple motor and cognitive tasks using a simple block design. J. Magn. Reson. Imaging 2008;28:1055–1060. © 2008 Wiley‐Liss, Inc.