Assessment of auditory cortex activation with functional magnetic resonance imaging.

OBJECTIVE: The goal was to assess auditory cortex activation evoked by pure-tone stimulus with functional MRI. METHODS: Five healthy children, aged 7 to 10 years, were studied. Hearing evaluation was performed by pure-tone audiometry in a sound-treated room and in the MRI scanner with the scanner noise in the background. Subjects were asked to listen to pure tones (500, 1000, 2000, and 4000 Hz) at thresholds determined in the MRI scanner. Functional image processing was performed with a cross-correlation technique with a correlation coefficient of 0.5 (P < 0.0001). Auditory cortex activation was assessed by observing activated pixels in functional images. RESULTS: Functional images of auditory cortex activation were obtained in 3 children. All children showed activation in Heschl's gyrus, middle temporal gyrus, superior temporal gyrus, and planum temporale. The number of activated pixels in auditory cortexes ranged from 4 to 33. CONCLUSIONS: Functional images of auditory cortex activation evoked by pure-tone stimuli are obtained in healthy children with the functional MRI technique.

Functional magnetic resonance imaging of auditory cortex in children.

OBJECTIVE: TO obtain images of auditory cortex activation in children by using functional magnetic resonance imaging (FMRI). METHODS: Seven healthy children (three girls and four boys), ages 6 to 10 years, were studied. Hearing evaluation was performed by puretone audiometry on the day of FMRI study. Brain imaging was performed on a commercial 1.5 T imager using a three-axis local gradient coil. During scanning the children were instructed to lie still and avoid any lip, eye, jaw, or other facial movements. Subjects were asked to listen to a standard text presented in on-off sequences. Functional images of the auditory cortex were acquired with FMRI technique. Functional imaging processing was done using cross-correlation techniques with a coefficient of 0.5 (P < .0001). RESULTS: Functional correlation images of the auditory cortex activation were obtained in six of seven children after image processing. All children showed activation in the superior temporal gyrus, Heschl's gyrus, planum temporale, frontal lobe, and parietal regions. There was no significant difference in the number and percentage of activated pixels on right and left auditory cortices. CONCLUSIONS: Functional images of auditory cortex activation were obtained in healthy children following binaural text presentation. Consistent activation was observed in primary and secondary auditory cortices with no hemispheric dominance. FMRI characteristics of the auditory cortex activation in healthy children should be established in order to study those with hearing impairment.

Functional MR of frontal lobe activation: comparison with Wada language results.

PURPOSE: Our purpose was to determine the utility of functional MR imaging in conjunction with a word-generation paradigm in the assessment of language lateralization. METHODS: Functional MR imaging and Wada testing for language lateralization was performed in patients with complex partial seizures during the performance of word-generation tasks. A language lateralization quotient was calculated from the number of activated pixels in the right and left hemispheres. A language laterality score was derived from the Wada results as the percentage of correct responses during right internal carotid artery injection minus the percentage of correct responses during left internal carotid injection. A correlation coefficient between the functional MR imaging results and the Wada language laterality scores was calculated. RESULTS: In 13 patients, hemispheric dominance based on Wada testing was confirmed by functional MR imaging during silent word generation. The Wada laterality scores varied from 100 to -100 and the functional MR imaging scores varied from 100 to -10. The language lateralization scores determined by functional MR imaging correlated significantly with the language lateralization scores derived from Wada testing. CONCLUSION: Functional MR imaging performed during word generation is an accurate method for lateralizing language function in patients with complex partial epilepsy.

Cortical activation response to acoustic echo planar scanner noise.

PURPOSE: Our goal was to determine the distribution of auditory and language cortex activation in response to acoustic echo planar scanner noise with functional MRI (fMRI). METHOD: Acoustic scanner noise and spoken text, reproduced on high output cassette tape, were separately delivered at equivalent intensities to six normal hearing adult volunteers through earphones during fMRI data acquisition. In nine other subjects, taped scanner noise was delivered in five successive iterations of the task to assess the consistency of cortical activation to the noise stimulus. Gyri of the auditory and language system were divided into 10 different subregions for analysis of cortical activation. The number of activated pixels and proportion of volunteers activating each cortical subregion were determined using a cross-correlation analysis. RESULTS: Cortical activation to taped acoustic scanner noise was present within the transverse temporal gyrus (primary auditory cortex) in all subjects, but activation was highly variable between subjects in auditory association and language relevant cortex. Auditory association cortex activation was seen in the planum polari, planum temporali, and middle temporal gyrus/superior temporal sulcus regions in one-half to two-thirds of the volunteers. There was no significant difference in the distribution of cortical activation within individual subjects across five successive iterations of the scanner noise task. Listening to spoken text consistently activated primary and association auditory cortex bilaterally as well as language relevant cortex in some cases. The mean number of activated pixels was significantly greater for text listening than acoustic scanner noise in auditory association and language relevant cortical subregions (p < 0.01), although the distribution of activity was similar between the two tasks. CONCLUSION: This preliminary investigation suggests that the complex sounds produced by the echo planar pulse sequence can activate relatively large regions of auditory and language cortex bilaterally, with the extent of activation outside the primary auditory cortex being variable between subjects. However, the distribution of activation within individual subjects was relatively constant across several iterations of the scanner noise stimulus.

Hemispheric language dominance studied with functional MR: preliminary study in healthy volunteers and patients with epilepsy.

PURPOSE: We used functional MR imaging to compare hemispheric language dominance in healthy volunteers and in patients with epilepsy. METHODS: We retrospectively reviewed the functional MR images of 23 healthy volunteers and 16 patients with epilepsy obtained by using an echo-planar technique designed for whole-brain imaging. The activation paradigm used was a silent word generation task. Hemispheric language dominance was assessed as the percentage of activated pixels in the left hemisphere minus the percentage of activated pixels in the right hemisphere x 100. RESULTS: We found no significant difference in language lateralization between right-handed male and right-handed female volunteers. However, a statistically significant difference in language distribution was found between left- and right-handed female volunteers. The left-handed female volunteers showed a more bilateral hemispheric language lateralization. Language lateralization in right-handed male epilepsy patients with early age at seizure onset and seizure locus in the left temporal lobe was not significantly different from that of healthy right-handed male volunteers. Similarly, we found no difference in language lateralization between right-handed female volunteers and right-handed female epilepsy patients with late age at seizure onset and seizures in the left temporal lobe. CONCLUSION: Handedness has a significant influence on hemispheric language dominance in healthy volunteers. Sex has no influence on hemispheric language dominance, regardless of the task used to assess such dominance, nor does age at seizure onset influence language lateralization in patients with left temporal lobe epilepsy. Therefore, hemispheric language dominance can be assessed and compared effectively with functional MR imaging.

Functional MR activation correlated with intraoperative cortical mapping.

PURPOSE: To evaluate the spatial specificity of functional MR imaging by comparing it with intraoperative electrocortical mapping. METHODS: Functional MR imaging was performed in 28 patients before awake craniotomy and intraoperative electrocortical mapping. Activation was mapped for finger movement, lip movement, tongue movement, word generation, and counting paradigms. During surgery, finger movement, lip movement, tongue movement, counting, and/or speaking were mapped. The functional images and the photographic recordings of the brain functions mapped during surgery were converted to bit maps and coregistered by a computer program. The distance between the intraoperatively mapped function site and the MR activation site for a comparable function was measured. RESULTS: Forty-six functions were recorded on MR images and intraoperative maps. In 100% of correlations, the intraoperative site and the MR activation site were within 20 mm; in 87% of correlations they were within 10 mm. For each paradigm, 67% or more of the intraoperative stimulation maps correlated within 10 mm of the MR activation site. CONCLUSIONS: For the tasks used in this study, the activation site on functional MR images correlated well with the site at which intraoperative stimulation identified function.

Functional magnetic resonance imaging of the somatosensory cortex.

Functional magnetic resonance (fMR) imaging, like positron emission tomography (PET), shows regions of activation in the brain resulting from the neuronal activity associated with cognitive, sensory, or motor function. An advantage of fMR imaging is that the functional and the reference anatomic images are acquired simultaneously. Additionally, fMR imaging is generally more available than PET or magnetoencephalography. This article reviews the applications of fMR imaging for studying the sensorimotor cortex prior to craniotomy.

Functional MR of the primary auditory cortex: an analysis of pure tone activation and tone discrimination.

PURPOSE: To use functional MR imaging to measure the effect of frequency (pitch), intensity (loudness), and complexity of auditory stimuli on activation in the primary and secondary auditory cortexes. METHODS: Multiplanar echo-planar images were acquired in healthy subjects with normal hearing to whom auditory stimuli were presented intermittently. Functional images were processed from the echo-planar images with conventional postprocessing methods. The stimuli included pure tones with a single frequency and intensity, pure tones with the frequency stepped between 1,000, 2,000, 3,000, or 4,000 Hz, and spoken text. The pixels activated by each task in the transverse temporal gyrus (TTG) and the auditory association areas were tabulated. RESULTS: The pure tone task activated the TTG. The 1,000-Hz tone activated significantly more pixels in the TTG than did the 4,000-Hz tone. The 4,000-Hz tone activated pixels primarily in the medial TTG, whereas the 1,000-Hz tone activated more pixels in the lateral TTG. Higher intensity tones activated significantly more pixels than did lower intensity tones at the same frequency. The stepped tones activated more pixels than the pure tones, but the difference was not significant. The text task produced significantly more activation than did the pure tones in the TTG and in the auditory association areas. The more complex tasks (stepped tones and listening to text) tended to activate more pixels in the left hemisphere than in the right, whereas the simpler tasks activated similar numbers of pixels in each hemisphere. CONCLUSION: Auditory stimuli activate the TTG and the association areas. Activation in the primary auditory cortex depends on frequency, intensity, and complexity of the auditory stimulus. Activation of the auditory association areas requires more complex auditory stimuli, such as the stepped tone task or text reading.

Hypercapnia reversibly suppresses low-frequency fluctuations in the human motor cortex during rest using echo-planar MRI.

Using magnetic resonance (MR) echo-planar imaging (EPI), we recently demonstrated the presence of low-frequency fluctuations (< 0.1 Hz) in MR signal intensity from the resting human brain that have a high degree of temporal correlation (p < 10(-3)) within and across associated regions of the sensorimotor cortex. These fluctuations in MR signal intensity are believed to arise from fluctuations in capillary blood flow and oxygenation. A substantial overlap between the activation map generated by bilateral finger tapping and temporally-correlated voxels from the sensorimotor cortex obtained during rest was observed. In the work reported here, we investigated whether respiratory hypercapnia, which is known to suspend spontaneous oscillations in regional cerebral blood flow, influences these low-frequency fluctuations. The magnitude of low-frequency fluctuations was reversibly diminished during hypercapnia, resulting in a substantial decrease of the temporal correlation both within and across contralateral hemispheres of the sensorimotor cortex. After the breathing mixture was returned to ambient air, the magnitude and spatial extent of the temporal correlation of low-frequency fluctuations returned to normal. Results of this study support the hypothesis that low-frequency physiological fluctuations observed by MR in the human cortex and spontaneous flow oscillations observed in early studies by laser-Doppler flowmetry (LDF) in the cortex of the rat are identical and are secondary to fluctuations in neuronal activity.

Functional imaging in treatment planning of brain lesions.

PURPOSE: Explore the use of functional imaging data in radiation treatment planning of brain lesions. METHODS AND MATERIALS: Compare the treatment-planning process with and without the use of functional brain imaging for clinical cases where functional studies using either single photon emission computed tomography or magnetic resonance imaging are available. RESULTS: A method to register functional image data with planning image studies is needed for functional treatment planning. Functional volumes are not simply connected regions. One activation study may produce many isolated functional areas. After finding the functional volumes and registering the functional information with the planning imaging data, the tools used for conventional three-dimensional treatment planning are sufficient for functional treatment planning. However, the planning system must provide dose-volume histograms for volumes of interest that consist of isolated pieces. Treatment plans that spare functional brain while providing identical target coverage can be constructed for lesions situated near the functional volume. However, the dose to other areas of the brain may be increased. CONCLUSIONS: Functional imaging will make determination of dose response of eloquent areas of the brain possible when combined with volumetric dose information and neuropsychological evaluation prior to and after radiation therapy. Realizing the full potential of functional imaging studies will require improved delineation of activated volumes and determination of the uncertainties in functional volume delineation. Optimization of treatment plans by minimizing dose to volumes activated during functional imaging studies should be used cautiously, because the dose to "silent," but possibly eloquent, brain may be increased.

Functional magnetic resonance imaging mapping of the motor cortex in patients with cerebral tumors.

OBJECTIVE: The purpose of this study was to determine the usefulness of functional magnetic resonance imaging (FMRI) to map cerebral functions in patients with frontal or parietal tumors. METHODS: Charts and images of patients with cerebral tumors or vascular malformations who underwent FMRI with an echoplanar technique were reviewed. The FMRI maps of motor (11 patients), tactile sensory (12 patients), and language tasks (4 patients) were obtained. The location of the FMRI activation and the positive responses to intraoperative cortical stimulation were compared. The reliability of the paradigms for mapping the rolandic cortex was evaluated. RESULTS: Rolandic cortex was activated by tactile tasks in all 12 patients and by motor tasks in 10 of 11 patients. Language tasks elicited activation in each of the four patients. Activation was obtained within edematous brain and adjacent to tumors. FMRI in three cases with intraoperative electrocortical mapping results showed activation for a language, tactile, or motor task within the same gyrus in which stimulation elicited a related motor, sensory, or language function. In patients with > 2 cm between the margin of the tumor, as revealed by magnetic resonance imaging, and the activation, no decline in motor function occurred from surgical resection. CONCLUSIONS: FMRI of tactile, motor, and language tasks is feasible in patients with cerebral tumors. FMRI shows promise as a means of determining the risk of a postoperative motor deficit from surgical resection of frontal or parietal tumors.

Effect of motion outside the field of view on functional MR.

PURPOSE: To evaluate the effect of objects moving outside the field of view on functional MR imaging. METHODS: Echo-Planar image sequences were acquired in the sagittal plane of a stationary phantom or of the head of a volunteer subject while a second phantom was moved periodically outside the field of view. The signal intensity changes in each pixel within the field of view were measured. RESULTS: Movement of the phantom outside the field of view produced signal intensity changes in the field of view that equaled or exceeded typical functional activation without the latency that characterizes activation. The greatest changes occurred at the bottom and top edges in the phantom and at the interfaces in the head. CONCLUSION: If temporally correlated with the performance of a task, movement of objects or tissues outside the field of view may produce artifactual changes in signal intensity. The artifactual signal intensity changes were characterized by their location, greater magnitude, and more rapid rise to maximum than seen with typical "activation."

Ipsilateral hemisphere activation during motor and sensory tasks.

PURPOSE: To compare activation of the ipsilateral cerebral hemisphere during tactile sensory and motor tasks involving the right and left hands. METHODS: Eight volunteers had functional MR imaging to measure the extent of cerebral hemisphere activation during a motor task and sensory task involving each hand. Hemispheric indexes (left hemisphere activation minus right hemisphere activation)/(left hemisphere activation plus right hemisphere activation) were computed for each hand and each task. The indexes for two tasks and the two hands were compared. RESULTS: The left-hand motor tasks activated the ipsilateral hemisphere in right handers significantly more than did the right-hand tasks. Motor tasks produced a greater activation of the ipsilateral hemisphere than did the sensory tasks. No significant differences were found between the hemispheric indexes for the right-hand and left-hand sensory tasks. CONCLUSION: This study confirms findings of a previous study, showing that the left hemisphere is active in left-hand motor tasks. Activation of the ipsilateral hemisphere is significantly less pronounced during sensory tasks than during motor tasks.

Test-retest precision of functional MR in sensory and motor task activation.

PURPOSE: To determine the test-retest precision of functional MR maps of regions in the brain "activated" by sensory, motor, and cognitive tasks. METHODS: Echo-planar images were acquired at 1.5 T in four subjects during voluntary motor activity involving the thumb and fingers and during tactile stimulation of the palm. Each subject performed the two tasks twice. Functional images of each task were generated at three thresholds. Test-retest precision was calculated in terms of two ratios: 1) the pixels activated in both iterations of the tasks in proportion to the pixels activated by either iteration of the task, and 2) the ratio modified to include first-order neighboring pixels. The first is referred to as pixel precision, and the latter as first-order-neighbor pixel precision. RESULTS: In each subject, activation from the first and second iteration of each task was located in the same region of the same gyrus. Pixel precision was .57 for the two tasks (at a threshold of 0.50). First-order-neighbor precision was greater than .80 for the two tasks at the same threshold. CONCLUSION: High test-retest precision can be obtained in functional MR.

Location of the sensorimotor cortex: functional and conventional MR compared.

PURPOSE: To determine the value of functional MR imaging to supplement conventional MR imaging for locating the rolandic cortex. METHODS: Parasagittal MR images acquired in conjunction with functional MR images were reviewed. The central sulcus was identified on the MR images by conventional parcellation methods. In the functional MR images, the sensorimotor cortex (rolandic cortex) was identified by the activation secondary to finger and thumb movement or tactile stimulation of the palm. The location of the central sulcus and rolandic cortex was compared. RESULTS: In 18 of 23 studies, the central sulcus selected by anatomic criteria coincided exactly or approximately with the cortex activated by the motor or sensory tasks. In two cases of tumor, the rolandic cortex could be located by means of the activation, but the central sulcus was not identified because of severe distortion of anatomic landmarks. In two volunteers, the central sulcus identified by anatomic landmarks did not coincide with the activated cortex. CONCLUSION: This study demonstrates that functional imaging supplements anatomic imaging in locating the sensorimotor cortex. Functional MR imaging may be a useful adjunct to conventional MR imaging to determine noninvasively the proximity of eloquent brain to focal brain lesions.

Functional connectivity in the motor cortex of resting human brain using echo-planar MRI.

An MRI time course of 512 echo-planar images (EPI) in resting human brain obtained every 250 ms reveals fluctuations in signal intensity in each pixel that have a physiologic origin. Regions of the sensorimotor cortex that were activated secondary to hand movement were identified using functional MRI methodology (FMRI). Time courses of low frequency (< 0.1 Hz) fluctuations in resting brain were observed to have a high degree of temporal correlation (P < 10(-3)) within these regions and also with time courses in several other regions that can be associated with motor function. It is concluded that correlation of low frequency fluctuations, which may arise from fluctuations in blood oxygenation or flow, is a manifestation of functional connectivity of the brain.

Functional magnetic resonance imaging mapping of the sensorimotor cortex with tactile stimulation.

The purpose of this study is to compare tactile stimulation of the palm with voluntary movement of the fingers as paradigms for mapping the sensorimotor cortex in functional magnetic resonance imaging. In 22 subjects, 24 sets of functional magnetic resonance images were obtained with echoplanar acquisitions and cross-correlation image processing techniques. Two tasks were employed: a motor task in which subjects moved the thumb and index finger of one hand and a sensory task in which the palm was scratched by another person. The activation from the two tasks coincided entirely in 20 sets and partially in 3 sets. In one case, no activation was seen with the motor task. The study suggests that tactile stimulation of the palm is useful and reliable for mapping the sensorimotor cortex.

A comparison of functional MR activation patterns during silent and audible language tasks.

PURPOSE: To compare word generation tasks performed silently and aloud as paradigms for functional MR. METHODS: Images were obtained at 1.5 T, with echoplanar acquisition in nine subjects performing word generation aloud or silently. Functional images created from the echoplanar images by means of cross-correlation techniques were superimposed on anatomic reference images. The location of activation from the two tasks was tabulated; the number of activated pixels in each region from the two tasks was compared. RESULTS: Both silent and aloud word generation produced activation in the inferior frontal lobes, sensorimotor cortex regions, supplementary motor areas, and anterior cingulate gyri, predominantly in the dominant hemisphere. Significantly more activated pixels and fewer artifacts were detected with silent word generation than with word generation aloud. CONCLUSION: Word generation silently or aloud produce activation in the brain. Greater activation can be detected in the left frontal lobe with silent word generation, although the subject's performance of the task cannot be monitored independently during silent word generation.

Functional magnetic resonance imaging in partial epilepsy.

Functional magnetic resonance imaging (FMRI) detects signal changes in brain that accompany regional changes in neuronal activity. In normal human brain, FMRI shows changes in signal in the postcentral gyrus or superior temporal gyrus that correlate with voluntary motor activity or language processing, respectively. The model used to explain the changes in signal linked temporally with cerebral activity is a reduction in cerebral capillary deoxyhemoglobin concentration due to the increased blood flow that accompanies neuronal activity in the cerebrum. FMRI has been used in normal subjects but not extensively in patients. To determine the feasibility of using FMRI to map cerebral functions in patients with partial epilepsy syndromes, we performed a pilot study, using FMRI to identify signal changes in motor and language areas in response to tasks that activate those areas. Signal changes in epilepsy patients approximated those observed in volunteers. We conclude that FMRI can be developed as a method for functional cerebral mapping in partial epilepsies.

Effect of dose and field strength on enhancement with paramagnetic contrast media.

PURPOSE: To compare contrast enhancement per unit of dose of contrast medium in MR imaging at 0.5 and 1.5 T. METHODS: Contrast enhancement in images made at 0.5 and 1.5 T after 0.1 mmol/kg of gadopentetate dimeglumine and 0.3 mmol/kg of gadodiamide was measured and the degree of contrast enhancement in the cavernous sinus and pituitary gland compared. RESULTS: At both field strengths and both contrast medium doses, contrast enhancement was noted in the cavernous sinus, pituitary gland, infundibulum, maxillary sinus mucosa, falx cerebri, and choroid plexus on inspection of images. Enhancement was significantly and conspicuously less in the cavernous sinus and pituitary gland at 0.5 T (96% and 33%, respectively) than at 1.5 T (160% and 102%, respectively). No tissues were identified that enhanced only with the larger dose or higher field strength. CONCLUSION: In tissues that normally enhance after intravenous administration of gadolinium chelates, enhancement is greater at 1.5 T than at 0.5 T.