Visual activation in infants and young children studied by functional magnetic resonance imaging

Functional connectivity of the sensorimotor area in naturally sleeping infants

Patterns of cortical functional connectivity in normal infants were examined during natural sleep by observing the time course of very low frequency oscillations. Such oscillations represent fluctuations in blood oxygenation level and cortical blood flow thus allowing computation of neurophysiologic connectivity. Structural and resting-state information were acquired for 11 infants, with a mean age of 12.8 months, using a GE 1.5 T MR scanner. Resting-state data were processed and significant functional connectivity within the sensorimotor area was identified using independent component analysis. Unilateral functional connectivity in the developing sensory-motor cortices was observed. Power spectral analysis showed that slow frequency oscillations dominated the hemodynamic signal at this age, with, on average, a peak frequency for all subjects of 0.02 Hz. Our data suggest that there is more intrahemispheric than interhemispheric connectivity in the sensorimotor area of naturally sleeping infants. This non-invasive imaging technique, developed to allow reliable scanning of normal infants without sedation, enabled computation of neurophysiologic connectivity for the first time in naturally sleeping infants. Such techniques permit elucidation of the role of slow cortical oscillations during early brain development and may reveal critical information regarding the normative development and lateralization of brain networks across time.

Hemodynamic response to visual stimulation in newborn infants using functional near-infrared spectroscopy

Brain activity is associated with physiological changes, which alter the optical properties of tissue. These changes can be detected by near-infrared spectroscopy (NIRS). Aim of the study was to determine changes in cerebral oxygenation in response to stimulation in the visual cortex in newborn infants during spontaneous sleep in the first days of life. We used an in-house developed multichannel NIRS imaging instrument, the MCP-II, to measure changes in concentration of oxyhemoglobin (O(2)Hb) and deoxyhemoglobin (HHb) in specific brain areas. In 10 out of 15 subjects, a significant increase in O(2)Hb and/or a significant decrease in HHb were found in one or more channels over the occipital cortex. During stimulation, O(2)Hb increased by a mean of 0.98 mumol/l, HHb decreased by a mean 0.17 mumol/l, and total-Hb increased by a mean of 0.81 mumol/l. The hemodynamic response to visual stimulation in the occipital cortex in newborn infants is similar to adults. The increase in O(2)Hb and the simultaneous decrease in HHb during stimulation suggest an increase in cerebral blood flow (CBF) that overcompensates for the increased oxygen consumption (CMRO(2)) in the activated cortical area.

Developmental neuroimaging of the human ventral visual cortex

Here, we review recent results that investigate the development of the human ventral stream from childhood, through adolescence and into adulthood. Converging evidence suggests a differential developmental trajectory across ventral stream regions, in which face-selective regions show a particularly long developmental time course, taking more than a decade to become adult-like. We discuss the implications of these recent findings, how they relate to age-dependent improvements in recognition memory performance and propose possible neural mechanisms that might underlie this development. These results have important implications regarding the role of experience in shaping the ventral stream and the nature of the underlying representations.

Functional near-infrared spectroscopy: current status and future prospects

Near-infrared spectroscopy (NIRS), which was originally designed for clinical monitoring of tissue oxygenation, has been developing into a useful tool for neuroimaging studies (functional near-infrared spectroscopy). This technique, which is completely noninvasive, does not require strict motion restriction and can be used in a daily life environment. It is expected that NIRS will provide a new direction for cognitive neuroscience research, more so than other neuroimaging techniques, although several problems with NIRS remain to be explored. This review demonstrates the strengths and the advantages of NIRS, clarifies the problems, and identifies the limitations of NIRS measurements. Finally, its future prospects are described.

Injury and recovery in the developing brain: evidence from functional MRI studies of prematurely born children

Functional MRI (fMRI) might provide important insights into emerging data that suggest that recovery from injury can occur in the brains of children born prematurely. Strategies employing auditory stimulation demonstrate blood-oxygen-level-dependent (BOLD) activation in preterm infants as young as 33 weeks' gestational age, and reliable BOLD signal in response to visual stimulation occurs at term-equivalent age. Strategies based on fMRI are particularly suited to the study of language and memory, and emerging data are likely to provide insights into perplexing reports that have demonstrated improving cognitive scores but persistent volumetric and microstructural changes in frontotemporal language systems in the prematurely born. Even when sex, gestational age and early medical and environmental interventions are taken into account, fMRI data from several investigators suggest the engagement of alternative neural networks for language and memory in the developing preterm brain.

Resting-state networks in the infant brain

In the absence of any overt task performance, it has been shown that spontaneous, intrinsic brain activity is expressed as systemwide, resting-state networks in the adult brain. However, the route to adult patterns of resting-state activity through neuronal development in the human brain is currently unknown. Therefore, we used functional MRI to map patterns of resting-state activity in infants during sleep. We found five unique resting-states networks in the infant brain that encompassed the primary visual cortex, bilateral sensorimotor areas, bilateral auditory cortex, a network including the precuneus area, lateral parietal cortex, and the cerebellum as well as an anterior network that incorporated the medial and dorsolateral prefrontal cortex. These results suggest that resting-state networks driven by spontaneous signal fluctuations are present already in the infant brain. The potential link between the emergence of behavior and patterns of resting-state activity in the infant brain is discussed.

Functional magnetic resonance imaging of hearing-impaired children under sedation before cochlear implantation

OBJECTIVE

To investigate functional magnetic resonance imaging (fMRI) in pediatric cochlear implantation candidates with residual hearing who are under sedation for evaluation of auditory function.

DESIGN

During fMRI, subjects heard a random sequence of tones (250-4000 Hz) presented 10 dB above hearing thresholds. Tones were interleaved with silence in a block-periodic fMRI design with 30-second on-off intervals. Twenty-four axial sections (5 mm thick) covering most of the brain were obtained every 3 seconds for a total acquisition time of 5.5 minutes.

SETTING

Single tertiary academic medical institution.

PATIENTS

Severely to profoundly hearing-impaired children (n=10; mean age, 49.1 months). During fMRI, subjects were awake (n=2) or sedated with pentobarbital sodium if their weight was 10 kg or greater (n=4) or chloral hydrate if their weight was less than 10 kg (n=4).

MAIN OUTCOME MEASURES

Detection of brain activation by fMRI in the primary auditory cortex (A1) in hearing-impaired patients under sedation, and correlation of A1 activation with hearing levels measured after cochlear implantation.

RESULTS

In most subjects, fMRI detected significant levels of activation in the A1 region before cochlear implantation. The improvement in hearing threshold after cochlear implantation correlated strongly (linear regression coefficient, R=0.88) with the amount of activation in the A1 region detected by fMRI before cochlear implantation.

CONCLUSIONS

Functional MRI can be considered a means of assessing residual function in the A1 region in sedated hearing-impaired toddlers. With improvements in acquisition, processing, and sedation methods, fMRI may be translated into a prognostic indicator for outcome after cochlear implantation in infants.

Different neuronal networks are associated with spikes and slow activity in hypsarrhythmia

PURPOSE

West syndrome is a severe epileptic encephalopathy of infancy characterized by a poor developmental outcome and hypsarrhythmia. The pathogenesis of hypsarrhythmia is insufficiently understood.

METHODS

We investigated eight patients with infantile spasms and hypsarrhythmia (group I) and 8 children with complex partial seizures (group II) using simultaneous recordings of electroencephalogram (EEG) and functional MRI. Hemodynamic responses to epileptiform discharges and slow wave activity (EEG delta power) were analyzed separately.

RESULTS

In group I (mean age, 7.82 +/- 2.87 months), interictal spikes within the hypsarrhythmia were associated with positive blood oxygenation level-dependent (BOLD) changes in the cerebral cortex (especially occipital areas). This was comparable with cortical positive BOLD responses in group II (mean age, 20.75 +/- 12.52 months). Slow wave activity in group I correlated significantly with BOLD signal in voxels, which were localized in brainstem, thalamus, as well as different cortical areas. There was no association between BOLD effect and EEG delta power in group II. Moreover, as revealed by group analysis, group I differed from group II according to correlations between BOLD signal and slow wave activity in putamen and brainstem.

CONCLUSIONS

This study demonstrates that multifocal interictal spikes and high-amplitude slow wave activity within the hypsarrhythmia are associated with the activation of different neuronal networks. Although spikes caused a cortical activation pattern similar to that in focal epilepsies, slow wave activity produced a hypsarrhythmia-specific activation in cortex and subcortical structures such as brainstem, thalamus, and putamen.

Optical imaging of the neonatal brain

Optical systems could be valuable tools for assessing cerebral function at the cotside

Selectivity and localization of cortical response to auditory and visual stimulation in awake infants aged 2 to 4 months

To better understand the development of multimodal perception, we examined selectivity and localization of cortical responses to auditory and visual stimuli in young infants. Near-infrared optical topography with 24 channels was used to measure event-related cerebral oxygenation changes of the bilateral temporal cortex in 15 infants aged 2 to 4 months, when they were exposed to speech sounds lasting 3 s and checkerboard pattern reversals lasting 3 s, which were asynchronously presented with different alternating intervals. Group analysis revealed focal increases in oxy-hemoglobin and decreases in deoxy-hemoglobin in both hemispheres in response to auditory, but not to visual, stimulation. These results indicate that localized areas of the primary auditory cortex and the auditory association cortex are involved in auditory perception in infants as young as 2 months of age. In contrast to the hypothesis that perception of distinct sensory modalities may not be separated due to cross talk over the immature cortex in young infants, the present study suggests that unrelated visual events do not influence on the auditory perception of awake infants.

Is near-infrared spectroscopy living up to its promises?

The first clinical application of near-infrared spectroscopy (NIRS) was made 20 years ago on the head of newborn infants under intensive care. Since then NIRS has yielded much credible and some important clinical research data. The most important results have been obtained using the cumbersome but quantitative techniques for measuring cerebral blood flow, cerebral blood volume, or venous oxygen saturation with manipulation of FiO(2) or impeding venous outflow from the brain. The continuous nature of NIRS has been combined with monitoring of arterial pressure to obtain measures of cerebrovascular regulation, but this method has not been applied on a larger scale. Second-generation instruments allow a running estimate of vascular haemoglobin oxygen saturation, named the tissue oxygenation index (TOI), in absolute terms. Applied to the head, this is a surrogate measure of cerebro-venous saturation, an important variable in neuro-intensive care. The precision, however, is insufficient to be useful.

IN CONCLUSION

clinical application is not in sight.

Functional MRI of the newborn

In order to provide accurate prognosis and developmental intervention to newborns, new methods of assessing cerebral functions are needed. The non-invasive technique of functional magnetic resonance imaging (fMRI) can be considered as the leading technique for functional exploration of the infant's brain. Several studies have previously applied fMRI in both healthy and diseased newborns with different sensory and cognitive tasks. In this chapter, the methodological issues that are proper to the use of fMRI in the newborn are detailed. In addition, an overview of the major findings of previous fMRI studies is provided, with a focus on notable differences from those in adult subjects. More specifically, the functional responses and the localization of cortical activations in healthy and diseased newborns are discussed. We expect a rapid expansion of this field and the establishment of fMRI as a valid clinical diagnostic tool in the newborn.

Near-infrared frequency-domain optical spectroscopy and magnetic resonance imaging: a combined approach to studying cerebral maturation in neonatal rabbits

The neonatal rabbit brain shows prolonged postnatal development both structurally and physiologically. We use noninvasive near-IR frequency-domain optical spectroscopy (NIRS) and magnetic resonance imaging (MRI) to follow early developmental changes in cerebral oxygenation and anatomy, respectively. Four groups of animals are measured: NIRS in normals, MRI in normals, and both NIRS and MRI with hypoxia-ischemia (HI) (diffusion MRI staging). NIRS and/or MRI are performed from P3 (postnatal day=P) up to P76. NIRS is performed on awake animals with a frequency-domain tissue photometer. Absolute values of oxyhemoglobin concentration ([HbO2]), deoxyhemoglobin concentration ([HbR]), total hemoglobin concentration (HbT), and hemoglobin saturation (StO2) are calculated. The brains of all animals appeared to be maturing as shown in the diffusion tensor MRI. Mean optical coefficients (reduced scattering) remained unchanged in all animals throughout. StO2 increased in all animals (40% at P9 to 65% at P43) and there are no differences between normal, HI controls, and HI brains. The measured increase in StO2 is in agreement with the reported increase in blood flow during the first 2 months of life in rabbits. HbT, which reflects blood volume, peaked at postnatal day P17, as expected since the capillary density increases up to P17 when the microvasculature matures.

Noninvasive optical imaging in the visual cortex in young infants

During the developmental stage, the brain undergoes anatomic, functional, and metabolic changes necessary to support the complex adaptive behavior of a mature individual. Estimation of developmental changes occurring in different regions of the brain would provide a means of relating various behavioral phenomena to maturation-specific brain structures, thereby providing useful information on structure-function relationships in both normal and disease states. We used multichannel near-infrared spectroscopy (MNIRS), a new noninvasive imaging technique for revealing the course of neural activity in selected brain regions, to monitor the activities of the visual cortex as mirrored by hemodynamic responses in infants subjected to photostimulation during natural sleep. In the infants, oxyhemoglobin and total hemoglobin decreased and deoxyhemoglobin increased in the visual cortex with photostimulation. This pattern of responses was different from the response pattern in adults reported previously. The different patterns of responses to photostimulation in the visual cortices of infants and adults might reflect developmental and behavioral differences. It may reflect a different functional organization of the visual cortex in infants or ongoing retinal development. Our results demonstrated that regional hemodynamic change could be detected in a small area around the visual cortex. MNIRS offers considerable potential for research and noninvasive clinical applications.

Fetal brain activity and hemodynamic response to a vibroacoustic stimulus

Previous studies have demonstrated the practicality of using functional magnetic resonance imaging (fMRI) techniques to assess fetal brain activity. The purpose of this study was to compare the fetal hemodynamic response to that of the adult. Seventeen pregnant subjects, all of whom were at more than 36 weeks gestation were scanned while the fetus was exposed to a vibroacoustic stimulus. Thirteen adult subjects were scanned with an equivalent acoustic stimulus. Of the fetal subjects, two could not be analyzed due to technical problems, eight did not show significant activation, and seven showed significant activation. In all cases, activation was localized within the temporal region. Measures of fetal hemodynamic responses revealed an average time to peak (ttp) of 7.36 +/- 0.94 sec and an average percentage change of 2.67 +/- 0.93%. In contrast, activation was detected in 5 of 13 adults with an average ttp of 6.54 +/- 0.54 sec and an average percentage change of 1.02 +/- 0.40%. The measurement of changes in the fetal hemodynamic response may be important in assessing compromised pregnancies.

Application of new MR techniques in pediatric patients

Pediatric neuroradiology is a fascinating and challenging field because there are normal changes associated with normal development and unique and unusual pathologies that occur in this population. The numerous new MR techniques first applied in the adult population are appropriate for use in the pediatric population, often with minimal modification of parameters. These new techniques will undoubtedly contribute significantly to use of pediatric neuroimaging, but the adult experience is not always directly transferable. The pediatric brain, particularly the immature brain is different in structure, has predilection for different types of disease processes, and may react differently to insults than the adult brain. As a result, the role of these techniques needs to be evaluated in the context of the pediatric brain and common pediatric disease processes.

Understanding Other Minds: Linking Developmental Psychology and Functional Neuroimaging

Evidence from developmental psychology suggests that understanding other minds constitutes a special domain of cognition with at least two components: an early-developing system for reasoning about goals, perceptions, and emotions, and a later-developing system for representing the contents of beliefs. Neuroimaging reinforces and elaborates upon this view by providing evidence that (a) domain-specific brain regions exist for representing belief contents, (b) these regions are apparently distinct from other regions engaged in reasoning about goals and actions (suggesting that the two developmental stages reflect the emergence of two distinct systems, rather than the elaboration of a single system), and (c) these regions are distinct from brain regions engaged in inhibitory control and in syntactic processing. The clear neural distinction between these processes is evidence that belief attribution is not dependent on either inhibitory control or syntax, but is subserved by a specialized neural system for theory of mind.

Combination of event-related fMRI and diffusion tensor imaging in an infant with perinatal stroke

Focal ischemic brain injury, or stroke, is an important cause of later handicap in children. Early assessment of structure-function relationships after such injury will provide insight into clinico-anatomic correlation and potentially guide early intervention strategies. We used combined functional MRI (fMRI) with diffusion tensor imaging (DTI) in a 3-month-old infant to explore the structure-function relationship after unilateral perinatal stroke that involved the visual pathways. With visual stimuli, fMRI showed a negative BOLD activation in the visual cortex of the intact right hemisphere, principally in the anterior part, and no activation in the injured hemisphere. The functional activation in the intact hemisphere correlated clearly with the fiber tract of the optic radiation visualized with DTI. DTI confirmed the absence of the optic radiation in the damaged left hemisphere. In addition, event-related fMRI (ER-fMRI) experiments were performed to define the characteristics of the BOLD response. The shape is that of an inverted gamma function (similar to a negative mirror image of the known positive adult BOLD response). The maximum decrease was reached at 5-7 s with signal changes of -1.7 +/- 0.4%.Thus, this report describes for the first time the combined use of DTI and event-related fMRI in an infant and provides insight into the localization of the fMRI visual response in the young infant and the characteristics of the BOLD response.

Fetal brain activity in response to a visual stimulus

Previous studies have demonstrated the use of functional magnetic resonance imaging (fMRI) to assess fetal brain activity. To extend these studies, a fetal fMRI experiment using a visual stimulus has been performed at 0.5 T. This used a block fMRI paradigm with a bright, constant-intensity light source being shone at the maternal abdomen for 8 sec followed by 16 sec of darkness. This was repeated typically 40 times on nine subjects all of whom were greater than 36 weeks gestational age. Of these, one could not be analysed due to motion, three did not show significant activation, and five showed significant activation (P < 0.0085). In all cases, activation was localised within the frontal cortex. Exact localisation was difficult but this may correspond to the frontal eye fields and dorsolateral prefontal cortex. In no cases was significant activation present within the occipital region as would have been expected and was observed in 2/8 adult subjects. Hum. Brain Mapping 20:239-245, 2003.

Hemodynamic responses to visual stimulation in occipital and frontal cortex of newborn infants: a near-infrared optical topography study

A near-infrared optical topography (OT) was used to reveal spatio-temporal changes in the cerebral oxygenation of newborn infants in response to brief visual stimulation. Newborn infants were presented 3-s stroboscopic light flashing at 14 Hz during spontaneous sleep. Event-related changes in oxy- and deoxyhemoglobin ([oxy-Hb] and [deoxy-Hb]) were observed over the occipital and frontal cortex. The visual stimulus produced statistically significant increases in oxyhemoglobin not only in the occipital cortex but also in the prefrontal cortex. These results suggest that the cerebrovascular coupling is already functioning in newborn's brain. The prefrontal activation implies that it may contribute to early processing of sensory signals.

Functional MRI in neonates using neonatal head coil and MR compatible incubator

Structural and functional magnetic resonance imaging of the newborn brain is a complex and challenging task. Term and preterm neonates require a controlled microenvironment and close monitoring during the MRI study to maintain respiratory and cardiovascular functions, body temperature, and fluid and electrolyte homeostasis. In addition, to minimize motion artifacts, most neonates also need to be sedated, which carries the risk of respiratory depression compromising the neonate's ability to maintain appropriate ventilation and oxygenation during the procedure. Finally, because of their small head size, the use of the standard MR head coils results in suboptimal picture quality in the neonate. Thus, these limitations affect our ability to obtain both high quality structural and functional MRI studies. To overcome these difficulties, we have utilized an MR compatible incubator with a built-in radiofrequency head coil optimized for the neonatal brain volume. In this study we demonstrate that functional MRI and high-resolution structural MRI of the newborn brain can be achieved with this novel design. The use of this equipment offers potential for studying the development of the preterm and term neonatal brain and obtaining state-of-the-art, high-resolution structural and functional imaging in this most vulnerable patient population.

Brain imaging in awake infants by near-infrared optical topography

Studies of young infants are critical to understand perceptual, motor, and cognitive processing in humans. However, brain mechanisms involved are poorly understood, because the use of brain-imaging methods such as functional magnetic resonance imaging in awake infants is difficult. In the present study we show functional brain imaging of awake infants viewing visual stimuli by means of multichannel near-infrared spectroscopy, a technique that permits a measurement of cerebral hemoglobin oxygenation in response to brain activation through the intact skull without subject constraint. We found that event-related increases in oxyhemoglobin were evident in localized areas of the occipital cortex of infants aged 2-4 months in response to a brief presentation of a checkerboard pattern reversal while they maintained fixation to attention-grabbing stimuli. The dynamic change in cerebral blood oxygenation was qualitatively similar to that observed in the adult brain. This result introduces near-infrared optical topography as a method for investigating the functional development of the brain in early infancy.

Functional magnetic resonance imaging and its clinical utility in patients with visual disturbances

Functional magnetic resonance imaging (fMRI) is a powerful, non-invasive technique for mapping human brain function. Because of the robust signal intensity changes associated with visual stimuli, fMRI is particularly useful for studying visual cortex (including both striate and extrastriate cortex). Also, activation of the lateral geniculate nuclei has been successfully demonstrated by fMRI. Therefore, fMRI may be potentially useful in patients with visual deficits by providing a non-invasive method for assessing the afferent visual pathways and higher cortical areas. Although there have been several reviews on fMRI, few have highlighted its clinical applicability in patients with visual disturbances. Our article will review fMRI principles and methodology, then focus on the possible applications and limitations of this technique in clinical ophthalmology.

Cortical deactivation induced by visual stimulation in human slow-wave sleep

It has previously been demonstrated that sleeping and sedated young children respond with a paradoxical decrease in the blood oxygenation level-dependent (BOLD) functional magnetic resonance imaging (fMRI) signal in the rostro-medial occipital visual cortex during visual stimulation. It is unresolved whether this negative BOLD response pattern is of developmental neurobiological origin particular to a given age or to a general effect of sleep or sedative drugs. To further elucidate this issue, we used fMRI and positron emission tomography (PET) to study the brain activation pattern during visual stimulation in spontaneously sleeping adult volunteers. In five sleeping volunteers fMRI studies confirmed a robust signal decrease during stimulation in the rostro-medial occipital cortex. A similar relative decrease at the same location was found during visual stimulation and polysomnographically verified slow-wave sleep in a separate group of six subjects using H(2)(15)O PET measures of the regional cerebral blood flow (rCBF). This decrease was more rostro-dorsal compared to the relative rCBF increase along the calcarine sulcus found during visual stimulation in the awake state. This study reconfirms the previously described paradoxical stimulation-correlated negative BOLD signal change in the rostro-medial occipital cortex, expanding this response mode to an age spectrum ranging from the newborn to the adult. Further, the use of complementary brain mapping techniques suggests that this decrease was secondary to a relative rCBF decrease. Possible mechanisms for the paradoxical response pattern during sleep include an active inhibition of the visual cortex or a disruption of an energy-consuming process.

Age-dependent change in metabolic response to photic stimulation of the primary visual cortex in infants: functional magnetic resonance imaging study

The blood oxygen level-dependent (BOLD) response to photic stimulation in the primary visual cortex (V1) reverses from positive to negative around 8 weeks of age. This phenomenon may be caused by increased oxygen consumption during stimulation as the result of a rapid increase of synaptic density at this age. To test this hypothesis, we applied existing mathematic models of BOLD signals to the experimental data from infants. When the stimulus-related increments of cerebral blood flow and cerebral blood volume were fixed at 60% and 20%, respectively, the mean estimated increment of the cerebral metabolic rate of oxygen of the V1 in the elder infant group (57.1% +/- 8.8%) was twice as large as that in the younger infant group (32.2% +/- 4.7%), which corresponds to the reported difference in synaptic density. The present data confirmed that a change in oxygen consumption could explain a transition from a positive to a negative BOLD response.

Paradoxical correlation between signal in functional magnetic resonance imaging and deoxygenated haemoglobin content in capillaries: a new theoretical explanation

Signal increases in functional magnetic resonance imaging (fMRI) are believed to be a result of decreased paramagnetic deoxygenated haemoglobin (deoxyHb) content in the neural activation area. However, discrepancies in this canonical blood oxygenation level dependent (BOLD) theory have been pointed out in studies using optical techniques, which directly measure haemoglobin changes. To explain the discrepancies, we developed a new theory bridging magnetic resonance (MR) signal and haemoglobin changes. We focused on capillary influences, which have been neglected in most previous fMRI studies and performed a combined fMRI and near-infrared spectroscopy (NIRS) study using a language task. Paradoxically, both the MR signal and deoxyHb content increased in Broca's area. On the other hand, fMRI activation in the auditory area near large veins correlated with a mirror-image decrease in deoxyHb and increase in oxygenated haemoglobin (oxyHb), in agreement with canonical BOLD theory. All fMRI signal changes correlated consistently with changes in oxyHb, the diamagnetism of which is insensitive to MR. We concluded that the discrepancy with the canonical BOLD theory is caused by the fact that the BOLD theory ignores the effect of the capillaries. Our theory explains the paradoxical phenomena of the oxyHb and deoxyHb contributions to the MR signal and gives a new insight into the precise haemodynamics of activation by analysing fMRI and NIRS data.

Bedside functional imaging of the premature infant brain during passive motor activation

BACKGROUND

Changes in regional brain blood flow and hemoglobin oxygen saturation occur in the human cortex in response to neural activation. Traditional functional radiologic methods cannot provide continuous, portable measurements. Imaging methods, which use near-infrared light allow for non-invasive measurements by taking advantage of the fact that hemoglobin is a strong absorber at these wavelengths.

AIMS

To test the feasibility of a new optical functional imaging system in premature infants, and to obtain preliminary brain imaging of passive motor activation in this population.

METHODS

A new optical imaging system, the Diffuse Optical Tomography System (DOTS), was used to provide real-time, bedside assessments. Custom-made soft flexible fiberoptic probes were placed on two extremely ill, mechanically ventilated 24 week premature infants, and three healthier 32 week premature infants. Passive motor stimulation protocols were used during imaging.

RESULTS

Specific movement of the arm resulted in reproducible focal, contralateral changes in cerebral absorption. The data suggest an overall increase in blood volume to the imaged area, as well as an increase in deoxyhemoglobin concentration. These findings in premature infants differ from those expected in adults.

CONCLUSIONS

In the intensive care setting, continuous non-invasive optical functional imaging could be critically important and, with further study, may provide a bedside monitoring tool for prospectively identifying patients at high risk for brain injury.

Visual cortex reactivity in sedated children examined with perfusion MRI (FAIR)

Sleeping and sedated children can respond to visual stimulation with a decrease in blood oxygenation level dependent (BOLD) functional MRI signal response. The contribution of metabolic and hemodynamic parameters to this inverse signal response is incompletely understood. It has been hypothesized that it is caused by a relatively greater increase of oxygen consumption compared to rCBF (regional cerebral blood flow) increase. We studied the rCBF changes during visual stimulation in four sedated children, aged 4-71 months, and four alert adults, with an arterial water spin labeling technique (FAIR) and BOLD fMRI in a 1.5T MR scanner. In the children, FAIR signal decreased by a mean of 0.96% (range 0.77-1.05) of the baseline periods of the non-selective images, while BOLD signal decreased by 2.03% (range 1.99-2.93). In the adults, FAIR and BOLD signal increased by 0.88% (range 0.8-0.99) and 2.63% (range 1.99-2.93), respectively. Thus, in the children, an rCBF increase could not be detected by perfusion MRI, but indications of a FAIR signal decrease were found. An rCBF decrease in the primary visual cortex during stimulation has not been reported previously, but it is a possible explanation for the negative BOLD response. Future studies will have to address if this response pattern is a consequence of age or sleep/sedation.

Pediatric functional magnetic resonance imaging: progress and challenges

Functional magnetic resonance imaging (fMRI) in the pediatric population promises to provide novel insights into the nature of both normal and abnormal functional brain development as well as changes in brain function due to various interventions. Although acquisition of fMRI data from children is associated with a number of methodological challenges, primarily compliance and head motion, good quality data can be obtained. For example, conditioning and personal interactions can improve compliance, and motion reduction techniques can successfully reduce artifacts due to head motion. Analysis of pediatric fMRI data also involves challenges regarding spatial normalization and characterization of the hemodynamic response across development. Substantial progress has been made in understanding cognitive function and developmental disorders in children, but attention to the methodological issues raised in this review and continued investigations in this area are expected to result in further progress.

Task-related signal decrease on functional magnetic resonance imaging

An atypical pattern of signal change was identified on functional magnetic resonance (fMR) imaging in pathologic patients. Three normal volunteers and 34 patients with pathologic lesions near the primary motor cortex underwent fMR imaging with echo-planar imaging while performing a hand motor task. Signal intensities were evaluated with the z-score method, and the time course and changes of the signal intensity were calculated. Nine of the 34 patients with pathologic lesions displayed a significant task-related signal reduction in motor-related areas. They also presented a conventional task-related signal increase in other motor-related areas. The time courses of the increase and decrease were the inverse of each other. There was no significant difference between rates of signal increase and decrease. Our findings suggest that this atypical signal decrease is clinically significant, and that impaired vascular reactivity and altered oxygen metabolism could contribute to the task-related signal reduction. Brain areas showing such task-related signal decrease should be preserved at surgery.

Comparison between anisometropic and strabismic amblyopia using functional magnetic resonance imaging

AIMS

To assess calcarine activation with functional magnetic resonance imaging (fMRI) in patients with anisometropic and strabismic amblyopia.

METHODS

14 amblyopes (eight anisometropic and six strabismic) were studied with fMRI using stimuli of checkerboards of various checker sizes and temporal frequencies. While T2* weighted MRI were obtained every 3 seconds for 6 minutes, patients viewed the stimuli monocularly with either the amblyopic or sound eye.

RESULTS

Amblyopic eyes showed reduced calcarine activation compared with contralateral sound eyes in fMRI in all subjects. The calcarine activation from amblyopic eyes in anisometropic amblyopes was more suppressed at higher spatial frequencies, while that from amblyopic eyes in strabismic amblyopes was more suppressed at lower spatial frequencies.

CONCLUSION

These results suggest that fMRI is a useful tool for the study of amblyopia in humans. The calcarine activation via amblyopic eyes because of anisometropia or strabismus has different temporospatial characteristics, which suggests differences in the neurophysiological mechanisms between two types of amblyopia.

Ocular dominance in anterior visual cortex in a child demonstrated by the use of fMRI

Negative signal changes in the visual cortex have been observed during visual stimulation when performing functional magnetic resonance imaging (fMRI) in children. This report investigated whether the ocular dominance, which has been demonstrated in the contralateral anterior visual cortex in adults, could be observed in a child by the use of fMRI. A 5-year-old child was studied using fMRI at 1.5 T during alternating monocular visual stimulation under sedation with morphine and pentobarbital. The functional images were motion corrected, and statistical parametric maps were made by contrasting the left or right eye stimulation conditions vs the right or left eye stimulation conditions, respectively, at each voxel. Areas with negative signal changes were found on the left anterior visual cortex during monocular visual stimulation of the right eye and vice versa. There was no area with negative or positive signal change on the ipsilateral visual cortex to the stimulated eye and no area with positive signal change on the contralateral visual cortex. Contralateral ocular dominance of anterior visual cortex similar to that of adults was demonstrated in this child with a negative correlation with the visual stimulus. This finding suggests that peripheral visual fields are represented in the anterior visual cortex of 5-year-old children.

Functional imaging of the brain in sedated newborn infants using near infrared topography during passive knee movement

Near infrared topography was used for functional imaging of the sensorimotor cortex of newborn infants during passive knee movement under sedated sleep. Contralateral knee movement caused a marked increase in oxyhemoglobin and total hemoglobin from the baseline values at almost all locations in the primary sensorimotor area of all neonates and a decrease in local deoxyhemoglobin in six of seven neonates. During ipsilateral knee movement, oxyhemoglobin and total hemoglobin showed slighter changes at a few locations, equal to 30% (mean) and 29% (mean) of the changes that occurred with contralateral stimulation, respectively. The mean times corresponding to maximal changes were 11.9 s for oxyhemoglobin and 19.1 s for deoxyhemoglobin, demonstrating that oxyhemoglobin has a much faster response than does deoxyhemoglobin.

Developmental aspects of pediatric fMRI: considerations for image acquisition, analysis, and interpretation

Functional MRI provides a powerful means to identify and trace the evolution, development, and consolidation of cognitive neural networks through normal childhood. Neural network perturbations due to disease and other adverse factors during development can also be explored. Studies performed to date suggest that normal children older than 5 years show activation maps comparable to adults for similar cognitive paradigms. Minor differences in adult and pediatric activation maps may reflect age dependent strategies or maturation of cognitive networks. However, there are important physiologic and anatomic differences in children, varying with age, that may affect the acquisition, analysis, and interpretation of pediatric fMRI data. Differences between children and adult fMRI comparison studies may reflect technical aspects of data acquisition as much as developmental and brain maturation factors.

Neonatal auditory activation detected by functional magnetic resonance imaging

The objective of this study was to detect auditory cortical activation in non-sedated neonates employing functional magnetic resonance imaging (fMRI). Using echo-planar functional brain imaging, subjects were presented with a frequency-modulated pure tone; the BOLD signal response was mapped in 5 mm-thick slices running parallel to the superior temporal gyrus. Twenty healthy neonates (13 term, 7 preterm) at term and 4 adult control subjects. Blood oxygen level-dependent (BOLD) signal in response to auditory stimulus was detected in all 4 adults and in 14 of the 20 neonates. FMRI studies of adult subjects demonstrated increased signal in the superior temporal regions during auditory stimulation. In contrast, signal decreases were detected during auditory stimulation in 9 of 14 newborns with BOLD response. fMRI can be used to detect brain activation with auditory stimulation in human infants.

New radiographic techniques to evaluate cerebrovascular disorders in children

The radiographic evaluation of the pediatric patient with cerebrovascular disease has dramatically improved during the past decade. Few new technologies have been introduced, but significant new developments in data acquisition and post-processing have resulted from refinements in both software and, to a lesser extent, hardware. This review focuses on the advantages and limitations of the different imaging modalities and their recommended role in managing the pediatric patient who presents with signs or symptoms of cerebrovascular disease.

Hemodynamic responses to photic stimulation in neonates

A three-channel near-infrared monitoring system was used to evaluate the regional hemodynamic responses to photic stimulation during spontaneous sleep in seven healthy neonates. Three pairs of parallel light guides, separated by 15 mm each, were placed over a 450-mm(2) occipital region of the head. Increases in oxygenated and total hemoglobin were observed during photic stimulation only in one channel, and no change or decreases in oxygenated, deoxygenated, and total hemoglobin were observed in the other two channels. The change in the direction of deoxygenated hemoglobin accompanying the increases in oxygenated and total hemoglobin (usually a decrease in adults) differed in each subject and also varied with each measurement even in the same subject. An increase, decrease, and no change were observed. The results imply that an increase in regional cerebral blood flow occurs because of stimulation specific to the visual cortex and that the increase in deoxygenated hemoglobin observed in the visual cortex of the neonatal brain is attributable to venous dilation.

Difference in the metabolic response to photic stimulation of the lateral geniculate nucleus and the primary visual cortex of infants: a fMRI study

The metabolic change that occurs during early development of the human brain was studied with functional magnetic resonance imaging (fMRI), in which the signal change reflects the balance between the supply and the demand of oxygen during stimulus-related neuronal activation. The subjects were 16 infants, aged < 1 year. They were sedated with pentobarbital, and 8-Hz flickering light was intermittently projected onto their eyelids. Two age groups were analyzed: infants < 60 days old and > 60 days old (corrected for gestational age at birth). The stimulus-related signal change was positive in the lateral geniculate nucleus regardless of the infants' age, but in the primary visual cortex reversed from positive in the younger group to negative in the older group. It is known that synaptogenesis in the lateral geniculate nucleus peaks before birth, and in the primary visual cortex accelerates in the second month after birth. Hence, the inversion of the stimulus-related signal change in the primary visual cortex may be due to an increased demand for oxygen owing to rapid synaptogenesis.

Adaptive mechanisms of developing brain. The neuroradiologic assessment of the preterm infant

Since the 1980s, cranial sonography has been routinely performed in premature infants. This has produced a wealth of information about the more dramatic central nervous system lesions of IVH, PVL, and late VM. This information has included timing and evolution of these lesions and their eventual correlation with outcome. For two reasons the advent of MR imaging scanning has produced an interest in using this modality to evaluate these same infants. First, MR imaging gives an obviously superior image, and its ability to detect lesions is far superior to that of ultrasound. Second, the ability of cranial sonography to detect all of the children with CP or low IQ is limited. In our studies of outcome in very low-birth weight infants grade 3 to 4 IVH, PVL, or VM are able to detect only about 50% of the infants who developed CP by 3 years. This condition should be highly correlated with structural brain disease; an imaging modality that was more sensitive to central nervous system lesions should offer an advantage in predicting outcome. In the only prospective assessment of the ability of these two modalities to predict outcome at 3 years, van de Bor and colleagues found MR imaging did not do better than cranial sonography. This was largely because both modalities detected the most severe lesions, and most children with milder lesions on MR imaging had normal outcome. Studies of late (age 1 to teenage years) MR imaging scans in preterm infants show that a high percentage have white matter lesions but these lesions correlate poorly with outcome. If our concern when counseling parents is to alert them when a serious adverse outcome is likely in their child, then cranial sonography is to be favored precisely because it is less able to detect subtle lesions, which the developing brain has the capacity to overcome. On the other hand, if our aim is to detect all lesions, even though these lesions do not predict serious adverse outcomes, then MR imaging is to be favored. Research aimed at discovering etiologies and mechanisms of brain injury in these high-risk infants should use the more sensitive modality MR imaging. Finally, the interesting observation that preterm infants fare as well as they do despite MR imaging-identified lesions might stimulate research studying the adaptive mechanisms of developing brain.

Prenatal and perinatal striatal injury: a hypothetical cause of attention-deficit-hyperactivity disorder?

Experimental data indicate a particular vulnerability of striatal neurons in the developing brain, and together with the idea that the striatum is important for context recognition and behavior, these data have led the author to search for subtle striatal lesions, in the form of biochemical changes, in children who have suffered perinatal adverse events. Evidence is presented to demonstrate that the composition of metabolites in the striatum is altered, primarily in the form of an elevated level of lactate, in human neonates who have suffered various perinatal disorders, such as germinal matrix hemorrhage, intrauterine growth retardation, and asphyxia. An elevated level of lactate suggests tissue hypoxia, which may interfere with the formation of frontostriatal circuits and may play a role in the pathogenesis of the behavioral disturbances observed in a proportion of children with a history of perinatal adverse events.