Systematic Review of fMRI Compatible Devices: Design and Testing Criteria

Development and Assessment of a New Multichannel Electrocutaneous Device for Non-Invasive Somatosensory Stimulation for Magnetic Resonance Applications

Non-invasive electrocutaneous stimulation, which applies an electrical current flowing through the skin's surface to elicit a tactile percept, can be used in combination with functional magnetic resonance imaging (fMRI) to obtain somatotopic maps that illustrate the spatial patterns and functional organization of the primary somatosensory cortex (S1). However, accessibility to this technique, combined with fMRI, is limited, especially for applications requiring multiple stimulation channels. This study presents the development and assessment of a novel multichannel electrocutaneous stimulation device designed for non-invasive somatosensory stimulation of the upper limbs in human participants within a magnetic resonance (MR) environment. The current-controlled, voltage-limited stimulation device features 20 stimulation channels that can be individually configured to deliver various non-simultaneous combinations of personalized electrical pulses, tailored to the subject, stimulation site, and paradigm. It was designed with a modular assembly to ensure compatibility with the MR environment. The assessment of the device consisted of four stages. First, the feasibility of generating controllable electrical stimuli outside the MR environment was validated using an electrical circuit equivalent to the impedance of the human body and the electrode-skin interface. Subsequently, safety and compatibility were evaluated in a 3 Tesla Magnetom Prisma fit scanner using a phantom. Next, the device's capacity to generate perceptible tactile sensations and user acceptability were assessed by testing the device on a single participant outside the MR environment. Finally, structural and functional data were acquired from three participants during a somatosensory stimulation experiment as a proof of concept to confirm the brain activity elicited by stimulation. These assessments confirmed the device's capacity to generate controllable electrical stimuli both outside and in the MR environment, its compatibility and safety in this MR environment, and its effectiveness in eliciting brain activity in the expected brain areas without causing any discomfort to the participant. This study paves the way for future research on somatotopic mapping of S1 using this device.

An MRI-Compatible System for Characterizing Supraspinal Processing of Walking-Related Foot-Sole Somatosensory Stimulation

Foot soles are the only part in direct contact with the ground during walking. The mechanoreceptors on foot soles continuously obtain somatosensory information (e.g., ground reaction forces) that is delivered to spinal and supraspinal networks. The timely and accurate supraspinal processing of such information, which can be captured by the activation of the supraspinal regions, is critical to the regulation of walking. However, little is known about supraspinal somatosensory processing related to walking. Characterizing the supraspinal response to walking-related somatosensory inputs using MRI is challenging, because individuals are required to stay motionless during MRI scan. We thus developed a stimulation system that simulates the amplitude and timing of foot-sole pressure changes experienced during each step of overground walking, without inducing significant head motion. In the study to examine its validity and reliability of simulation, seven younger adults completed two trials of eight-meter walking. The temporal changes of foot-sole pressure of each step during walking were recorded using a pressure insole and used to program the motion of the system. The results indicated high validity and reliability of the stimulation (rho $= 0.94\sim 0.98$ , p<0.0001). Phantom imaging test revealed that the signal-to-noise ratio of the MR image when the system working was similar to when the system was off, suggesting excellent MRI compatibility. Finally, block-designed test indicated that, compared to rest, multiple supraspinal regions (e.g., postcentral gyrus) were activated (p<0.005) by foot-sole stimulation. This MRI-compatible system provides a novel approach to characterizing the supraspinal sensorimotor control of walking via MRI.

Abnormal brain activity in lumbar disc herniation patients with chronic pain is associated with their clinical symptoms

Introduction

Lumbar disc herniation, a chronic degenerative disease, is one of the major contributors to chronic low back pain and disability. Although many studies have been conducted in the past on brain function in chronic low back pain, most of these studies did not classify chronic low back pain (cLBP) patients according to their etiology. The lack of etiologic classification may lead to inconsistencies between findings, and the correlation between differences in brain activation and clinical symptoms in patients with cLBP was less studied in the past.

Methods

In this study, 36 lumbar disc herniation patients with chronic low back pain (LDHCP) and 36 healthy controls (HCs) were included to study brain activity abnormalities in LDHCP. Visual analogue scale (VAS), oswestry disability index (ODI), self-rating anxiety scale (SAS), self-rating depression scale (SDS) were used to assess clinical symptoms.

Results

The results showed that LDHCP patients exhibited abnormally increased and diminished activation of brain regions compared to HCs. Correlation analysis showed that the amplitude of low frequency fluctuations (ALFF) in the left middle frontal gyrus is negatively correlated with SAS and VAS, while the right superior temporal gyrus is positively correlated with SAS and VAS, the dorsolateral left superior frontal gyrus and the right middle frontal gyrus are negatively correlated with VAS and SAS, respectively.

Conclusion

LDHCP patients have brain regions with abnormally increased and abnormally decreased activation compared to healthy controls. Furthermore, some of the abnormally activated brain regions were correlated with clinical pain or emotional symptoms.

Assessing MR-compatibility of somatosensory stimulation devices: A systematic review on testing methodologies

Functional magnetic resonance imaging (fMRI) has been extensively used as a tool to map the brain processes related to somatosensory stimulation. This mapping includes the localization of task-related brain activation and the characterization of brain activity dynamics and neural circuitries related to the processing of somatosensory information. However, the magnetic resonance (MR) environment presents unique challenges regarding participant and equipment safety and compatibility. This study aims to systematically review and analyze the state-of-the-art methodologies to assess the safety and compatibility of somatosensory stimulation devices in the MR environment. A literature search, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines, was performed in PubMed, Scopus, and Web of Science to find original research on the development and testing of devices for somatosensory stimulation in the MR environment. Nineteen records that complied with the inclusion and eligibility criteria were considered. The findings are discussed in the context of the existing international standards available for the safety and compatibility assessment of devices intended to be used in the MR environment. In sum, the results provided evidence for a lack of uniformity in the applied testing methodologies, as well as an in-depth presentation of the testing methodologies and results. Lastly, we suggest an assessment methodology (safety, compatibility, performance, and user acceptability) that can be applied to devices intended to be used in the MR environment.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42021257838.

Evaluation of a Portable fMRI Compatible Robotic Wrist Interface

This paper presents evaluation of a portable fMRI compatible haptic interface to study the brain correlates of sensorimotor control during wrist motion. The interface is actuated by a shielded DC motor located more than 2 m away from the 3T MR scanner's bore. The achievable wrist torque of the interface is up to 2 Nm, and the interface provides sufficient bandwidth for human motor control experiments. Ergonomic and fMRI compatibility testing with a 3T MR scanner showed that the interface is MR safe, compatible with a strong static magnetic field and radio frequency emission, and its operation does not affect the quality of the acquired images. Clinical Relevance- We present and evaluate an fMRI compatible robotic interface to study human wrist joint motor function.

An fMRI-compatible system for targeted electrical stimulation

BACKGROUND

Neuromodulation is a rapidly expanding therapeutic option considered within neuropsychiatry, pain and rehabilitation therapy. Combining electrostimulation with feedback from fMRI can provide information about the mechanisms underlying the therapeutic effects, but so far, such studies have been hampered by the lack of technology to conduct safe and accurate experiments. Here we present a system for fMRI compatible electrical stimulation, and the first proof-of-concept neuroimaging data with deep brain stimulation (DBS) in pigs obtained with the device.

NEW METHOD

The system consists of two modules, placed in the control and scanner room, connected by optical fiber. The system also connects to the MRI scanner to timely initiate the stimulation sequence at start of scan. We evaluated the system in four pigs with DBS in the subthalamic nucleus (STN) while we acquired BOLD responses in the STN and neocortex.

RESULTS

We found that the system delivered robust electrical stimuli to the implanted electrode in sync with the preprogrammed fMRI sequence. All pigs displayed a DBS-STN induced neocortical BOLD response, but none in the STN.

COMPARISONS WITH EXISTING METHOD

The system solves three major problems related to electric stimuli and fMRI examinations, namely preventing distortion of the fMRI signal, enabling communication that synchronize the experimental conditions, and surmounting the safety hazards caused by interference with the MRI scanner.

CONCLUSIONS

The fMRI compatible electrical stimulator circumvents previous problems related to electroceuticals and fMRI. The system allows flexible modifications for fMRI designs and stimulation parameters, and can be customized to electroceutical applications beyond DBS.

Improving motor function after chronic stroke by interactive gaming with a redesigned MR-compatible hand training device

New rehabilitation strategies enabled by technological developments are challenging the prevailing concept of there being a limited window for functional recovery after stroke. In this study, we examined the utility of a robot-assisted therapy used in combination with a serious game as a rehabilitation and motor assessment tool in patients with chronic stroke. We evaluated 928 game rounds from 386 training sessions of 8 patients who had suffered an ischemic stroke affecting middle cerebral artery territory that incurred at least 6 months prior. Motor function was assessed with clinical motor scales, including the Fugl-Meyer upper extremity (FM UE) scale, Action Research Arm Test, Modified Ashworth scale and the Box and Blocks test. Robotic device output measures (mean force, force-position correlation) and serious game score elements (collisions, rewards and total score) were calculated. A total of 2 patients exhibited a marginal improvement after a 10-week training protocol according to the FM UE scale and an additional patient exhibited a significant improvement according to Box and Blocks test. Motor scales showed strong associations of robotic device parameters and game metrics with clinical motor scale scores, with the strongest correlations observed for the mean force (0.677<Ρ<0.869), followed by the number of collisions (-0.670<Ρ<-0.585). Linear regression analysis showed that these indices were independent predictors of motor scale scores. In conclusion, a robotic device linked to a serious game can be used by patients with chronic stroke and induce at least some clinical improvements in motor performance. Robotic device output parameters and game score elements associate strongly with clinical motor scales and have the potential to be used as predictors in models of rehabilitation progress.

Left hemispheric α band cerebral oscillatory changes correlate with verbal memory

Event-related synchronisation (ERS) and event-related desynchronisation (ERD) have been observed via magnetoencephalography (MEG) in the language-dominant hemisphere. However, the relationship between ERS/ERD and clinical language indices is unclear. Therefore, the present study evaluated brain activity utilising MEG during a verb generation task in 36 subjects and determined ERS/ERD power values in θ, α, β, low γ and high γ frequency bands. To measure clinical language indices, we adopted Wechsler Memory Scale-revised. We observed ERD in the α band from the bilateral occipital to the left central brain region, in the β band from the bilateral occipital to the left frontal region and in the low γ band a high-power signal in the left frontal region. We also observed ERS in the θ band in bilateral frontal region and in the high γ band in bilateral occipital region. Furthermore, we found a significant negative correlation between α-band ERD power at the left postcentral gyrus and medial superior frontal gyrus and verbal memory score (correlation coefficients =  − 0.574 and − 0.597, respectively). These results suggest that individuals with lower linguistic memory have less desynchronised α-band ERD power and α-band ERD power in the left hemisphere may be a neurophysiological biomarker for verbal memory.

Pediatric Functional Neuroimaging: Practical Tips and Pearls

OBJECTIVE. Functional MRI (fMRI) is clinically used for localization of eloquent cortex before surgical intervention, most commonly motor and language function in patients with tumors or epilepsy. In the pediatric population, special considerations for fMRI relate to limited examination tolerance, small head size, developing anatomy and physiology, and diverse potential abnormalities. In this article, we will highlight pearls and pitfalls of clinical pediatric fMRI including blood oxygenation level-dependent imaging principles, patient preparation, study acquisition, data postprocessing, and examination interpretation. CONCLUSION. Clinical fMRI is indicated for presurgical localization of eloquent cortex in patients with tumors, epilepsy, or other neurologic conditions and requires a solid understanding of technical considerations and data processing. In children, special approaches are needed for patient preparation as well as study design, acquisition, and interpretation. Radiologists should be cognizant of developmental neuroanatomy, causes of neuropathology, and capacity for neuroplasticity in the pediatric population.

A Simple and Compact MR-Compatible Electromagnetic Vibrotactile Stimulator

We have developed a low-cost electromagnetic vibrotactile stimulator that uses the magnetic field of an MR scanner as a permanent magnet to power a vibrating motor. A simple variable current power supply is controlled by software using a USB data acquisition controller. In our study, the function of our novel stimulator was verified in a vibration frequency discrimination working memory task, in which various ranges of frequencies and amplitudes are delivered in MRI scanner. Furthermore, our functional MRI study revealed activations of the primary and secondary somatosensory cortices during the perception of tactile stimulation. Therefore, the new designed electromagnetic vibrotactile stimulator is capable of generating various frequencies of tactile stimuli and represents a powerful and useful tool for studying somatosensory functions with functional MRI.

Novel imaging technologies for genetic diagnoses in the inborn errors of metabolism

Many inborn errors of metabolism and genetic disorders affect the brain. The brain biochemistry may differ from that in the periphery and is not accessible by simple blood and urine sampling. Therefore, neuroimaging has proven to be a valuable tool to not only evaluate the brain structure, but also biochemistry, blood flow and function. Neuroimaging in patients with inborn errors of metabolism can include additional sequences in addition to T1 and T2-weighted imaging because in early stages, there may be no significant findings on the routine sequnces due to the lack of sensitivity or the evolution of abnormalities lags behind the ability of the imaging to detect it. In addition, findings on T1 and T2-weighted imaging of several inborn errors of metabolism may be non-specific and be seen in other non-genetic conditions. Therefore, additional neuroimaging modalities that have been employed including diffusion tensor imaging (DTI), magnetic resonance spectroscopy, functional MRI (fMRI), functional near infrared spectroscopy (fNIRS), or positron emission tomography (PET) imaging may further inform underlying changes in myelination, biochemistry, and functional connectivity. The use of Magnetic Resonance Spectroscopy in certain disorders may add a level of specificity depending upon the metabolite levels that are abnormal, as well as provide information about the process of brain injury (i.e., white matter, gray matter, energy deficiency, toxic buildup or depletion of key metabolites). It is even more challenging to understand how genetic or metabolic disorders contribute to short and/or long term changes in cognition which represent the downstream effects of IEMs. In order to image “cognition” or the downstream effects of a metabolic disorder on domains of brain function, more advanced techniques are required to analyze underlying fiber tracts or alternatively, methods such as fMRI enable generation of brain activation maps after both task based and resting state conditions. DTI can be used to look at changes in white matter tracks. Each imaging modality can explore an important aspect of the anatomy, physiology or biochemisty of the central nervous system. Their properties, pros and cons are discussed in this article. These imaging modalities will be discussed in the context of several inborn errors of metabolism including Galactosemia, Phenylketonruia, Maple syrup urine disease, Methylmalonic acidemia, Niemann-Pick Disease, type C1, Krabbe Disease, Ornithine transcarbamylase deficiency, Sjogren Larsson syndrome, Pelizeaus-Merzbacher disease, Pyruvate dehydrogenase deficiency, Nonketotic Hyperglycinemia and Fabry disease. Space constraints do not allow mention of all the disorders in which one of these modalities has been investigated, or where it would add value to diagnosis or disease progression.

An MRI-Compatible Foot-Sole Stimulation System Enabling Characterization of the Brain Response to Walking-Related Tactile Stimuli

Foot-sole somatosensory impairment is a main contributor to balance decline and falls in aging and disease. The cortical networks involved in walking-related foot sole somatosensation, however, remain poorly understood. We thus created and tested a novel MRI-compatible device to enable study of the cortical response to pressure stimuli applied to the foot sole that mimic those stimuli experienced when walking. The device consists of a dual-drive stimulator equipped with two pneumatic cylinders, which are separately programed to apply pressure waveforms to the entire foot sole. In a sample of nine healthy younger adults, the pressure curve applied to the foot sole closely correlated with that experienced during over ground walking (r = 0.811 ± 0.043, P < 0.01). MRI compatibility testing indicated that the device has no or negligible impact on MR image quality. Gradient-recalled echo-planar images of nine healthy young adults using a block-designed 3.5-min walking-related stimulation revealed significant activation within the supplementary motor area, supramarginal gyrus, paracingulate gyri, insula, precentral gyrus, middle temporal gyrus, and hippocampus (uncorrected P < 0.001, k ≥ 10). Together, these results indicate that this stimulation system is MRI-compatible and capable of mimicking walking-related pressure waveforms on foot sole. It may thus be used as a research tool to identify cortical targets for interventions (e.g., non-invasive brain stimulation) aimed at enhancing this important source of input to the locomotor control system.

TOWARDS A PERSONALISED AND INTERACTIVE ASSESSMENT OF OCCUPATIONAL EXPOSURE TO MAGNETIC FIELD DURING DAILY ROUTINE IN MAGNETIC RESONANCE

Magnetic resonance imaging (MRI) is one of the most common sources of electromagnetic (EM) fields as a diagnostic technique widely used in medicine. MRI staff during the working day is constantly exposed to static and spatially heterogeneous magnetic field. Also, moving around the MRI room to perform their functions, workers are exposed to slowly time-varying magnetic fields that induce electrical currents and fields in the body. The development of new exposure assessment methodologies to collect exposure data at a personal level using simple everyday equipment is hence necessary, also in view of future epidemiological studies. This paper describes the design and testing of a novel device for assessing personal exposure to static and time-varying magnetic fields during daily clinical practice. The dosemeter will be also used to ensure effective training of technicians who will be instructed to avoid, where possible, risk behaviour in terms of high exposure.