Does clinical memory fMRI provide a comprehensive map of medial temporal lobe structures?

Robust presurgical functional MRI at 7 T using response consistency

Functional MRI is valuable in presurgical planning due to its non-invasive nature, repeatability, and broad availability. Using ultra-high field MRI increases the specificity and sensitivity, increasing the localization reliability and reducing scan time. Ideally, fMRI analysis for this application should identify unreliable runs and work even if the patient deviates from the prescribed task timing or if there are changes to the hemodynamic response due to pathology. In this study, a model-free analysis method-UNBIASED-based on the consistency of fMRI responses over runs was applied, to ultra-high field fMRI localizations of the hand area. Ten patients with brain tumors and epilepsy underwent 7 Tesla fMRI with multiple runs of a hand motor task in a block design. FMRI data were analyzed with the proposed approach (UNBIASED) and the conventional General Linear Model (GLM) approach. UNBIASED correctly identified and excluded fMRI runs that contained little or no activation. Generally, less motion artifact contamination was present in UNBIASED than in GLM results. Some cortical regions were identified as activated in UNBIASED but not GLM results. These were confirmed to show reproducible delayed or transient activation, which was time-locked to the task. UNBIASED is a robust approach to generating activation maps without the need for assumptions about response timing or shape. In presurgical planning, UNBIASED can complement model-based methods to aid surgeons in making prudent choices about optimal surgical access and resection margins for each patient, even if the hemodynamic response is modified by pathology. Hum Brain Mapp 38:3163-3174, 2017. © 2017 The Authors Human Brain Mapping Published by Wiley Periodicals, Inc.

The benefits of skull stripping in the normalization of clinical fMRI data

Establishing a reliable correspondence between lesioned brains and a template is challenging using current normalization techniques. The optimum procedure has not been conclusively established, and a critical dichotomy is whether to use input data sets which contain skull signal, or whether skull signal should be removed. Here we provide a first investigation into whether clinical fMRI benefits from skull stripping, based on data from a presurgical language localization task. Brain activation changes related to deskulled/not-deskulled input data are determined in the context of very recently developed (New Segment, Unified Segmentation) and standard normalization approaches. Analysis of structural and functional data demonstrates that skull stripping improves language localization in MNI space — particularly when used in combination with the New Segment normalization technique.

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First investigation of the possible effects of skull-stripping with clinical fMRI data.

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Comparison of standard and most recent normalization approaches.

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Skull stripping improves language localization in MNI space.

Applying independent component analysis to clinical FMRI at 7 t

Increased BOLD sensitivity at 7 T offers the possibility to increase the reliability of fMRI, but ultra-high field is also associated with an increase in artifacts related to head motion, Nyquist ghosting, and parallel imaging reconstruction errors. In this study, the ability of independent component analysis (ICA) to separate activation from these artifacts was assessed in a 7 T study of neurological patients performing chin and hand motor tasks. ICA was able to isolate primary motor activation with negligible contamination by motion effects. The results of General Linear Model (GLM) analysis of these data were, in contrast, heavily contaminated by motion. Secondary motor areas, basal ganglia, and thalamus involvement were apparent in ICA results, but there was low capability to isolate activation in the same brain regions in the GLM analysis, indicating that ICA was more sensitive as well as more specific. A method was developed to simplify the assessment of the large number of independent components. Task-related activation components could be automatically identified via these intuitive and effective features. These findings demonstrate that ICA is a practical and sensitive analysis approach in high field fMRI studies, particularly where motion is evoked. Promising applications of ICA in clinical fMRI include presurgical planning and the study of pathologies affecting subcortical brain areas.

Functional MRI and structural MRI as tools for understanding comorbid conditions in children with epilepsy

Children with epilepsy are at risk for behavioral and cognitive comorbidities. Potential etiologies can be assessed in part by neuroimaging. Functional magnetic resonance imaging (MRI) has a major role in presurgical evaluation and prediction of postoperative outcome by mapping of language and memory. Structural MRI and functional MRI have shown changes in children and adolescents with attention deficit hyperactivity disorder and disruptive behavior, common comorbidities in children with epilepsy. Neuroimaging has the potential for significantly increasing understanding of the basis of cognitive and behavioral problems in children with epilepsy.

Neuropsychology in temporal lobe epilepsy: influences from cognitive neuroscience and functional neuroimaging

Neuropsychologists assist in diagnosis (i.e., localization of dysfunction) and in prediction (i.e., how cognition may change following surgery) in individuals being considered for temporal lobe surgery. The current practice includes behavioural testing as well as mapping function via stimulation, inactivation, and (more recently) functional imaging. These methods have been providing valuable information in surgical planning for 60 years. Here, we discuss current assessment strategies and highlight how they are evolving, particularly with respect to integrating recent advances in cognitive neuroscience.

How much are clinical fMRI reports influenced by standard postprocessing methods? An investigation of normalization and region of interest effects in the medial temporal lobe

Recent evidence has indicated that standard postprocessing methods such as template-based region of interest (ROI) definition and normalization of individual brains to a standard template may influence final outcome of functional magnetic resonance imaging investigations. Here, we provide the first comprehensive investigation into whether ROI definition and normalization may also change the clinical interpretation of patient data. A series of medial temporal lobe epilepsy patients were investigated with a clinical memory paradigm and individually delineated as well as template-based ROIs. Different metrics for activation quantification were applied. Results show that the application of template-based ROIs can significantly change the clinical interpretation of individual patient data. This relates to sensitivity for brain activation and hemispheric dominance. We conclude that individual ROIs should be defined on nontransformed functional data and that use of more than one metric for activation quantification is beneficial.

[Methodological problems with clinical functional MRI investigations]

During presurgical diagnostics clinical functional magnetic resonance imaging is increasingly being performed to improve the management of epilepsy and tumor patients. Rapid technical developments in fMRI technology continuously further new diagnostic applications. Safe clinical application requires a profound and critical handling of the various methodological problems inherent with this complex technique. This article reviews relevant problems and solutions for patient investigations up to the preparation of an individual clinical fMRI report.

Assessment of verbal memory by fMRI: lateralization and functional neuroanatomy

OBJECTIVES

The medial temporal lobe (MTL) is essential for declarative memory formation, but also a frequent source of seizures. To decrease the risk of amnestic impairments after temporal lobectomy, functional magnetic resonance imaging (fMRI) is increasingly used to establish pre-operative measures for a prognosis of postoperative memory performance. The present study addresses one of the major challenges in clinical fMRI, the interpretation of activation pattern in single subjects. Before investigating patients however, it must be first assessed to which extent the verbal memory paradigm can be used to determine the lateralization and the functional neuroanatomy of MTL-activity. Therefore, this study took a "step backwards" by first examining healthy subjects without known MTL pathology.

PATIENTS AND METHODS

An implicit verbal encoding task was applied to a group of ten healthy volunteers using fMRI.

RESULTS

At the group level the MTL activation was strongly left-lateralized and separated into three distinct clusters. At the individual level, the lateralization of MTL-activity could be determined in 9 of 10 subjects. In contrast, its localization was inter-individually highly variable. In each case, only one of the three group activation clusters was detected.

CONCLUSIONS

The present study shows that fMRI can be used to assess the lateralization of brain activity related to verbal encoding even in individual subjects. For the routine use in a clinical setting however, the results of verbal memory paradigms must at present be treated with care if they are used to support decisions as to how far the resection of one MTL can be extended.