Non-invasive assessment of language lateralization by transcranial near infrared optical topography and functional MRI

Retinotopic mapping of adult human visual cortex with high-density diffuse optical tomography

Functional neuroimaging is a vital element of neuroscience and cognitive research and, increasingly, is an important clinical tool. Diffuse optical imaging is an emerging, noninvasive technique with unique portability and hemodynamic contrast capabilities for mapping brain function in young subjects and subjects in enriched or clinical environments. We have developed a high-performance, high-density diffuse optical tomography (DOT) system that overcomes previous limitations and enables superior image quality. We show herein the utility of the DOT system by presenting functional hemodynamic maps of the adult human visual cortex. The functional brain images have a high contrast-to-noise ratio, allowing visualization of individual activations and highly repeatable mapping within and across subjects. With the improved spatial resolution and localization, we were able to image functional responses of 1.7 cm in extent and shifts of <1 cm. Cortical maps of angle and eccentricity in the visual field are consistent with retinotopic studies using functional MRI and positron-emission tomography. These results demonstrate that high-density DOT is a practical and powerful tool for mapping function in the human cortex.

Neuropsychology: traditional and new methods of investigation

The neuropsychological assessment is an integral part of the clinical investigation of patients suffering from epilepsy. The aim of the evaluation is to determine disease-related and treatment-related effects on cognition and behavior in order to orient therapeutic interventions, by taking into account the compensatory mechanisms that are available to the patient. Examples of the tests best illustrating the classical neuropsychological protocol are presented. Neuropsychology also plays an important role in the assessment of language lateralization in patients slated for epilepsy surgery. Traditionally, this has been achieved by means of the rather invasive Wada procedure. However, with the advent of new neuroimaging techniques, this procedure is gradually being replaced by minimally invasive or noninvasive methods, such as functional magnetic resonance imaging, positron emission tomography, and optical imaging. In the present paper, we discuss some of the newer techniques that are available to the neuropsychologist for the study of the impact of epilepsy on cerebral functioning.

An update on determination of language dominance in screening for epilepsy surgery: the Wada test and newer noninvasive alternatives

The intracarotid amobarbital procedure or Wada test has been the gold standard for lateralization of language dominance before epilepsy surgery. It is based on deactivation of language cortex with intracarotid anesthesia. However, it is an invasive test with risks and discomforts, and it also has limitations. There has been great interest in replacing the Wada test with a noninvasive procedure. One alternative, repetitive magnetic stimulation works by deactivating language cortex, but most other promising alternatives are based on brain activation. Functional magnetic resonance imaging (fMRI), 15O-water positron emission tomography, single photon emission computerized tomography, transcranial Doppler, and near infrared spectroscopy detect hemodynamic responses to language cortex activation, while magnetoencephalography more directly measures event-related physiological activation. Some of the techniques also provide localization of language functions, whereas the Wada test is strictly a lateralization method. Based on widespread availability, fMRI will likely be the most widely used alternative.

A spatial and temporal comparison of hemodynamic signals measured using optical and functional magnetic resonance imaging during activation in the human primary visual cortex

Functional near infrared spectro-imaging (fNIRSI) is potentially a very useful technique for obtaining information about the underlying physiology of the blood oxygenation level dependent (BOLD) signal used in functional magnetic resonance imaging (fMRI). In this paper the temporal and spatial statistical characteristics of fNIRSI data are compared to those of simultaneously acquired fMRI data in the human visual cortex during a variable-frequency reversing checkerboard activation paradigm. Changes in the size of activated volume caused by changes in checkerboard reversal frequency allowed a comparison of the behavior of the spatial responses measured by the two imaging methods. fNIRSI and fMRI data were each analyzed using standard correlation and fixed-effect group analyses of variance pathways. The statistical significance of fNIRSI data was found to be much lower than that of the fMRI data, due mainly to the low signal-to-noise of the measurements. Reconstructed images also showed that, while the time-course of changes in the oxy-, deoxy-, and total hemoglobin concentrations all exhibit high correlation with that of the BOLD response, the changes in the volume of tissue measured as "activated" by the BOLD response demonstrate a closer similarity to the corresponding changes in the oxy- and total hemoglobin concentrations than to that of the deoxyhemoglobin.

A spatial and temporal comparison of hemodynamic signals measured using optical and functional magnetic resonance imaging during activation in the human primary visual cortex

Functional near infrared spectro-imaging (fNIRSI) is potentially a very useful technique for obtaining information about the underlying physiology of the blood oxygenation level dependent (BOLD) signal used in functional magnetic resonance imaging (fMRI). In this paper the temporal and spatial statistical characteristics of fNIRSI data are compared to those of simultaneously acquired fMRI data in the human visual cortex during a variable-frequency reversing checkerboard activation paradigm. Changes in the size of activated volume caused by changes in checkerboard reversal frequency allowed a comparison of the behavior of the spatial responses measured by the two imaging methods. fNIRSI and fMRI data were each analyzed using standard correlation and fixed-effect group analyses of variance pathways. The statistical significance of fNIRSI data was found to be much lower than that of the fMRI data, due mainly to the low signal-to-noise of the measurements. Reconstructed images also showed that, while the time-course of changes in the oxy-, deoxy-, and total hemoglobin concentrations all exhibit high correlation with that of the BOLD response, the changes in the volume of tissue measured as "activated" by the BOLD response demonstrate a closer similarity to the corresponding changes in the oxy- and total hemoglobin concentrations than to that of the deoxyhemoglobin.

An integrated measurement system for simultaneous functional magnetic resonance imaging and diffuse optical tomography in human brain mapping

An integrated measurement system is described for performing simultaneous functional magnetic resonance imaging (fMRI) and diffuse optical tomography (DOT) for human brain mapping experiments. The components of this system consist of an MRI-compatible multi-overlapping-channel optical probe, methods for co-registration of optical and fMRI measurements, and DOT reconstruction algorithms with structural and physiological constraints derived from the MRI data. The optical probe is fully MRI-compatible in the sense that it produces negligible MR image distortion and does not require any modification to the MRI scanner or data acquisition protocol. The probe can be attached to any part of the head without posing any limitation on optical data acquisition. Co-registration of images from fMRI and optical measurements was achieved by localizing the positions of the optical fibers using MRI markers. Human studies show successful implementation of the entire system.

Effect of fMRI acoustic noise on sensorimotor activation examined using optical topography

Functional magnetic resonance imaging (fMRI) is an important tool for noninvasively imaging the hemodynamic responses accompanying brain activity, but fMRI measurements are accompanied by loud acoustic noises resulting from Lorentz forces that cannot be completely excluded when the present technology is used. We used recorded fMRI acoustic noise and examined its effect on sensorimotor activation in optical topography measurement when subjects were instructed to tap the fingers of the right hand under a 23-dB non-noise condition and 46-, 56-, and 65-dB noise conditions. The results showed that the amplitude of the activation signal (relative change in concentration) for oxygenated hemoglobin in the sensorimotor cortex decreased with increasing noise. The activation signal for deoxygenated hemoglobin did not depend significantly on the noise level but did tend to decrease with increasing noise. These results suggest that fMRI acoustic noise affects the hemodynamics of cortical areas associated with the processing of information other than auditory information.

Investigating the post-stimulus undershoot of the BOLD signal--a simultaneous fMRI and fNIRS study

Measuring the hemodynamic response with functional magnetic resonance imaging (fMRI) together with functional near-infrared spectroscopy (fNIRS) may overcome limitations of single-method approaches. Accordingly, we measured the event-related hemodynamic response with both imaging methods simultaneously in young subjects during visual stimulation. An intertrial interval of 60 s was chosen to include the prolonged post-stimulus undershoot of the blood oxygenation level dependent (BOLD) signal. During visual stimulation, the BOLD signal, oxy-, and total hemoglobin (Hb) increased, whereas deoxy-Hb decreased. The post-stimulus period was characterized by an undershoot of the BOLD signal, oxy-Hb, and an overshoot of deoxy-Hb. Total Hb as measured by fNIRS returned to baseline immediately after the end of stimulation. Results suggest that the post-stimulus events as measured by fNIRS are dominated by a prolonged high-level oxygen consumption in the microvasculature. The contribution of a delayed return of blood volume to the BOLD post-stimulus undershoot in post-capillary veins as suggested by the Balloon and Windkessel models remains ambiguous. Temporal changes in the BOLD signal were highly correlated with deoxy-Hb, with lower correlation values for oxy- and total Hb. Furthermore, data show that fNIRS covers the outer 1 cm of the brain cortex. These results were confirmed by simultaneous fMRI/fNIRS measurements during rest. In conclusion, multimodal imaging approaches may contribute to the understanding of neurovascular coupling.

Intersubject variability of near-infrared spectroscopy signals during sensorimotor cortex activation

We investigate the intersubject signal variability of near-infrared spectroscopy (NIRS), which is commonly used for noninvasive measurement of the product of the optical path length and the concentration change in oxygenated hemoglobin (DeltaC'oxy) and deoxygenated hemoglobin (DeltaC'deoxy) and their sum (DeltaC'total) related to human cortical activation. We do this by measuring sensorimotor cortex activation in 31 healthy adults using 24-measurement-position near-infrared (NIR) topography. A finger-tapping task is used to activate the sensorimotor cortex, and significant changes in the hemisphere contralateral to the tapping hand are assessed as being due to the activation. Of the possible patterns of signal changes, 90% include a positive DeltaC'oxy, 76% included a negative DeltaC'deoxy, and 73% included a positive DeltaC'total. The DeltaC'deoxy and DeltaC'total are less consistent because of a large intersubject variability in DeltaC'deoxy; in some cases there is a positive DeltaC'deoxy. In the cases with no positive DeltaC'oxy in the contralateral hemisphere, there are cases of other possible changes for either or both hemispheres and no cases of no change in any hemoglobin species in either hemisphere. These results suggest that NIR topography is useful for observing brain activity in most cases, although intersubject signal variability still needs to be resolved.

Multi-channel near-infrared spectroscopy detects specific inferior-frontal activation during incongruent Stroop trials

Near-infrared spectroscopy (NIRS) is an optical method, which allows non-invasive in vivo measurements of changes in the concentration of oxygenated (O2Hb) and deoxygenated (HHb) hemoglobin in brain tissue. In the present study we investigated 10 healthy subjects by means of multi-channel NIRS (Optical Topography; ETG-100, Hitachi Medical Co., Japan) during performance of congruent and incongruent trials of the Stroop color word task. With a similar pattern of activation for both congruent and incongruent Stroop trials in the NIRS channels located left superior-frontally, the results for O2Hb and the total amount of hemoglobin (Hb-tot) indicate specific activation for interference trials in inferior-frontal areas of the left hemisphere. This result is in line with several neuroimaging studies (fMRI, PET) that have already investigated the frontal activation related to Stroop interference, which further supports the assumption that multi-channel NIRS is sensitive enough to detect spatially specific activation during the performance of cognitive tasks.

Principles, techniques, and limitations of near infrared spectroscopy

In the last decade the study of the human brain and muscle energetics underwent a radical change, thanks to the progressive introduction of noninvasive techniques, including near-infrared (NIR) spectroscopy (NIRS). This review summarizes the most recent literature about the principles, techniques, advantages, limitations, and applications of NIRS in exercise physiology and neuroscience. The main NIRS instrumentations and measurable parameters will be reported. NIR light (700-1000 m) penetrates superficial layers (skin, subcutaneous fat, skull, etc.) and is either absorbed by chromophores (oxy- and deoxyhemoglobin and myoglobin) or scattered within the tissue. NIRS is a noninvasive and relatively low-cost optical technique that is becoming a widely used instrument for measuring tissue O2 saturation, changes in hemoglobin volume and, indirectly, brain/muscle blood flow and muscle O2 consumption. Tissue O2 saturation represents a dynamic balance between O2 supply and O2 consumption in the small vessels such as the capillary, arteriolar, and venular bed. The possibility of measuring the cortical activation in response to different stimuli, and the changes in the cortical cytochrome oxidase redox state upon O2 delivery changes, will also be mentioned.

Multichannel NIRS analysis of brain activity during semantic differential rating of drawing stimuli containing different affective polarities

We used 24-channel near-infrared spectroscopy (NIRS) to measure activity in the temporal, parietal, and frontal regions of the brain in eight Japanese women while the participants rated line drawings using semantic differential scales. Participants rated the seven line drawings on 15 bipolar semantic scales, each of which belonged to one of three semantic classes: Evaluation, Activity, or Potency. Suzuki et al. [M. Suzuki, J. Gyoba, Y. Sakuta, Multichannel near-infrared spectroscopy analysis of brain activities during semantic differential rating of drawings, Tohoku Psychologica Folia 62 (2003) 86-98.] had reported previously that the right superior temporal gyrus and the right inferior parietal lobule are associated with Activity rating, while the brain regions around the central fissure were related to Potency rating. Based on these suggestions, we investigated the brain activity in these regions during rating of stimuli containing different affective polarities. When drawings were reported as 'static' or 'calm', oxyhemoglobin concentration was higher around the right superior temporal gyrus as compared to when they were considered 'noisy' or 'excitable'. Oxyhemoglobin concentrations around the central fissure were also higher when drawings were rated as 'soft', 'smooth', or 'blunt' compared to 'hard', 'rough', or 'sharp'. Any characteristic oxyhemoglobin changes were not found during the ratings on the evaluation scales. Our results suggest that activation patterns of the temporal and parietal regions are significantly modified by semantic polarities of Activity and Potency.

Bilateral prefrontal cortex oxygenation responses to a verbal fluency task: a multichannel time-resolved near-infrared topography study

The letter-fluency task-induced response over the prefrontal cortex is investigated bilaterally on eight subjects using a recently developed compact, eight-channel, time-resolved, near-IR system. The cross-subject mean values of prefrontal cortex oxygen saturation (SO2) were 68.8+/-3.2% (right) and 71.0+/-3.6% (left), and of total hemoglobin concentration (tHb) were 69.6+/-9.6 microM (right) and 69.5+/-9.9 microM (left). The typical cortical activation response to the cognitive task [characterized by an increase in oxyhemoglobin (O2Hb) with a concurrent decrease in deoxyhemoglobin (HHb)] at each measurement point is observed in only four subjects. In this subset, the amplitude of the O2Hb increase and HHb decrease is uniform over each prefrontal cortex area and comparable between the two hemispheres. These findings agree with previous studies using continuous wave functional near-IR spectroscopy and functional magnetic resonance imaging, therefore demonstrating the potential of a time-resolved spectroscopy approach. In addition, a significant increase in SO2 levels was observed in the right (1.1+/-0.5%) compared to left side of the prefrontal cortex (0.9+/-0.5%) (P=0.005). A different pattern of cortical activation (characterized by the lack of HHb decrease or even increased HHb) was observed in the remaining subjects.

Changes in serial optical topography and TMS during task performance after constraint-induced movement therapy in stroke: a case study

The authors examined serial changes in optical topography in a stroke patient performing a functional task, as well as clinical and physiologic measures while undergoing constraint-induced therapy (CIT). A 73-year-old right hemiparetic patient, who had a subcortical stroke 4 months previously, received 2 weeks of CIT. During the therapy, daily optical topography imaging using near-infrared light was measured serially while the participant performed a functional key-turning task. Clinical outcome measures included the Wolf Motor Function Test (WMFT), Motor Activity Log (MAL), and functional key grip test. Transcranial magnetic stimulation (TMS) and functional magnetic resonance imaging (fMRI) were also used to map cortical areas and hemodynamic brain responses, respectively. Optical topography measurement showed an overall decrease in oxy-hemoglobin concentration in both hemispheres as therapy progressed and the laterality index increased toward the contralateral hemisphere. An increased TMS motor map area was observed in the contralateral cortex following treatment. Posttreatment fMRI showed bilateral primary motor cortex activation, although slightly greater in the contralateral hemisphere, during affected hand movement. Clinical scores revealed marked improvement in functional activities. In one patient who suffered a stroke, 2 weeks of CIT led to improved function and cortical reorganization in the hemisphere contralateral to the affected hand.

The concept of 'developing the brain': a new natural science for learning and education

From the viewpoint of biology, learning and education can be defined as the processes of forming neuronal connections in response to external environmental stimuli, and of controlling or adding appropriate stimuli, respectively. Learning and education can thus be studied as a new field of natural sciences with the entire human life span as its subject, thus including various problems such as fetal environment, childcare, language acquisition, general/special education, and rehabilitation. Non-invasive imaging of higher-order brain functions in humans will clarify the brain's developmental processes, and will provide various evidence for learning sciences. This new approach is called 'developing the brain' or 'brain science and education'. The origin of the concept and its present state are described and its future prospects are briefly analyzed.

Decreased cerebral perfusion correlates with increased BOLD hyperoxia response in transgenic mouse models of sickle cell disease

Neurological complications such as stroke are known consequences of sickle cell disease (SCD). In order to improve methods for the evaluation of stroke risk in SCD, MRI was used to evaluate cerebrovascular function in transgenic mouse models of human SCD. It is hypothesized that oxygen-sensitive imaging in the brain will reveal areas of excess deoxygenation that are either at risk of or the result of vaso-occlusion. Arterial spin labeling (ASL) perfusion was performed in order to correlate BOLD results with microvascular cerebral blood flow. Upon comparison with control animals, there was a relative increase in BOLD hyperoxia response of 42-67% (P < 0.001) in the transgenic mice while cerebral blood flow during normoxia was reduced by 30-40% (P < 0.02). Hyperoxia caused cerebral blood flow to decrease in control mice, whereas blood flow increased in the sickle transgenic mice. These results indicate impairment in brain autoregulation in the sickle cell transgenic mice leading to increased cerebral deoxyhemoglobin. Increased deoxyhemoglobin coupled with reduced perfusion may further increase the risk of vaso-occlusion and stroke. This may reflect polymer reduction or reduced cell adhesion during hyperoxia. The MRI protocol is noninvasive and thus directly applicable to a clinical population.

Practicality of wavelength selection to improve signal-to-noise ratio in near-infrared spectroscopy

Near-infrared spectroscopy (NIRS), which can be used to detect changes in the concentration of oxygenated hemoglobin (oxy-Hb) and deoxygenated hemoglobin (deoxy-Hb) in tissue by using illumination at two different wavelengths, is often applied to noninvasive measurements of human brain functions. It is common to use two wavelengths that are on opposite sides of the point where the optical absorptions of oxy- and deoxy-Hb are equal (about 800 nm) but an optimal wavelength pair has not yet been determined. In this study, we conducted simultaneous recordings at five wavelengths (678, 692, 750, 782, and 830 nm) to determine the best wavelength for pairing with 830 nm. A theory suggests that pairing a shorter wavelength with 830 nm can provide more sensitivity because of the larger difference in absorption coefficients of hemoglobin between two wavelengths. The changes measured in four cortical areas (frontal, occipital, parietal, and temporal) showed that the noise level when the 678-, 692-, and 750-nm wavelengths were paired with 830 nm was usually lower than when the 782-nm wavelength was paired with 830 nm, which is consistent with theoretical prediction. Moreover, the signal-to-noise ratios (S/Ns) and wavelength dependencies of the power detected in all areas and subjects together suggest that the 692-nm pairing had the highest S/N. This suggests that the optimal wavelengths depend on not only the difference in the absorption coefficients of hemoglobin but also on the optical properties in the measurement area, which affect the strength of the attenuation data. The 692-nm wavelength is thus a more optimal choice than wavelengths around 780 nm for pairing with 830 nm to measure Hb changes induced by cortical activation. The improved S/N enables more sensitive statistical analysis, which is essential to functional mapping with NIRS.

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.

Language lateralization in patients with temporal lobe epilepsy: a comparison of functional transcranial Doppler sonography and the Wada test

This study prospectively investigates whether noninvasive functional transcranial Doppler sonography (fTCD) is a useful tool to determine hemispheric language lateralization in the presurgical evaluation of patients with medically intractable temporal lobe epilepsy (TLE). fTCD results were compared with the Wada test as the gold standard. Wada test and fTCD were performed in 13 patients suffering from TLE. fTCD continuously measured blood flow velocities in both middle cerebral arteries, while the patient was performing a cued word generation task. During the Wada test, spontaneous speech, comprehension, reading, naming, and repetition were investigated. A laterality index (LI) was obtained by both procedures. Due to a lack of an acoustic temporal bone window, fTCD could not be performed in two patients (15%). In 9 of the remaining 11 patients hemispheric language dominance was found on the left side, in 1 patient on the right side, and 1 patient showed bihemispheric language representation. In all patients fTCD and the Wada test were in good agreement regarding hemispheric language lateralization, and the LI of both techniques were highly correlated (r = 0.776, P = 0.005). fTCD gives predictions of hemispheric language dominance consistent with the Wada test results even in children, patients with low IQ, and nonnative speakers. It is an alternative to the Wada test in determining language lateralization in patients with temporal lobe epilepsy.

Optical topography: practical problems and new applications

We will briefly review the present status of optical topography and then discuss the method of improving practicality, i.e., the signal-to-noise (S/N) ratio and the spatial resolution in observations of higher-order brain functions. The optimum wavelength pair improved the S/N ratio sixfold for deoxyhemoglobin, and new configurations of light irradiation and detection positions doubled the spatial resolution. We also report on developing application fields of optical topography. This modality will bridge the gap between natural sciences, neuroscience, and pedagogy, and show actual real-time brain activity.

A functional MRI protocol for localizing language comprehension in the human brain

We describe a functional magnetic resonance imaging (fMRI) protocol to separate activation of areas in the brain associated with language comprehension from sensory areas activated as a result of the presentation of the language stimulus, by comparing cortical activation patterns during the presentation of similar or the same language stimulus via two different sensory modalities (auditory and visual), and identifying the regions of activation that are common to both modalities. The protocol can be implemented on any MR scanner capable of functional imaging, and has proven valuable for the reliable identification of the lateralization and location of language centres in patients being considered for neurosurgical procedures. As well, the method has potential for the study of cortical processing of auditory speech and written language in healthy subjects and in subjects suffering from language disorders.

Beyond the visible--imaging the human brain with light

Optical approaches to investigate cerebral function and metabolism have long been applied in invasive studies. From the neuron cultured to the exposed cortex in the human during neurosurgical procedures, high spatial resolution can be reached and several processes such as membrane potential, cell swelling, metabolism of mitochondrial chromophores, and vascular response can be monitored, depending on the respective preparation. The authors focus on an extension of optical methods to the noninvasive application in the human. Starting with the pioneering work of Jöbsis 25 years ago, near-infrared spectroscopy (NIRS) has been used to investigate functional activation of the human cerebral cortex. Recently, several groups have started to use imaging systems that allow the generation of images of a larger area of the subject's head and, thereby, the production of maps of cortical oxygenation changes. Such images have a much lower spatial resolution compared with the invasively obtained optical images. The noninvasive NIRS images, however, can be obtained in undemanding set-ups that can be easily combined with other functional methods, in particular EEG. Moreover, NIRS is applicable to bedside use. The authors briefly review some of the abundant literature on intrinsic optical signals and the NIRS imaging studies of the past few years. The weaknesses and strengths of the approach are critically discussed. The authors conclude that NIRS imaging has two major advantages: it can address issues concerning neurovascular coupling in the human adult and can extend functional imaging approaches to the investigation of the diseased brain.