Functional magnetic resonance imaging of the normal and abnormal visual system in early life

What effect does measuring children under anesthesia have on the blood oxygenation level-dependent signal? A functional magnetic resonance imaging study of visual cortex

We performed functional magnetic resonance measurements involving visual stimuli on 10 children. Half of the children were measured awake, the other half were measured under light Sevoflurane anesthesia corresponding to 0.5 mean alveolar concentration. Each child was presented with a flashed and a reversing checkerboard, which previous investigations have shown to induce identical increases in cerebral blood flow. The latter stimulus activated double the number of neurons as the former so that cerebral metabolic rate of oxygen consumption (CMRO(2)) was doubled, leading to an effective rise of the oxygen extraction fraction. We measured the extent of activation by counting the number of activated pixels and assessed the change in CMRO(2) by measuring the change in the local deoxyhemoglobin (HbR) concentration, using change in spin relaxivity. In both groups of children, the extent of activation was larger for the flashed than the reversing checkerboard, although the absolute number of activated voxels was smaller for the children who were measured under anesthesia. The HbR concentration was significantly higher during the presentation of the reversing compared with the flashed checkerboard. The relative change in the HbR concentration to the flashed and reversing checkerboard was the same in the children who were measured under anesthesia as in the children who were measured awake. We conclude that light levels of anesthesia may reduce the extent of activation but does not unduly influence either CMRO(2) or cerebral blood flow, thus preserving the blood oxygenation level-dependent signal amplitude.

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.

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.

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.

Functional neuroimaging of speech perception in infants

Human infants begin to acquire their native language in the first months of life. To determine which brain regions support language processing at this young age, we measured with functional magnetic resonance imaging the brain activity evoked by normal and reversed speech in awake and sleeping 3-month-old infants. Left-lateralized brain regions similar to those of adults, including the superior temporal and angular gyri, were already active in infants. Additional activation in right prefrontal cortex was seen only in awake infants processing normal speech. Thus, precursors of adult cortical language areas are already active in infants, well before the onset of speech production.

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.

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.

Functional magnetic resonance imaging of the visual system

Functional magnetic resonance imaging (fMRI), which is a technique useful for non-invasive mapping of brain function, is well suited for studying the visual system. This review highlights current clinical applications and research studies involving patients with visual deficits. Relevant reports regarding the investigation of the brain's role in visual processing and some newer fMRI techniques are also reviewed. Functional magnetic resonance imaging has been used for presurgical mapping of visual cortex in patients with brain lesions and for studying patients with amblyopia, optic neuritis, and residual vision in homonymous hemianopia. Retinotopic borders, motion processing, and visual attention have been the topics of several fMRI studies. These reports suggest that fMRI can be useful in clinical and research studies in patients with visual deficits.

Magnetic resonance techniques in the evaluation of the perinatal brain: recent advances and future directions

Magnetic resonance (MR) techniques are attractive for use in the developing brain because of their resolving power and their relative noninvasiveness. Their ability to provide detailed structural as well as metabolic and functional information without the use of ionizing radiation is unique. Conventional MR Imaging has widely proven its potential for identifying normal and pathologic brain morphology. Functional MR imaging such as diffusion-weighted imaging (DWI) and perfusion and blood-oxygenation-dependent BOLD imaging are newer imaging methods providing insights into brain physiology. This review will focus on the application of different MR techniques including the conventional structural MR imaging techniques and the more advanced MR techniques, such as the quantitative morphometric MR methods, the diffusion weighted MR techniques, the functional MR techniques and MR spectroscopy in the study of the fetal and newborn brain.

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.

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.