Special considerations for functional magnetic resonance imaging of pediatric populations

The effect of video-based education program applied before children's pediatric Magnetic Resonance Imaging (MRI) on anxiety in Turkey: A randomized controlled study

OBJECTIVE

This study is a randomized controlled trial conducted to examine the effects of a Turkish video-based education program on scanned image quality and child and parent anxiety during Magnetic Resonance Imaging (MRI).

DESIGN AND METHODS

The study was conducted with 66 children aged between 4 and 15 years at Zonguldak Bulent Ecevit University Health Practice and Research Hospital, between January 2019 and December 2019. A video-based educational program was applied to an intervention group before MRI.

RESULTS

The video-based education program reduced children's anxiety and fear (p < 0.001). The study also showed a significant reduction in parental stress (p < 0.001). The image quality in the intervention group was better than that in the control group (control group: 3.24 ± 1.20; intervention group: 4.18 ± 0.81) (p = 0.001). Significantly fewer children refused to enter the MRI room in the intervention group than in the control group (p < 0.05).

CONCLUSION

Child-friendly and video-based educational programs can be organized for children and parents in diagnostic and treatment procedures for children in hospitals.

PRACTICE IMPLICATIONS

MRI scans can be uncomfortable for children and require transport to a better-equipped hospital for sedation. They can also cause financial loss for children and their parents and disrupt facility workflow. An educational program to adjust the children and their families will improve the scanning process and its success rate.

Denoising task-correlated head motion from motor-task fMRI data with multi-echo ICA

Motor-task functional magnetic resonance imaging (fMRI) is crucial in the study of several clinical conditions, including stroke and Parkinson's disease. However, motor-task fMRI is complicated by task-correlated head motion, which can be magnified in clinical populations and confounds motor activation results. One method that may mitigate this issue is multi-echo independent component analysis (ME-ICA), which has been shown to separate the effects of head motion from the desired BOLD signal but has not been tested in motor-task datasets with high amounts of motion. In this study, we collected an fMRI dataset from a healthy population who performed a hand grasp task with and without task-correlated amplified head motion to simulate a motor-impaired population. We analyzed these data using three models: single-echo (SE), multi-echo optimally combined (ME-OC), and ME-ICA. We compared the models' performance in mitigating the effects of head motion on the subject level and group level. On the subject level, ME-ICA better dissociated the effects of head motion from the BOLD signal and reduced noise. Both ME models led to increased t-statistics in brain motor regions. In scans with high levels of motion, ME-ICA additionally mitigated artifacts and increased stability of beta coefficient estimates, compared to SE. On the group level, all three models produced activation clusters in expected motor areas in scans with both low and high motion, indicating that group-level averaging may also sufficiently resolve motion artifacts that vary by subject. These findings demonstrate that ME-ICA is a useful tool for subject-level analysis of motor-task data with high levels of task-correlated head motion. The improvements afforded by ME-ICA are critical to improve reliability of subject-level activation maps for clinical populations in which group-level analysis may not be feasible or appropriate, for example in a chronic stroke cohort with varying stroke location and degree of tissue damage.

Brief mock-scan training reduces head motion during real scanning for children: A growth curve study

Pediatric neuroimaging datasets are rapidly increasing in scales. Despite strict protocols in data collection and preprocessing focused on improving data quality, the presence of head motion still impedes our understanding of neurodevelopmental mechanisms. Large head motion can lead to severe noise and artifacts in magnetic resonance imaging (MRI) studies, inflating correlations between adjacent brain areas and decreasing correlations between spatial distant territories, especially in children and adolescents. Here, by leveraging mock-scans of 123 Chinese children and adolescents, we demonstrated the presence of increased head motion in younger participants. Critically, a 5.5-minute training session in an MRI mock scanner was found to effectively suppress the head motion in the children and adolescents. Therefore, we suggest that mock scanner training should be part of the quality assurance routine prior to formal MRI data collection, particularly in large-scale population-level neuroimaging initiatives for pediatrics.

Evaluating fMRI-Based Estimation of Eye Gaze During Naturalistic Viewing

The collection of eye gaze information during functional magnetic resonance imaging (fMRI) is important for monitoring variations in attention and task compliance, particularly for naturalistic viewing paradigms (e.g., movies). However, the complexity and setup requirements of current in-scanner eye tracking solutions can preclude many researchers from accessing such information. Predictive eye estimation regression (PEER) is a previously developed support vector regression-based method for retrospectively estimating eye gaze from the fMRI signal in the eye's orbit using a 1.5-min calibration scan. Here, we provide confirmatory validation of the PEER method's ability to infer eye gaze on a TR-by-TR basis during movie viewing, using simultaneously acquired eye tracking data in five individuals (median angular deviation < 2°). Then, we examine variations in the predictive validity of PEER models across individuals in a subset of data (n = 448) from the Child Mind Institute Healthy Brain Network Biobank, identifying head motion as a primary determinant. Finally, we accurately classify which of the two movies is being watched based on the predicted eye gaze patterns (area under the curve = 0.90 ± 0.02) and map the neural correlates of eye movements derived from PEER. PEER is a freely available and easy-to-use tool for determining eye fixations during naturalistic viewing.

Test-retest reliability of hippocampal subfield volumes in a developmental sample: Implications for longitudinal developmental studies

The hippocampus (Hc) is composed of cytoarchitectonically distinct subfields: dentate gyrus (DG), cornu ammonis sectors 1-3 (CA1-3), and subiculum. Limited evidence suggests differential maturation rates across the Hc subfields. While longitudinal studies are essential in demonstrating differential development of Hc subfields, a prerequisite for interpreting meaningful longitudinal effects is establishing test-retest consistency of Hc subfield volumes measured in vivo over time. Here, we examined test-retest consistency of Hc subfield volumes measured from structural MR images in two independent developmental samples. Sample One (n = 28, ages 7-20 years, M = 12.64, SD = 3.35) and Sample Two (n = 28, ages 7-17 years, M = 11.72, SD = 2.88) underwent MRI twice with a 1-month and a 2-year delay, respectively. High-resolution PD-TSE-T₂ -weighted MR images (0.4 × 0.4 × 2 mm³ ) were collected and manually traced using a longitudinal manual demarcation protocol. In both samples, we found excellent consistency of Hc subfield volumes between the two visits, assessed by two-way mixed intraclass correlation (ICC (3) single measures ≥ 0.87), and no difference between children and adolescents. The results further indicated that discrepancies between repeated measures were not related to Hc subfield volumes, or visit number. In addition to high consistency, with the applied longitudinal protocol, we detected significant variability in Hc subfield volume changes over the 2-year delay, implying high sensitivity of the method in detecting individual differences. Establishing unbiased, high longitudinal consistency of Hc subfield volume measurements optimizes statistical power of a hypothesis test and reduces standard error of the estimate, together improving external validity of the measures in constructing theoretical models of memory development.

Educational fMRI: From the Lab to the Classroom

Functional MRI (fMRI) findings hold many potential applications for education, and yet, the translation of fMRI findings to education has not flowed. Here, we address the types of fMRI that could better support applications of neuroscience to the classroom. This 'educational fMRI' comprises eight main challenges: (1) collecting artifact-free fMRI data in school-aged participants and in vulnerable young populations, (2) investigating heterogenous cohorts with wide variability in learning abilities and disabilities, (3) studying the brain under natural and ecological conditions, given that many practical topics of interest for education can be addressed only in ecological contexts, (4) depicting complex age-dependent associations of brain and behaviour with multi-modal imaging, (5) assessing changes in brain function related to developmental trajectories and instructional intervention with longitudinal designs, (6) providing system-level mechanistic explanations of brain function, so that useful individualized predictions about learning can be generated, (7) reporting negative findings, so that resources are not wasted on developing ineffective interventions, and (8) sharing data and creating large-scale longitudinal data repositories to ensure transparency and reproducibility of fMRI findings for education. These issues are of paramount importance to the development of optimal fMRI practices for educational applications.

Genetic and environmental influences on MRI scan quantity and quality

The current study provides an overview of quantity and quality of MRI data in a large developmental twin sample (N = 512, aged 7–9), and investigated to what extent scan quantity and quality were influenced by genetic and environmental factors. This was examined in a fixed scan protocol consisting of two functional MRI tasks, high resolution structural anatomy (3DT1) and connectivity (DTI) scans, and a resting state scan. Overall, scan quantity was high (88% of participants completed all runs), while scan quality decreased with increasing session length. Scanner related distress was negatively associated with scan quantity (i.e., completed runs), but not with scan quality (i.e., included runs). In line with previous studies, behavioral genetic analyses showed that genetics explained part of the variation in head motion, with heritability estimates of 29% for framewise displacement and 65% for absolute displacement. Additionally, our results revealed that subtle head motion (after exclusion of excessive head motion) showed lower heritability estimates (0–14%), indicating that findings of motion-corrected and quality-controlled MRI data may be less confounded by genetic factors. These findings provide insights in factors contributing to scan quality in children, an issue that is highly relevant for the field of developmental neuroscience.

Community and household-level socioeconomic disadvantage and functional organization of the salience and emotion network in children and adolescents

Socioeconomic disadvantage (SED) during childhood has been linked to disparities in physical and mental health. A growing body of research has focused on identifying neurodevelopmental consequences of SED, commonly measured using within-household factors (e.g., household income), to better understand the processes underlying SED-related disparities. These studies suggest that childhood SED has a widespread impact on brain development, altering development of multiple brain regions simultaneously. These findings also raise the possibility that childhood SED impacts development of key brain systems, such as the salience and emotion network (SEN), which is positioned at the intersection of brain systems involved in cognitive and emotion-related functioning and is thought to mediate information flow within and between these networks. The present study tests for associations between household- and community-level SED, as well as their interaction, and measures of SEN-based functional neural organization in 57 children and adolescents (ages 6-17). We applied graph theoretical analyses to resting-state functional magnetic resonance imaging (fMRI) data to examine SEN-based functional network topology. Results showed that youth residing in more distressed communities demonstrate lower hub-like properties (i.e., less efficient global information transfer and fewer connections) of two core SEN nodes - the anterior cingulate cortex and the left supramarginal gyrus. Similarly, lower household income was associated with lower efficiency of the anterior cingulate, but had no effect on the supramarginal gyrus. There was, however, an interaction between income and community SED in the rostral prefrontal cortex, such that higher income was associated with higher clustering coefficient and lower betweenness centrality, suggesting greater local processing and lower influence of this region on information flow across the network. These effects were significant only among youth living in low (but not high) SED communities, suggesting that within-household SED factors may not protect against the detrimental effects of a disadvantaged community context. Similarly, the age-related increase in average path length of the left rostral prefrontal cortex was only significant among youth living in low (but not high) SED communities. Given that maturation of the SEN is considered to be a critical functional backbone supporting the development of more flexible cognitive and emotional processes into adulthood, we tested for links between SEN graph metrics and measures of cognitive and emotion-related functioning. We found that higher community SED and lower income were both associated with lower IQ. Lower IQ, in turn, was associated with global efficiency of the left supramarginal gyrus. Observed effects of SED on SEN-based functional neural organization may help to explain the strong and pervasive link between childhood SED and disparities in cognitive and emotional outcomes.

Poor between-session recall of extinction learning and hippocampal activation and connectivity in children

BACKGROUND

In healthy adults, successful between-session recall of extinction learning depends on the hippocampus and ventromedial prefrontal cortex (vmPFC), especially when tested in the extinction context. Poor extinction recall and dysfunction within hippocampal-vmPFC circuitry are associated with fear-based disorders (e.g., anxiety, posttraumatic stress disorder). Despite the early age of onset of virtually all fear-based disorders and the protracted development of the hippocampus and vmPFC across the first two decades of life, little is known about extinction recall and the underlying neural correlates in children.

METHODS

Here, we tested extinction recall in 43 pre-adolescent children (ages 6-11 yrs) by coupling functional magnetic resonance imaging and virtual reality with a novel interpersonal threat-related two-day (ABBA) fear-extinction paradigm. Conditioned fear responding was assessed at behavioral, subjective, physiological, and neural levels.

RESULTS

Although children demonstrated intact within-session extinction, there was poor between-session recall of extinction learning (retention index: 13.56%), evidenced by elevations in skin conductance, avoidant behavioral responses, and subjective ratings. Elevations in conditioning fear responding were accompanied by activation in the hippocampus and insula, and increased connectivity of the hippocampus with the insula and dorsal anterior cingulate cortex - regions implicated in the return of fear in adult studies. Children who kept more distance from the extinguished cue during extinction subsequently demonstrated heightened hippocampal-cingulate coupling during recall, suggesting that avoidant behavior interferes with extinction retention.

CONCLUSIONS

Poor extinction recall in children may have implications for developmental vulnerability to fear-based disorders, and for the application of therapeutic strategies that rely on principles of extinction (e.g., exposure therapy) to pediatric samples.

Clinical application of advanced MR methods in children: points to consider

The application of both functional MRI and diffusion MR tractography prior to a neurosurgical operation is well established in adults, but less so in children, for several reasons. For this review, we have identified several aspects (task design, subject preparation, actual scanning session, data processing, interpretation of results, and decision-making) where pediatric peculiarities should be taken into account. Further, we not only systematically identify common issues, but also provide solutions, based on our experience as well as a review of the pertinent literature. The aim is to provide the clinician as well as the imaging scientist with information that helps to plan, conduct, and interpret such a clinically-indicated exam in a way that maximizes benefit for, and minimizes the burden on the individual child.

Why parametric measures are critical for understanding typical and atypical cognitive development

Children's cognitive abilities improve significantly over childhood and adolescence. We know from behavioral research that core cognitive processes such as working memory and mental attention improve significantly across development. Functional magnetic resonance imaging (fMRI) allows for investigating the typically developing, living brain in action. In the last twenty years we have learned a great deal about brain correlates associated with how adults hold and manipulate information in mind, however, neurocognitive correlates across development remain inconsistent. We present developmental fMRI findings on cognitive processes such as working memory and mental attention and discuss methodological and theoretical issues in the assessment of cognitive limitations in the visual spatial and verbal domains. We also review data from typical and atypical development and emphasize the unique contribution parametric measures can make in understanding neurocognitive correlates of typical and atypical development.

Mindfulness and dynamic functional neural connectivity in children and adolescents

BACKGROUND

Interventions that promote mindfulness consistently show salutary effects on cognition and emotional wellbeing in adults, and more recently, in children and adolescents. However, we lack understanding of the neurobiological mechanisms underlying mindfulness in youth that should allow for more judicious application of these interventions in clinical and educational settings.

METHODS

Using multi-echo multi-band fMRI, we examined dynamic (i.e., time-varying) and conventional static resting-state connectivity between core neurocognitive networks (i.e., salience/emotion, default mode, central executive) in 42 children and adolescents (ages 6-17).

RESULTS

We found that trait mindfulness in youth relates to dynamic but not static resting-state connectivity. Specifically, more mindful youth transitioned more between brain states over the course of the scan, spent overall less time in a certain connectivity state, and showed a state-specific reduction in connectivity between salience/emotion and central executive networks. The number of state transitions mediated the link between higher mindfulness and lower anxiety, providing new insights into potential neural mechanisms underlying benefits of mindfulness on psychological health in youth.

CONCLUSIONS

Our results provide new evidence that mindfulness in youth relates to functional neural dynamics and interactions between neurocognitive networks, over time.

Brain areas associated with numbers and calculations in children: Meta-analyses of fMRI studies

Children use numbers every day and typically receive formal mathematical training from an early age, as it is a main subject in school curricula. Despite an increase in children neuroimaging studies, a comprehensive neuropsychological model of mathematical functions in children is lacking. Using quantitative meta-analyses of functional magnetic resonance imaging (fMRI) studies, we identify concordant brain areas across articles that adhere to a set of selection criteria (e.g., whole-brain analysis, coordinate reports) and report brain activity to tasks that involve processing symbolic and non-symbolic numbers with and without formal mathematical operations, which we called respectively number tasks and calculation tasks. We present data on children 14 years and younger, who solved these tasks. Results show activity in parietal (e.g., inferior parietal lobule and precuneus) and frontal (e.g., superior and medial frontal gyri) cortices, core areas related to mental-arithmetic, as well as brain regions such as the insula and claustrum, which are not typically discussed as part of mathematical problem solving models. We propose a topographical atlas of mathematical processes in children, discuss findings within a developmental constructivist theoretical model, and suggest practical methodological considerations for future studies.

Language Ability Predicts Cortical Structure and Covariance in Boys with Autism Spectrum Disorder

There is significant clinical heterogeneity in language and communication abilities of individuals with Autism Spectrum Disorders (ASD). However, no consistent pathology regarding the relationship of these abilities to brain structure has emerged. Recent developments in anatomical correlation-based approaches to map structural covariance networks (SCNs), combined with detailed behavioral characterization, offer an alternative for studying these relationships. In this study, such an approach was used to study the integrity of SCNs of cortical thickness and surface area associated with language and communication, in 46 high-functioning, school-age children with ASD compared with 50 matched, typically developing controls (all males) with IQ > 75. Findings showed that there was alteration of cortical structure and disruption of fronto-temporal cortical covariance in ASD compared with controls. Furthermore, in an analysis of a subset of ASD participants, alterations in both cortical structure and covariance were modulated by structural language ability of the participants, but not communicative function. These findings indicate that structural language abilities are related to altered fronto-temporal cortical covariance in ASD, much more than symptom severity or cognitive ability. They also support the importance of better characterizing ASD samples while studying brain structure and for better understanding individual differences in language and communication abilities in ASD.

Advanced imaging techniques in pediatric body MRI

While there are many challenges specific to pediatric abdomino-pelvic MRI, many recent advances are addressing these challenges. It is therefore essential for radiologists to be familiar with the latest advances in MR imaging. Laudable efforts have also recently been implemented in many centers to improve the overall experience of pediatric patients, including the use of dedicated radiology child life specialists, MRI video goggles, and improved MR suite environments. These efforts have allowed a larger number of children to be scanned while awake, with fewer studies being done under sedation or anesthesia; this has resulted in additional challenges from patient motion and difficulties with breath-holding and tolerating longer scan times. In this review, we highlight common challenges faced in imaging the pediatric abdomen and pelvis and discuss the application of the newest techniques to address these challenges. Additionally, we highlight the newest advances in quantified imaging techniques, specifically in MR liver iron quantification. The techniques described in this review are all commercially available and can be readily implemented.

Minimizing noise in pediatric task-based functional MRI; Adolescents with developmental disabilities and typical development

Functional Magnetic Resonance Imaging (fMRI) represents a powerful tool with which to examine brain functioning and development in typically developing pediatric groups as well as children and adolescents with clinical disorders. However, fMRI data can be highly susceptible to misinterpretation due to the effects of excessive levels of noise, often related to head motion. Imaging children, especially with developmental disorders, requires extra considerations related to hyperactivity, anxiety and the ability to perform and maintain attention to the fMRI paradigm. We discuss a number of methods that can be employed to minimize noise, in particular movement-related noise. To this end we focus on strategies prior to, during and following the data acquisition phase employed primarily within our own laboratory. We discuss the impact of factors such as experimental design, screening of potential participants and pre-scan training on head motion in our adolescents with developmental disorders and typical development. We make some suggestions that may minimize noise during data acquisition itself and finally we briefly discuss some current processing techniques that may help to identify and remove noise in the data. Many advances have been made in the field of pediatric imaging, particularly with regard to research involving children with developmental disorders. Mindfulness of issues such as those discussed here will ensure continued progress and greater consistency across studies.

Constructivist developmental theory is needed in developmental neuroscience

Neuroscience techniques provide an open window previously unavailable to the origin of thoughts and actions in children. Developmental cognitive neuroscience is booming, and knowledge from human brain mapping is finding its way into education and pediatric practice. Promises of application in developmental cognitive neuroscience rests however on better theory-guided data interpretation. Massive amounts of neuroimaging data from children are being processed, yet published studies often do not frame their work within developmental models-in detriment, we believe, to progress in this field. Here we describe some core challenges in interpreting the data from developmental cognitive neuroscience, and advocate the use of constructivist developmental theories of human cognition with a neuroscience interpretation.

Considerations for MRI study design and implementation in pediatric and clinical populations

Human neuroimaging, specifically magnetic resonance imaging (MRI), is being used with increasing popularity to study brain structure and function in development and disease. When applying these methods to developmental and clinical populations, careful consideration must be taken with regard to study design and implementation. In this article, we discuss two major considerations particularly pertinent to brain research in special populations. First, we discuss considerations for subject selection and characterization, including issues related to comorbid conditions, medication status, and clinical assessment. Second, we discuss methods and considerations for acquisition of adequate, useable MRI data. Given that children and patients may experience anxiety with the scanner environment, preventing participation, and that they have a higher risk of motion artifact, resulting in data loss, successful subject compliance and data acquisition are not trivial tasks. We conclude that, as researchers, we must consider a number of issues when using neuroimaging tools to study children and patients, and we should thoughtfully justify our choices of methods and study design.

A "one size fits all" approach to language fMRI: increasing specificity and applicability by adding a self-paced component

We have previously established an fMRI task battery suitable for mapping the language processing network in children. Among the tasks used, the synonyms and the vowel identification task induced robust task-related activations in children with average language abilities; however, the fixed presentation time seems to be a drawback in participants with above- or below-average language abilities. This feasibility study in healthy adults (n = 20) was aimed at adapting these tasks to the individual level of each patient by implementing a self-paced stimulus presentation. The impact of using a block- versus an event-related statistical approach was also evaluated. The self-paced modification allowed our participants with above-average language abilities to process stimuli much faster than originally implemented, likely increasing task adherence. A higher specificity of the event-related analysis was confirmed by stronger left inferior frontal and crossed cerebellar activations. We suggest that self-paced paradigms and event-related analyses may both increase specificity and applicability.

Using fMRI to Investigate Memory in Young Children Born Small for Gestational Age

Objectives

Intrauterine growth restriction (IUGR) can lead to infants being born small for gestational age (SGA). SGA is associated with differences in brain anatomy and impaired cognition. We investigated learning and memory in children born SGA using neuropsychological testing and functional Magnetic Resonance Imaging (fMRI).

Study Design

18 children born appropriate for gestational age (AGA) and 34 SGA born children (18 with and 16 without postnatal catch-up growth) participated in this study. All children were between 4 and 7 years old. Cognitive functioning was assessed by IQ and memory testing (Digit/Word Span and Location Learning). A newly developed fMRI picture encoding task was completed by all children in order to assess brain regions involved in memory processes.

Results

Neuropsychological testing demonstrated that SGA children had IQ’s within the normal range but lower than in AGA and poorer performances across measures of memory. Using fMRI, we observed memory related activity in posterior parahippocampal gyrus as well as the hippocampus proper. Additionally, activation was seen bilaterally in the prefrontal gyrus. Children born SGA showed less activation in the left parahippocampal region compared to AGA.

Conclusions

This is the first fMRI study demonstrating different brain activation patterns in 4-7 year old children born SGA, suggesting that intrauterine growth restriction continues to affect neural functioning in children later-on.

Age differences in high frequency phasic heart rate variability and performance response to increased executive function load in three executive function tasks

The current study examines similarity or disparity of a frontally mediated physiological response of mental effort among multiple executive functioning tasks between children and adults. Task performance and phasic heart rate variability (HRV) were recorded in children (6 to 10 years old) and adults in an examination of age differences in executive functioning skills during periods of increased demand. Executive load levels were varied by increasing the difficulty levels of three executive functioning tasks: inhibition (IN), working memory (WM), and planning/problem solving (PL). Behavioral performance decreased in all tasks with increased executive demand in both children and adults. Adults' phasic high frequency HRV was suppressed during the management of increased IN and WM load. Children's phasic HRV was suppressed during the management of moderate WM load. HRV was not suppressed during either children's or adults' increasing load during the PL task. High frequency phasic HRV may be most sensitive to executive function tasks that have a time-response pressure, and simply requiring performance on a self-paced task requiring frontal lobe activation may not be enough to generate HRV responsitivity to increasing demand.

Deliver us from evil? The temptation, realities, and neuroethico-legal issues of employing assessment neurotechnologies in public safety initiatives

In light of the recent events of terrorism and publicized cases of mass slayings and serial killings, there have been calls from the public and policy-makers alike for neuroscience and neurotechnology (neuroS/T) to be employed to intervene in ways that define and assess, if not prevent, such wanton acts of aggression and violence. Ongoing advancements in assessment neuroS/T have enabled heretofore unparalleled capabilities to evaluate the structure and function of the brain, yet each and all are constrained by certain technical and practical limitations. In this paper, we present an overview of the capabilities and constraints of current assessment neuroS/T, address neuro-ethical and legal issues fostered by the use and potential misuse of these approaches, and discuss how neuroethics may inform science and the law to guide right and sound applications of neuroS/T to "deliver us from evil" while not being led into temptations of ampliative claims and inapt use.

Anxious and non-anxious adolescents' experiences of non-clinical magnetic resonance imaging research

Magnetic resonance imaging (MRI) has become a ubiquitous research tool for developmental neuroscientists interested in brain structure and function in children and adolescents. However, ethical concerns are sometimes raised about using MRI with children and adolescents, especially when participants have anxiety. We asked 17 clinically/sub-clinically anxious and 19 non-anxious adolescents about their experiences of taking part in MRI for research purposes. Although the anxious group reported experiencing more anxiety during the scan, these differences had attenuated by the time participants got home. We found no evidence that anxious adolescents would be less likely to choose to have another scan or would feel more nervous during another scan. There was some evidence that more trait anxious adolescents found the MRI study enjoyable. These findings should give ethics committees, clinicians, and parents confidence that so long as researchers exercise appropriate care, MRI research is acceptable to adolescents, including those with clinical anxiety.

Empirical examination of the potential adverse psychological effects associated with pediatric FMRI scanning

BACKGROUND

Over the past decade, the number of functional magnetic resonance imaging (fMRI) studies has increased dramatically. As MRI scans may be anxiety provoking, performing them in a research setting, particularly with children already prone to anxiety, raises questions about ethics as well as methodological feasibility. It is essential to address these questions before expanding the use of this technique to clinical settings, or more widely in the context of pediatric psychopharmacology and biological psychiatry research. The current study investigates the psychological reactions of anxious and non-anxious children and non-anxious adults to an fMRI scan.

METHODS

Eighty-seven anxious children, 140 non-anxious children, and 98 non-anxious adults rated their emotional reactions to an fMRI scan.

RESULTS

Results indicated that anxious and non-anxious children reported no greater anxiety after fMRI scanning than did adults. In addition, no age-related differences in distress were observed. These data demonstrate that anxious children, healthy children, and healthy adults have similar emotional reactions to fMRI scanning.

CONCLUSIONS

The observed findings suggest that the potential for fMRI to produce anxiety should not impede its widespread use in clinical research, psychopharmacology, and biological psychiatry.

Brain development during the preschool years

The preschool years represent a time of expansive mental growth, with the initial expression of many psychological abilities that will continue to be refined into young adulthood. Likewise, brain development during this age is characterized by its "blossoming" nature, showing some of its most dynamic and elaborative anatomical and physiological changes. In this article, we review human brain development during the preschool years, sampling scientific evidence from a variety of sources. First, we cover neurobiological foundations of early postnatal development, explaining some of the primary mechanisms seen at a larger scale within neuroimaging studies. Next, we review evidence from both structural and functional imaging studies, which now accounts for a large portion of our current understanding of typical brain development. Within anatomical imaging, we focus on studies of developing brain morphology and tissue properties, including diffusivity of white matter fiber tracts. We also present new data on changes during the preschool years in cortical area, thickness, and volume. Physiological brain development is then reviewed, touching on influential results from several different functional imaging and recording modalities in the preschool and early school-age years, including positron emission tomography (PET), electroencephalography (EEG) and event-related potentials (ERP), functional magnetic resonance imaging (fMRI), magnetoencephalography (MEG), and near-infrared spectroscopy (NIRS). Here, more space is devoted to explaining some of the key methodological factors that are required for interpretation. We end with a section on multimodal and multidimensional imaging approaches, which we believe will be critical for increasing our understanding of brain development and its relationship to cognitive and behavioral growth in the preschool years and beyond.

Natural history of untreated syringomyelia in pediatric patients

OBJECT

The natural history of syringomyelia in pediatric patients remains uncertain. Although symptomatic and operative cases of syringomyelia are well studied, there are fewer articles in the literature on the nonoperative syrinx and its clinical and radiological course. The purpose of this research was to analyze the natural history of untreated syringomyelia in pediatric patients presenting with minimal neurological symptoms.

METHODS

A review of the neurosurgery database at British Columbia's Children's Hospital identified all pediatric patients (< 18 years of age) with syringes identified on MR imaging. Patients were included in this study if they had at least 2 MR images of the spine, at least 1 year apart, while receiving nonoperative treatment. Magnetic resonance imaging was used to determine changes in the size of the syrinx over time. Clinic notes were analyzed to establish demographic and clinical features and to determine any clinical changes over time.

RESULTS

A total of 17 patients were included in the study. Symptoms at presentation were often mild and included limb numbness (3 cases), headaches (2 cases), mild sensory deficits (2 cases), mild motor deficits (3 cases), and intermittent incontinence (7 cases). The consultant neurosurgeon believed that the syrinx was not contributing to the symptoms in these 17 patients. The syrinx either remained unchanged (7 cases) or diminished in size (8 cases) in a total of 15 patients (88%). In the remaining 2 patients the authors noted an increase in syrinx size, in 1 of whom the clinical course also worsened. Both of these patients had a Chiari malformation and subsequently underwent craniocervical decompression. Overall, the mean change was -0.7 mm of maximal axial diameter (range -2.6 to +2.7 mm). Sixteen patients (94%) exhibited no worsening of symptoms over time.

CONCLUSIONS

Syringomyelia often remains stable in patients receiving nonoperative treatment. However, given that 2 (12%) of 17 syringes in this series enlarged, it is likely appropriate to include periodic imaging in the follow-up of these cases.

Considerations for imaging the adolescent brain

In recent years the number of functional neuroimaging studies on adolescence has exploded. These studies have led to important new insights about the relation between functional brain development and behavior. However, special consideration is warranted when working with adolescents. In this review, we review variables, including pubertal stage, sleep patterns and pregnancy, which are particularly relevant for developmental cognitive neuroscience studies involving adolescents. Consideration of the unique challenges associated with adolescence will help the growing field of developmental neuroimaging standardize procedures and will eventually facilitate interpretation across studies.

Functional neuroimaging of treatment effects in psychiatry: methodological challenges and recommendations

Functional magnetic resonance imaging (fMRI) has helped to elucidate the neurobiological bases of psychiatric and neurodevelopmental disorders by localizing etiologically-relevant aberrations in brain function. Functional MRI also has shown great promise to help understand potential mechanisms of action of effective treatments for a range of psychiatric and neurodevelopmental disorders, including mood and anxiety disorders, schizophrenia, and autism. However, the use of fMRI to probe intervention effects in psychiatry is associated with unique methodological considerations, including the psychometric properties of repeated fMRI scans, how to assess potential relations between the effects of an intervention on symptoms and on specific brain activation patterns, and how to best make causal inferences about intervention effects on brain function. Additionally, the study of treatment effects in neurodevelopmental disorders presents additional unique challenges related to brain maturation, analysis methods, and the potential for motion artifacts. We review these methodological considerations and provide recommendations for best practices for each of these topics.

Language mapping in temporal lobe epilepsy in children: special considerations

Temporal lobe epilepsy (TLE) in children is a slightly different entity than TLE in adults not only because of its semiology and pathology but also because of the different approach to surgical treatment. Presurgical investigations for eloquent cortex, especially language, must take these differences into account. Most diagnostic tests were created for adults, and many of the assessment tools need to be adapted for children because they are not just small adults. This paper will highlight the specific challenges and solutions in mapping language in a pediatric population with TLE.

Neural correlates of pediatric obesity

OBJECTIVE

Childhood obesity rates have increased over the last 40 years and have a detrimental impact on public health. While the causes of the obesity epidemic are complex, obesity ultimately arises from chronic imbalances between energy intake and expenditure. An emerging area of research in obesity has focused on the role of the brain in evaluating the rewarding properties of food and making decisions about what and how much to eat.

METHOD

This article reviews recent scientific literature regarding the brain's role in pediatric food motivation and childhood obesity.

RESULTS

The article will begin by reviewing some of the recent literature discussing challenges associated with neuroimaging in children and the relevant developmental brain changes that occur in childhood and adolescence. The article will then review studies regarding neural mechanisms of food motivation and the ability to delay gratification in children and how these responses differ in obese compared to healthy weight children.

CONCLUSION

Increasing our understanding about how brain function and behavior may differ in children will inform future research, obesity prevention, and interventions targeting childhood obesity.

Pediatric functional magnetic resonance neuroimaging: tactics for encouraging task compliance

Background

Neuroimaging technology has afforded advances in our understanding of normal and pathological brain function and development in children and adolescents. However, noncompliance involving the inability to remain in the magnetic resonance imaging (MRI) scanner to complete tasks is one common and significant problem. Task noncompliance is an especially significant problem in pediatric functional magnetic resonance imaging (fMRI) research because increases in noncompliance produces a greater risk that a study sample will not be representative of the study population.

Method

In this preliminary investigation, we describe the development and application of an approach for increasing the number of fMRI tasks children complete during neuroimaging. Twenty-eight healthy children ages 9-13 years participated. Generalization of the approach was examined in additional fMRI and event-related potential investigations with children at risk for depression, children with anxiety and children with depression (N = 120). Essential features of the approach include a preference assessment for identifying multiple individualized rewards, increasing reinforcement rates during imaging by pairing tasks with chosen rewards and presenting a visual 'road map' listing tasks, rewards and current progress.

Results

Our results showing a higher percentage of fMRI task completion by healthy children provides proof of concept data for the recommended tactics. Additional support was provided by results showing our approach generalized to several additional fMRI and event-related potential investigations and clinical populations.

Discussion

We proposed that some forms of task noncompliance may emerge from less than optimal reward protocols. While our findings may not directly support the effectiveness of the multiple reward compliance protocol, increased attention to how rewards are selected and delivered may aid cooperation with completing fMRI tasks

Conclusion

The proposed approach contributes to the pediatric neuroimaging literature by providing a useful way to conceptualize and measure task noncompliance and by providing simple cost effective tactics for improving the effectiveness of common reward-based protocols.

Functional neuroimaging in the examination of effects of prenatal alcohol exposure

Functional neuroimaging offers the opportunity to understand the effect of prenatal alcohol exposure on the activities of the brain as well as providing a window into the relationship between neural activation and the behavioral outcomes that have been described in affected individuals. Several different methodologies have been used to examine the neurophysiological signal changes associated with different brain functions in prenatally exposed individuals and those diagnosed with fetal alcohol syndrome (FAS) or other fetal alcohol spectrum disorders (FASD). These include electroencephalography (EEG), positron emission tomography (PET), single-photon emission computed tomography (SPECT), and functional magnetic resonance imaging (fMRI). These studies demonstrate that it is feasible to use these technologies with this clinical population and that the damage to the central nervous system associated with prenatal alcohol exposure has widespread functional implications; however, currently, the literature in these areas is limited and unsystematic. Functional MRI with this clinical population has just begun to explore the implications of prenatal alcohol exposure with the first paper published in 2005. Other methodologies are similarly limited in scope. Nonetheless, these functional neuroimaging studies suggest that prenatal alcohol exposure, or a diagnosis of FAS, may lead to restrictions in neural efficiency or a global decrement in processing resources.

Practical aspects of running developmental studies in the MEG

Developmental neuroimaging studies offer a unique opportunity to gain insight into the underpinnings of various cognitive functions by examining age-related changes in brain structure and function. There is an increasing body of neuroimaging literature discussing issues related to testing children in developmental studies (Crone et al. Human Brain Mapping 31:835-837, 2010). These deal with fMRI developmental studies and discuss methods (Luna et al. Human Brain Mapp 31:863-871, 2010), data interpretation (Poldrack Human Brain Mapp 31:872-878, 2010), and theoretical approaches (Karmiloff-Smith Human Brain Mapp 31:934-941, 2010). There has not yet been an equivalent discussion for MEG developmental studies. This paper will address issues specific to data acquisition, analysis, and interpretation for MEG developmental studies.

Methodological approaches in developmental neuroimaging studies

Pediatric neuroimaging is increasingly providing insights into the neural basis of cognitive development. Indeed, we have now arrived at a stage where we can begin to identify optimal methodological and statistical approaches to the acquisition and analysis of developmental imaging data. In this article, we describe a number of these approaches and how their selection impacts the ability to examine and interpret developmental effects. We describe preferred approaches to task selection, definition of age groups, selection of fMRI designs, definition of regions of interest (ROI), optimal baseline measures, and treatment of timecourse data. Consideration of these aspects of developmental neuroimaging reveals that unlike single-group neuroimaging studies, developmental studies pose unique challenges that impact study planning, task design, data analysis, and the interpretation of findings.

The "Task B problem" and other considerations in developmental functional neuroimaging

Functional neuroimaging provides a remarkable tool to allow us to study cognition across the lifespan and in special populations in a safe way. However, experimenters face a number of methodological issues, and these issues are particularly pertinent when imaging children. This brief article discusses assessing task performance, strategies for dealing with group performance differences, controlling for movement, statistical power, proper atlas registration, and data analysis strategies. In addition, there will be discussion of two other topics that have important implications for interpreting fMRI data: the question of whether functional neuroanatomical differences between adults and children are the consequence of putative developmental neurovascular differences, and the issue of interpreting negative blood oxygenation-level dependent (BOLD) signal change.

Functional magnetic resonance imaging for presurgical evaluation of very young pediatric patients with epilepsy

OBJECT

The authors describe their experience with functional MR (fMR) imaging in children as young as 5 years of age, or even younger in developmental age equivalent. Functional MR imaging can be useful for identifying eloquent cortex prior to surgical intervention. Most fMR imaging clinical work has been done in adults, and although children as young as 8 years of age have been included in larger clinical series, cases in younger children are rarely reported.

METHODS

The authors reviewed presurgical fMR images in eight patients who were 8 years of age or younger, six of whom were 5 or 6 years of age. Each patient had undergone neuropsychological testing. Three patients functioned at a below-average level, with adaptive functioning age scores of 3 to 4 years. Self-paced finger tapping (with passive movement in one patient) and silent language tasks were used as activation tasks. The language task was modified for younger children, for whom the same (not novel) stimuli were used for extensive practice ahead of time and in the MR imaging unit. Patient preparation involved techniques such as having experienced staff present to work with patients and providing external management during imaging. Six of eight patients had extensive training and practice prior to the procedure. In the two youngest patients, this training included use of a mock MR unit.

RESULTS

All cases yielded successful imaging. Finger tapping in all seven of the patients who could perform it demonstrated focal motor activation in the frontal-parietal region, with expected activation elsewhere, including in the cerebellum. Three of four patients had the expected verb generation task activations, with left-hemisphere dominance, including a 6-year-old child who functioned at the 3-year, 9-month level. The only child (an 8-year-old) who was not prepared prior to the imaging session for the verb generation task failed this task due to movement artifact.

CONCLUSIONS

Despite the challenges of successfully using fMR imaging in very young and clinically involved patients, these studies can be performed successfully in children with a chronological age of 5 or 6 years and a developmental age as young as 3 or 4 years.

Adolescent development of the reward system

Adolescence is a developmental period characterized by increased reward-seeking behavior. Investigators have used functional magnetic resonance imaging (fMRI) in conjunction with reward paradigms to test two opposing hypotheses about adolescent developmental changes in the striatum, a region implicated in reward processing. One hypothesis posits that the striatum is relatively hypo-responsive to rewards during adolescence, such that heightened reward-seeking behavior is necessary to achieve the same activation as adults. Another view suggests that during adolescence the striatal reward system is hyper-responsive, which subsequently results in greater reward-seeking. While evidence for both hypotheses has been reported, the field has generally converged on this latter hypothesis based on compelling evidence. In this review, I describe the evidence to support this notion, speculate on the disparate fMRI findings and conclude with future areas of inquiry to this fascinating question.

The role of functional magnetic resonance imaging in the study of brain development, injury, and recovery in the newborn

Development of brain functions and the structural-functional correlates of brain injury remain difficult to evaluate in the young infant. Thus, new noninvasive methods capable of early functional diagnosis are needed. This review describes the use of functional magnetic resonance imaging (fMRI) for studying localization of brain function in the developing brain when standard clinical investigations are not available or conclusive. This promising neuroimaging technique has been successfully used in healthy newborns and in newborns with brain injury using different paradigms, including passive visual, somato-sensorial, and auditory stimulation. We summarize the major findings of previous fMRI studies in young infants, describe ongoing methodological challenges, and propose exciting future developments in using resting-state protocols and functional connectivity techniques to assist in evaluating early life brain function and its recovery from injury.

Adolescent development of the reward system

Adolescence is a developmental period characterized by increased reward-seeking behavior. Investigators have used functional magnetic resonance imaging (fMRI) in conjunction with reward paradigms to test two opposing hypotheses about adolescent developmental changes in the striatum, a region implicated in reward processing. One hypothesis posits that the striatum is relatively hypo-responsive to rewards during adolescence, such that heightened reward-seeking behavior is necessary to achieve the same activation as adults. Another view suggests that during adolescence the striatal reward system is hyper-responsive, which subsequently results in greater reward-seeking. While evidence for both hypotheses has been reported, the field has generally converged on this latter hypothesis based on compelling evidence. In this review, I describe the evidence to support this notion, speculate on the disparate fMRI findings and conclude with future areas of inquiry to this fascinating question.

Functional MRI in children: clinical and research applications

Functional MRI has become a critical research tool for evaluating brain function and developmental trajectories in children. Its clinical use in children is becoming more common. This presentation will review the basic underlying physiologic and technical aspects of fMRI, review research applications that have direct clinical relevance, and outline the current clinical uses of this technology.

Group specific optimisation of fMRI processing steps for child and adult data

Motion is a major issue in functional magnetic resonance imaging (fMRI) dataseries and causes artifacts or increased overall noise obscuring signals of interest. It is particularly important to be able to control for and correct these artifacts when dealing with child data. We analysed the data from 35 children (4-8 years old) and 13 adults (18-30 years old) during an emotional face paradigm. The children were split into low and high motion groups on the basis of having less or more than an estimated maximal movement of one voxel (3.75 mm) and one degree of rotation in any motion direction between any pair of scans in the run. Several different preprocessing steps were evaluated for their ability to correct for the excess motion using agnostic canonical variates analysis (aCVA) in the NPAIRS (Nonparametric, Prediction, Activation, Influence, Reproducibility, re-Sampling) framework. The adult dataset was reasonably stable whereas the motion-prone child datasets benefited greatly from motion parameter regression (MPR). Motion parameter regression had a strong beneficial impact on all datasets, a result that was largely unaffected by other preprocessing choices; however, motion correction on its own did not have as much impact. The low motion child group subjected to MPR had reproducibility values at par with those of the adult group, but needed almost twice as many subjects to achieve this result, indicating weaker responses in young children. The aCVA showed greater sensitivity to the task response pattern than the mixed effects general linear model (mGLM) in the expected face processing regions, although the mGLM showed more responses in some other areas. This work illustrates that preprocessing choices must be made in a group-specific fashion to optimise fMRI results.

Applications of multivariate pattern classification analyses in developmental neuroimaging of healthy and clinical populations

Analyses of functional and structural imaging data typically involve testing hypotheses at each voxel in the brain. However, it is often the case that distributed spatial patterns may be a more appropriate metric for discriminating between conditions or groups. Multivariate pattern analysis has been gaining traction in neuroimaging of adult healthy and clinical populations; studies have shown that information present in neuroimaging data can be used to decode intentions and perceptual states, as well as discriminate between healthy and diseased brains. While few studies to date have applied these methods in pediatric populations, in this review we discuss exciting potential applications for studying both healthy, and aberrant, brain development. We include an overview of methods and discussion of challenges and limitations.

Regional brain activation during verbal declarative memory in metastatic breast cancer

PURPOSE

To determine the neurofunctional basis of verbal memory dysfunction in women with metastatic breast cancer. This objective was based on previous research suggesting memory and other cognitive deficits in this population. We attempted to determine if verbal memory impairments were related to the most commonly studied disease parameters including adjuvant chemotherapy and chronic stress-related disruption of limbic system structures.

EXPERIMENTAL DESIGN

We used functional magnetic resonance imaging to test our hypothesis that women with breast cancer would show significantly lower brain activation during verbal declarative memory tasks compared with age and education-matched healthy female controls. We also assessed several stress-related variables including diurnal cortisol levels to test our hypothesis that women with breast cancer would show higher stress and this would contribute to brain activation deficits during memory tasks.

RESULTS

Women with breast cancer had significantly lower prefrontal cortex activation during the memory encoding condition compared with controls. However, the breast cancer group showed significantly greater activation than controls during the recall condition in multiple, diffuse brain regions. There were no significant differences between the groups in stress-related variables. Women who were treated with cyclophosphamide, methotrexate, and 5-fluorouracil chemotherapy showed lower prefrontal cortex activation during memory encoding.

CONCLUSIONS

These results suggest that women with metastatic breast cancer may be at risk for verbal memory impairments as a result of altered functional brain activation profiles. These findings may be associated with chemotherapy type and/or other aspects of the breast cancer disease process.

Making MR imaging child's play - pediatric neuroimaging protocol, guidelines and procedure

Within the last decade there has been an increase in the use of structural and functional magnetic resonance imaging (fMRI) to investigate the neural basis of human perception, cognition and behavior. Moreover, this non-invasive imaging method has grown into a tool for clinicians and researchers to explore typical and atypical brain development. Although advances in neuroimaging tools and techniques are apparent, (f)MRI in young pediatric populations remains relatively infrequent. Practical as well as technical challenges when imaging children present clinicians and research teams with a unique set of problems. To name just a few, the child participants are challenged by a need for motivation, alertness and cooperation. Anxiety may be an additional factor to be addressed. Researchers or clinicians need to consider time constraints, movement restriction, scanner background noise and unfamiliarity with the MR scanner environment. A progressive use of functional and structural neuroimaging in younger age groups, however, could further add to our understanding of brain development. As an example, several research groups are currently working towards early detection of developmental disorders, potentially even before children present associated behavioral characteristics. Various strategies and techniques have been reported as a means to ensure comfort and cooperation of young children during neuroimaging sessions. Play therapy, behavioral approaches and simulation, the use of mock scanner areas, basic relaxation and a combination of these techniques have all been shown to improve the participant's compliance and thus MRI data quality. Even more importantly, these strategies have proven to increase the comfort of families and children involved. One of the main advances of such techniques for the clinical practice is the possibility of avoiding sedation or general anesthesia (GA) as a way to manage children's compliance during MR imaging sessions. In the current video report, we present a pediatric neuroimaging protocol with guidelines and procedures that have proven to be successful to date in young children.

Quantification of head motion in children during various fMRI language tasks

PURPOSE

Head motion during functional MRI scanning can lead to signal artifact, a problem often more severe with children. However, the documentation for the characteristics of head motion in children during various language functional tasks is very limited in the current literature. This report characterizes head motion in children during fMRI as a function of age, sex, and task.

METHODS

Head motion during four different fMRI language tasks was investigated in a group of 323 healthy children between the age of 5 and 18 years. A repeated measures ANOVA analysis was used to study the impact of age, sex, task, and the interaction of these factors on the motion.

RESULTS

Pediatric subjects demonstrated significantly different amounts of head motion during fMRI when different language tasks were used. Word-Picture Matching, the only task that involved visual engagement, suffered the least amount of motion, which was significantly less than in any of the other three tasks; the latter were not significantly different from each other. Further examination revealed that the main effect of language task on motion was significantly affected by age, sex, and their interaction.

CONCLUSION

Our results suggest that age, sex, and task are all associated with the degree of head motion in children during fMRI experiments. Investigators working with pediatric patients may increase their success by using task components associated with less motion (e.g., visual stimuli), or by using this large scale dataset to estimate the effects of sex and age on motion for planning purposes.

Neural origin of cognitive shifting in young children

Cognitive shifting is the ability to adapt to changes in the environment. Extensive research has revealed that the prefrontal cortex plays an important role in cognitive shifting. Adult neuroimaging studies have shown that the inferior prefrontal cortex is activated during cognitive shifting tasks. Developmental studies have shown that cognitive shifting changes significantly during preschool years. It is known that 3-year-old children often perseverate to previous mental sets, whereas 5-year-old children do not. Developmental psychologists assume that maturation of the prefrontal cortex plays an essential role in the development of shifting; however, direct supporting evidence is lacking. We used near-infrared spectroscopy and showed that inferior prefrontal activation is associated with successful shifting in young children. We also showed that even preschool children display adult-like inferior prefrontal activation during a simple cognitive shifting task. This report demonstrates the neural origins of cognitive shifting in young children. These results have the potential to contribute to our understanding of cognitive and brain development in both typically and atypically developed children.