We perform functional magnetic resonance imaging (fMRI) utilizing numerous paradigms. We evaluate language, auditory, vision, skin sensory and motor functions. In order to obtain a comprehensive understanding of language we will perform paradigms utilizing verb generation, word generation and/or sentence completion. Each gives a slightly different evaluation of language function. Passive listening is utilized to test auditory activation. Motor functional analysis may involve finger tapping, foot tapping, and lip motion. We recently have instituted a resting state MRI paradigm. This is a promising technique that should allow us to obtain functional brain information even when a patient is not able to successfully complete a routine paradigm.
A computer driven fMRI paradigm system delivers the data to the patient. In real-time we analyze the data as it is generated. This allows us to tell if a certain activation paradigm is working or not. If something is not working we then are able to intervene and try a new approach in order to maximize the possibility of getting the functional activation we are seeking.
Functional magnetic resonance imaging activates brain cortex. To optimize evaluation the activation maps are overlayed /analyzed in comparison to high resolution conventional MRI images such as T1-weighted gadolinium enhanced images or T2-weighted 3D FLAIR images. The fMRI data is also mapped in comparison to critical white matter pathways.
Fig 1. This is a T2–FLAIR image with language activation (yellow areas) seen adjacent to the hyperintense lesion on the left. This means the language functional cortex would be at risk with resection of this mass since language activation is right at the edge of the mass and activation is also present within the center of the lesion.
Fig 2. T1 FLAIR image with a mass demonstrated in the left posterior frontal lobe. The fMRI activation (yellow) is seen at the edge of the lesion. The area of activation was created with right finger tapping. This indicates the mass is in the motor strip and alerts the neurosurgeon to the risk of creating motor deficits at surgery.