Chad H. Moritz

Activation of brain regions vulnerable to Alzheimer's disease: the effect of mild cognitive impairment.

This study examined the functionality of the medial temporal lobe (MTL) and posterior cingulate (PC) in mild cognitive impairment amnestic type (MCI), a syndrome that puts patients at greater risk for developing Alzheimer disease (AD). Functional MRI (fMRI) was used to identify regions normally active during encoding of novel items and recognition of previously learned items in a reference group of 77 healthy young and middle-aged adults. The pattern of activation in this group guided further comparisons between 14 MCI subjects and 14 age-matched controls. The MCI patients exhibited less activity in the PC during recognition of previously learned items, and in the right hippocampus during encoding of novel items, despite comparable task performance to the controls. Reduced fMRI signal change in the MTL supports prior studies implicating the hippocampus for encoding new information. Reduced signal change in the PC converges with recent research on its role in recognition in normal adults as well as metabolic decline in people with genetic or cognitive risk for AD. Our results suggest that a change in function in the PC may account, in part, for memory recollection failure in AD.

Power spectrum ranked independent component analysis of a periodic fMRI complex motor paradigm

Independent component analysis (ICA) has been demonstrated to be an effective data‐driven method for analyzing fMRI data. However, a method for objective differentiation of task‐related components from those that are artifactually non‐relevant is needed. We propose a method of constant‐cycle (periodic) fMRI task paradigm combined with ranking of spatial ICA components by the magnitude contribution of their temporal aspects to the fundamental task frequency. Power spectrum ranking shares some similarity to correlation with an a priori hemodynamic response, but without a need to presume an exact timing or duration of the fMRI response. When applied to a complex motor task paradigm with auditory cues, multiple task‐related activations are successfully identified and separated from artifactual components. These activations include sensorimotor, auditory, and superior parietal areas. Comparisons of task‐related component time courses indicate the temporal relationship of fMRI responses in functionally involved regions. Results indicate the sensitivity of ICA to short‐duration hemodynamics, and the efficacy of a power spectrum ranking method for identification of task‐related components. Hum. Brain Mapping 18:111–122, 2003.

Functional MR imaging: paradigms for clinical preoperative mapping

Clinical applications of functional MR imaging include mapping of brain functions in relationship to intracranial tumors, seizure foci, or vascular malformations to determine the risk for performing surgical excision, the need for intraoperative mapping during excision, and selecting the optimal surgical approach to a lesion. A variety of paradigms are used to produce a blood-oxygen-level-dependent response in various brain regions, which can be identified with functional MR imaging. The paradigms used include active motor, language, or cognitive tasks, and passive tactile, auditory, or visual stimuli. Activation usually indicates the location of eloquent cortex. Lack of function in a region cannot be assumed when functional MR imaging shows absence of activation within the region.

Functional MR imaging assessment of a non-responsive brain injured patient

Functional magnetic resonance imaging (fMRI) was requested to assist in the evaluation of a comatose 38-year-old woman who had sustained multiple cerebral contusions from a motor vehicle accident. Previous electrophysiologic studies suggested absence of thalamocortical processing in response to median nerve stimulation. Whole-brain fMRI was performed utilizing visual, somatosensory, and auditory stimulation paradigms. Results demonstrated intact task-correlated sensory and cognitive blood oxygen level dependent (BOLD) hemodynamic response to stimuli. Electrodiagnostic studies were repeated and evoked potentials indicated supratentorial recovery in the cerebrum. At 3-months post trauma the patient had recovered many cognitive & sensorimotor functions, accurately reflecting the prognostic fMRI evaluation. These results indicate that fMRI examinations may provide a useful evaluation for brain function in non-responsive brain trauma patients.

Independent component analysis applied to self-paced functional MR imaging paradigms☆

Self-paced functional MR imaging (fMRI) paradigms, in which the task timing is determined by the subjects performance, can offer several advantages over commonly applied paradigms with predetermined stimulus timing. Independent component analysis (ICA) does not require specification of a timed response function, and could be an advantageous method of deriving results from fMRI data sets with varying response timings and durations. In this study normal volunteers (N = 10) each performed two self-paced fMRI motor and arithmetic paradigms. Individual data sets were analyzed with the Infomax spatial ICA algorithm. Conventional regression analysis was performed for comparison purposes. Spatial ICA effectively produced task-related components from each of the self-paced data sets, even in a few cases where regression analysis yielded non-specific functional maps. For the motor paradigm, these components consistently mapped to primary motor areas. ICA of the arithmetic paradigm yielded multiple task-related components that variably mapped to regions of parietal and frontal lobes. Regression analysis generally yielded similar spatial maps. The multiple task-related ICA components that were sometimes produced from each self-paced data set can be challenging to identify and evaluate for significance. These preliminary results indicate that ICA is useful as an exploratory and complementary method to conventional regression analysis for fMRI of self-paced paradigms.

Impact of Brain Tumor Location on Morbidity and Mortality: A Retrospective Functional MR Imaging Study

These investigators assessed the relationship between the distance of tumor border to eloquent brain regions (motor and language) identified by fMRI and pre- and postoperative morbidity and mortality. Factors that affected patient motor and language presentation and outcomes were close proximity of tumor to functional areas and advanced age. Right-handedness affected only language deficits. Variables that influenced survival included tumor grade, location, and proximity to language and motor areas. These findings indicate that tumors may affect language and motor function differently, depending on tumor lesion to activation distance. Overall, the data support the use of fMRI as a tool to evaluate patient prognosis and are directly applicable to preoperative neurosurgical planning. BACKGROUND AND PURPOSE: fMRI is increasingly used in neurosurgery to preoperatively identify areas of eloquent cortex. Our study evaluated the efficacy of clinical fMRI by analyzing the relationship between the distance from the tumor border to the area of functional activation (LAD) and patient pre- and postoperative morbidity and mortality. MATERIALS AND METHODS: The study included patients with diagnosis of primary or metastatic brain tumor who underwent preoperative fMRI-based motor mapping (n=74) and/or language mapping (n=77). The impact of LAD and other variables collected from patient records was analyzed with respect to functional deficits in terms of morbidity (paresis and aphasia) and mortality. RESULTS: Significant relationships were found between motor and language LAD and the existence of either pre- or postoperative motor (P < .001) and language deficits (P=.009). Increasing age was associated with motor and language deficits (P=.02 and P=.04 respectively). Right-handedness was related to language deficits (P=.05). Survival analysis revealed that pre- and postoperative deficits, grade, tumor location, and LAD predicted mortality. Motor deficits increased linearly as the distance from the tumor to the primary sensorimotor cortex decreased. Language deficits increased exponentially as the distance from the tumor to the language areas decreased below 1 cm. Postoperative mortality analysis showed an interaction effect between motor or language LAD and mortality predictors (grade and tumor location, respectively). CONCLUSIONS: These findings indicate that tumors may affect language and motor function differently depending on tumor LAD. Overall, the data support the use of fMRI as a tool to evaluate patient prognosis and are directly applicable to neurosurgical planning.

Functional MRI neuroanatomic correlates of the Hooper Visual Organization Test

The Hooper Visual Organization Test (VOT), a commonly applied neuropsychological test of visual spatial ability, is used for assessing patients with suspected right hemisphere, or parietal lobe involvement. A controversy has developed over whether the inferences of this test metric can be assumed to involve global, lateralized, or regional functionality. In this study, the characteristic visual organization and object naming aspects of the VOT task presentation were adapted to a functional MR imaging (fMRI) paradigm to probe the neuroanatomic correlates of this neuropsychological test. Whole brain fMRI mapping results are reported on a cohort of normal subjects. Bilateral fMRI responses were found predominantly in the posterior brain, in regions of superior parietal lobules, ventral temporal-occipital cortex, and posterior visual association areas, and to a lesser extent, the frontal eye fields bilaterally, and left dorsolateral prefrontal cortex. The results indicate a general brain region or network in which VOT impairment, due to its visuospatial and object identification demands, is possible to be detected. Discussion is made of interpretive limitations when adapting neuropsychological tests to fMRI analysis.

Characterizing instantaneous phase relationships in whole-brain fMRI activation data

Typically, fMRI data is processed in the time domain with linear methods such as regression and correlation analysis. We propose that the theory of phase synchronization may be used to more completely understand the dynamics of interacting systems, and can be applied to fMRI data as a novel method of detecting activation. Generalized synchronization is a phenomenon that occurs when there is a nonlinear functional relationship present between two or more coupled, oscillatory systems, whereas phase synchronization is defined as the locking of the phases while the amplitudes may vary. In this study, we developed an application of phase synchronization analysis that is appropriate for fMRI data, in which the phase locking condition is investigated between a voxel time series and the reference function of the task performed. A synchronization index is calculated to quantify the level of phase locking, and a nonparametric permutation test is used to determine the statistical significance of the results. We performed the phase synchronization analysis on the data from five volunteers for an event‐related finger‐tapping task. Functional maps were created that provide information on the interrelations between the instantaneous phases of the reference function and the voxel time series in a whole‐brain fMRI activation data set. We conclude that this method of analysis is useful for revealing additional information on the complex nature of the fMRI time series. Hum. Brain Mapping 16:71–80, 2002.

Test-retest precision of functional magnetic resonance imaging processed with independent component analysis

This study was designed to compare the test-retest precision of functional magnetic resonance imaging (fMRI) data processed with independent component analysis (ICA) and the same data analyzed with a conventional model-dependent method (Students-t mapping). Volunteers underwent two or three iterations of visual and auditory stimuli, while data were collected for fMRI scans. The scan data were separately processed with ICA and with Students-t mapping (STM). As a measure of test-retest precision, concurrence ratios were calculated for each subject and each task as the number of voxels that were activated by two iterations of a task divided by the average number of voxels activated in each repetition. In 28 test-retest comparisons, the average concurrence ratio was 0.69±0.10 for ICA and 0.65±0.13 for the conventional method, a statistically insignificant difference. In fMR image data of block stimulus paradigms, ICA had similar test-retest precision to a conventional model-dependent method.

Association of functional magnetic resonance imaging indices with postoperative language outcomes in patients with primary brain tumors

OBJECT Functional MRI (fMRI) has the potential to be a useful presurgical planning tool to treat patients with primary brain tumor. In this study the authors retrospectively explored relationships between language-related postoperative outcomes in such patients and multiple factors, including measures estimated from task fMRI maps (proximity of lesion to functional activation area, or lesion-to-activation distance [LAD], and activation-based language lateralization, or lateralization index [LI]) used in the clinical setting for presurgical planning, as well as other factors such as patient age, patient sex, tumor grade, and tumor volume. METHODS Patient information was drawn from a database of patients with brain tumors who had undergone preoperative fMRI-based language mapping of the Broca and Wernicke areas. Patients had performed a battery of tasks, including word-generation tasks and a text-versus-symbols reading task, as part of a clinical fMRI protocol. Individually thresholded task fMRI activation maps had been provided for use in the clinical setting. These clinical imaging maps were used to retrospectively estimate LAD and LI for the Broca and Wernicke areas. RESULTS There was a relationship between postoperative language deficits and the proximity between tumor and Broca area activation (the LAD estimate), where shorter LADs were related to the presence of postoperative aphasia. Stratification by tumor location further showed that for posterior tumors within the temporal and parietal lobes, more bilaterally oriented Broca area activation (LI estimate close to 0) and a shorter Wernicke area LAD were associated with increased postoperative aphasia. Furthermore, decreasing LAD was related to decreasing LI for both Broca and Wernicke areas. Preoperative deficits were related to increasing patient age and a shorter Wernicke area LAD. CONCLUSIONS Overall, LAD and LI, as determined using fMRI in the context of these paradigms, may be useful indicators of postsurgical outcomes. Whereas tumor location may influence postoperative deficits, the results indicated that tumor proximity to an activation area might also interact with how the language network is affected as a whole by the lesion. Although the derivation of LI must be further validated in individual patients by using spatially specific statistical methods, the current results indicated that fMRI is a useful tool for predicting postoperative outcomes in patients with a single brain tumor.