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Functional MRI

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The Broca-Wernicke Doctrine

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Abstract

Functional neuroimaging techniques, first positron emission tomography (PET) and later functional MRI (fMRI), have revolutionized cognitive neuroscience. These tools have also greatly improved our understanding of how language is implemented in the brain. Almost from the beginning, fMRI was also applied as a tool for language mapping in surgical practice because of its obvious benefits: high-resolution whole-brain mapping without the need for invasive procedures. Other clinical applications that have been investigated, although less frequently, are the use of fMRI as a tool to help diagnose or understand diseases that lack clear neuroanatomical characteristics or as a predictor for language outcome after stroke (see Chap. 9).

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Notes

  1. 1.

    The BOLD contrast is sensitive to the level of deoxygenated haemoglobin in the blood. Haemoglobin is a large protein that contains iron and transports oxygen. When the molecule releases its oxygen, and gets deoxygenated, it becomes much more magnetic; it now acts as a little magnet that distorts the local magnetic field of the MR scanner. With the inflow of new oxygenated blood, in response to increased neural activity, deoxygenated blood is washed out, and the ability to measure signals from the tissue with the MR scanner improves. Although BOLD imaging is the most frequently used fMRI technique, there are several other methods that rely on other physiological changes (e.g. arterial, capillary or venous flow) [13].

  2. 2.

    When fMRI images are spatially smoothed, the signal from any given voxel is averaged with that of its neighbours. This results in an image that is blurred and has less anatomical detail. The spatial extent of smoothing is determined by the experimenter. In mathematical terms, a convolution is done with a Gaussian kernel of which the full width at half of its maximum (FWHM) determines the spatial extent of smoothing. Smoothing accounts for local differences in anatomy across individuals so that images can more easily be aligned with those of other brains or with a standard template. This process generally also increases the signal-to-noise ratio. However, there are important downsides: small areas of activation are lost in the process (resulting in false-negative activation), and the spatial detail may not be good enough for surgical purposes [20, 21].

  3. 3.

    The validity of many published fMRI studies has been seriously questioned over the past years (e.g. Vul 2009, Eklund 2016), suggesting that these had too high rates of false positives or have reported correlations between brain and behaviour that are ‘impossibly high’ [22, 23]. This reflects the ongoing discussion in search for valid methods to analyse and interpret fMRI data.

  4. 4.

    Quote taken from The principles of psychology by William James, 1890 [107]

  5. 5.

    There are, however, critics who state that group studies of patients, and even of normal subjects, have no relevance to the understanding of brain function. Read Caramazza (1986) for an elegant overview of arguments [35]. Caramazza strongly proposed that single-case studies are the only valid manner to study brain–behaviour relations. Others have reasoned that this could potentially lead ‘to the logical absurdity of there being as many theories as there are patients’ (Halai 2016) or warn that individual patient measurements may be too specific to allow meaningful generalization to a reference population [35, 36]. It is indeed difficult to draw general conclusions when experimental conditions and performance among patients are not homogeneous. However, deviant responses from brain-damaged patients are, of course, not entirely unconstrained and as such can be used to test new hypotheses and models. As Caramazza wrote ‘the performance of all individual patients (as well as the performance of normal subjects) must be considered in the evaluation of a proposed model of a cognitive system’ [35]. In recent years, new and complementary methods are being developed that not only generate a model for the group as a whole but also capture individual differences (e.g. [36]).

  6. 6.

    This has also been repeatedly shown with electrical stimulation mapping. Individual sites can be involved in more than one function, for instance, auditory and visual naming [60], reading and naming [61], writing and naming [62] or different languages in bilingual patients [63, 64].

  7. 7.

    This is best explained by the fact that primary cortices have a direct relationship with large subcortical fibre bundles, such as the corticospinal tract or optical radiation, which probably restricts variability and plasticity.

  8. 8.

    In science it is generally considered less of a problem when the hypothesis is not rejected on false grounds (i.e. a false-negative result).

  9. 9.

    Even if an experiment has no effect on the signals that are measured from the brain, due to pure noise, on average one in a hundred voxels will show a significant result if all voxels are tested with a p-value of 1%.

  10. 10.

    In scientific papers on fMRI, unfortunately, non-significant regions are usually reported as ‘not active’. Instead, it would be better to label these areas as ‘unknown’, as there is a fair chance that these areas in fact are false negatives.

  11. 11.

    Note that there is virtually no data available on the reliability of the Wada test and electrocortical stimulation mapping, despite being the current clinical gold standards for language mapping.

  12. 12.

    Variability can be significantly lowered by calculating relative (and not absolute) measures. A lateralization index is a reliable measure to assess language representation when a verb-generation task is used, for instance [18, 84].

  13. 13.

    This study was conducted among members of the European Low-Grade Glioma Network (www.braintumours.eu). Data were included from Frankfurt (Elke Hattingen), Graz (Gord von Campen, Margit Jehna), Madrid (Mar Jiménez de la Peña), Milan (Alberto Bizzi), Regensburg (Katharina Rosengarth, Frank Dodoo-Schittko), Tilburg (Martijn Jansma, Geert-Jan Rutten) and Utrecht (Nick Ramsey).

  14. 14.

    A few percent of the normal population has a right-dominant hemisphere, but this becomes known only after sudden damage to the right hemisphere. There are no methods (yet) that accurately establish hemispheric dominance in healthy individuals.

  15. 15.

    In patients with typical language representation according to the Wada test, there is agreement with fMRI results in approximately 90–95% of cases [96].

  16. 16.

    DES is the reference technique for functional mapping in neurosurgery [12]. In general a low morbidity is observed after DES-guided surgical procedures, and this argument is frequently used to confirm its status as a gold standard technique. However, there is little evidence that resection of DES-positive sites leads to permanent language impairments. The method suffers from important conceptual and practical drawbacks, making its gold status questionable. See for a discussion Chap. 6.

  17. 17.

    A few companies nowadays facilitate this process and supply equipment and software to run fMRI experiments or perform analyses for clinical customers. Even with their help, though, it is cumbersome to get the data at the doctor’s desk or in the operating room in a routine fashion.

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    Geert-Jan Rutten

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Rutten, GJ. (2017). Functional MRI. In: The Broca-Wernicke Doctrine. Springer, Cham. https://doi.org/10.1007/978-3-319-54633-9_8

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  • DOI: https://doi.org/10.1007/978-3-319-54633-9_8

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-54632-2

  • Online ISBN: 978-3-319-54633-9

  • eBook Packages: MedicineMedicine (R0)

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