fMRI Basics and Clinical Applications

Ulmer S, Jansen O, eds.  fMRI Basics and Clinical Applications.  Springer 2010, 175 pages, 70 illustrations, $149.00.

With the ever-increasing availability of high-field strength MRI scanners, the demand for clinical functional MRI studies is outstripping the supply of formally trained individuals to fill this need.  fMRI: Basics and Clinical Applications seeks to address this critical need by providing the interested novice with the tools necessary to develop such a program.

The 181-page book is organized into two large sections that first review the basics of fMRI and then discuss various clinical applications.  The contributing authors are internationally distinguished experts in the fields of radiology, neurology, and neurosurgery.  The chapter topics are well organized and begin with an introductory overview of the challenges intrinsic to building a clinical fMRI program followed by a well-illustrated chapter reviewing neuroanatomy and cortical landmarks.   The neuroanatomy chapter is important, since fMRI interpretation requires a more in depth understanding of neural function and structure than radiologic interpretation of structural MRI. Missing from this chapter, however, is the inclusion of 3-D renderings that are now widely available.  Other topics reviewed in the Basics section include spatial resolution of fMRI techniques, a discussion on perfusion vs. blood oxygen level dependent (BOLD) imaging, the electrophysiologic basis underlying fMRI, and the pros and cons of high-field and ultra-high field MRI.  The Basics section ends with a chapter called “Press Button Solutions” that provides an incomplete review of various commercially available fMRI hardware and software tools.  The authors then compare these commercial solutions to spm2, a research-grade software solution, to determine how well each tool can reliably detect fMRI activations.  The author’s findings are not surprising, though one topic missing from the discussion involves regulatory issues that may restrict the ability to use more powerful research applications for clinical studies.

The Clinical Applications section is organized based on the type of indication for fMRI and includes standard clinical methodologies for pre-surgical brain mapping, as well as research-based applications and combining fMRI with other physiological tools.  Readers interested in getting a clinical fMRI program off the ground will find the chapters discussing sensorimotor and language mapping for epilepsy and tumor resections most informative and practical.  A full chapter is devoted to “Special Issues in fMRI-studies involving Children.”  The remaining chapters discuss more research-based applications, including mapping brain rehabilitation following stroke, and combining fMRI with direct cortical stimulation, transcranial magnetic stimulation, and magnetoencephalography.

This book accomplishes its goal of providing an overview of how fMRI can be applied to clinical applications.  The daunting challenges of conducting clinical fMRI studies are softened, and the reader gains focus on the various areas within their own program that they must strengthen.  While some editors may exclude valuable details that can shorten a text’s shelf-life, it is these pearls that make this title a must-have for the novice neuroimager.  While informative, this book does feed into the modern “fast and easy” philosophy and generally understates the challenges and limitations of push-button fMRI solutions that further separate the clinician from their data.  There were also a number of important issues the book did not cover, including how to properly use statistics in single subject studies, the role of functional connectivity in brain mapping, standardization of experimental paradigms, and quality control.  With these caveats in mind, I strongly recommend this book to anyone interested in learning more about the field of clinical fMRI.

fMRI Basics and Clinical Applications