Early fMRI Applications in Research and Medicine

Scientists and clinicians greeted the introduction of fMRI with enthusiasm. They immediately saw the benefits of a technique that is noninvasive, does not use ionizing radiation, and has higher temporal and spatial resolution than PET imaging, and in which there was no limit to the number of images that could be safely acquired from an individual. fMRI showed potential for a host of applications, including advancing psychology and psychiatry, presurgical mapping of the brain and imaging focal seizures. It opened up radiology research so it was no longer just for radiologists; it was now part of mainstream biomedical research. Two examples at the Massachusetts General Hospital are indicative of the breadth of research that was made possible by fMRI. First, Hans Breiter, MD, a psychiatrist working in the NMR Center, used fMRI to investigate the mediating anatomy of obsessive-compulsive disorder and observed brain activation in patients in response to provoking conditions—activation not present in normal subjects [1994]. He went on to investigate the effects of cocaine in volunteers (who were addicts), demonstrating brain activation induced by cocaine [1997]; he was able to differentiate between an anticipatory response and cocaine-induced euphoria. He then demonstrated, using a game that simulated monetary gains and losses, that the same brain-reward circuitry was stimulated by gambling [2001]. In the clinical realm, neuroradiologist Bradley R. Buchbinder, MD, together with G. Rees Cosgrove, MD, a neurosurgeon, developed methods to apply fMRI in presurgical planning to locate eloquent brain that could not be cut during surgery without causing loss of language or motor skills in the patient [1997]. fMRI demonstrated a tremendous improvement over conventional methods in which neurosurgeons mapped cortical function by direct electrical stimulation of the cortex. The latter techniques could be performed only after exposing the surface of the brain, and thus involved light general anesthesia and its associated risk and expense. fMRI, in contrast, could map brain function deep within the brain, was noninvasive, and could be applied preoperatively. The emergence of these new applications led to further studies and additional advances in functional imaging. Work coming out of the bustling NMR Center included the development of software that improved visualization by flattening the cortical surface, improved image quality through the introduction of ultra-high field MRI and the development of new radiofrequency coil systems. And of course many other groups around the world adopted the technique and contributed important advances of their own. All of this led Bruce Rosen to ask in his 2012 essay: Has fMRI changed the world? In some ways, he concluded, it has: The technique has already made its mark in scientific research (in terms of citations), cognitive neuroscience and mental illness. In other areas – medical practice, societal impact – we’re not quite there yet, but we’re clearly on the way. Stay tuned. With respect to development and application of fMRI, there’s plenty more to come. [REFERENCES]