Image: From a fMRI study in a 14-year-old patient with a large tumor (green) in the frontal part of the brain very near expected locations of the brain that control language. fMRI study was done while the patient thought about words (orange), moved their tongue (purple), and spoke “ahhh” (blue) to outline areas important for language. Using this information in the operating room, the brain surgeon was able to completely remove the tumor. The patient had no problems with language after the surgery.
Functional MRI (fMRI) examinations are special studies performed to determine the location of regions of brain that control specific functions like language, movement, and vision. These studies are usually done in patients prior to surgery so that the brain surgeon can avoid these critical areas.
During the fMRI examination, the patient will perform different tasks such as reading words and thinking about related action words, tapping their fingers, listening to stories, and watching images using a special sound system and TV screen made specifically for use in a MRI machine.
Dr. James Leach, a radiologist with specific training and experience in imaging of the brain, performs the fMRI examination and guides patients through the study with the help of our tremendous Child Life staff. He then processes the images using a special computer and program to make images for the brain surgeon (see above image). Because the examination requires patients to be awake, these examinations are not typically done on patients who require sedation or anesthesia to complete the exams.
Current research being performed at Cincinnati Children’s may someday make it possible to do fMRI examinations on children while under anesthesia by looking at brain activity in the “resting state” without the need for performing an active task. Children older than 6 are typically the best candidates for fMRI examinations, although we have performed these exams on children as young as 4 years old. The images Dr. Leach makes are often used inside the operating room to help guide the neurosurgeon to the safest route to the area they want to remove. Research on fMRI done at Cincinnati Children’s has shown good accuracy in determining areas of brain involved in language and movement, making it an excellent test for use in patients undergoing brain surgery.
Contributed by Dr. James Leach and edited by Glenn Miñano, BFA.