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DOI: 10.1055/s-0032-1324731
Identification of Successful Clinical fMRI Sessions in Children: An Objective Approach
Publication History
08 December 2011
29 May 2012
Publication Date:
23 September 2012 (online)
![](https://www.thieme-connect.de/media/neuropediatrics/201205/lookinside/thumbnails/10.1055-s-0032-1324731-1.jpg)
Abstract
Purpose The term clinical functional magnetic resonance imaging (fMRI) describes an examination with direct clinical impact on the patient. Interpretation of clinical fMRI especially in children, however, is often difficult due to suboptimal data quality. The current gold standard is standardized visual evaluation. To evaluate such data in an automated and objective way, we developed an approach to identify successful sessions.
Methods Average activation inside a predefined, task-specific region of interest (ROI) is compared with average activation in the rest of the brain, and their ratio (classification factor [F c]) is determined for different statistical thresholds (T). The approach was tested and validated using 239 clinical pediatric fMRI sessions (sensorimotor, perceptive /productive language). Performance was assessed in terms of sensitivity, specificity, and positive likelihood ratio.
Results Best performance was found for F c ≥ 2 and T ≥ 2.5, achieving a sensitivity of 0.87 and specificity of 0.94. Comparing the different domains, sensitivity was lowest for language production tasks, mainly due to atypical activation foci.
Conclusion We demonstrate that an objective, automated framework for the classification of clinical pediatric fMRI sessions may provide important additional information, supporting visual evaluation, especially from sensorimotor and language perception domains. In the current form, atypical or strong network activation is not easily captured.
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References
- 1 Cabeza R, Nyberg L. Imaging cognition II: An empirical review of 275 PET and fMRI studies. J Cogn Neurosci 2000; 12 (1) 1-47
- 2 Thulborn KR, Davis D, Erb P, Strojwas M, Sweeney JA. Clinical fMRI: implementation and experience. Neuroimage 1996; 4 (3 Pt 3) S101-S107
- 3 Anderson DP, Harvey AS, Saling MM , et al. FMRI lateralization of expressive language in children with cerebral lesions. Epilepsia 2006; 47 (6) 998-1008
- 4 Deblaere K, Boon PA, Vandemaele P , et al. MRI language dominance assessment in epilepsy patients at 1.0 T: region of interest analysis and comparison with intracarotid amytal testing. Neuroradiology 2004; 46 (6) 413-420
- 5 Lehéricy S, Duffau H, Cornu P , et al. Correspondence between functional magnetic resonance imaging somatotopy and individual brain anatomy of the central region: comparison with intraoperative stimulation in patients with brain tumors. J Neurosurg 2000; 92 (4) 589-598
- 6 Woermann FG, Jokeit H, Luerding R , et al. Language lateralization by Wada test and fMRI in 100 patients with epilepsy. Neurology 2003; 61 (5) 699-701
- 7 Maitra R. A re-defined and generalized percent-overlap-of-activation measure for studies of fMRI reproducibility and its use in identifying outlier activation maps. Neuroimage 2010; 50 (1) 124-135
- 8 Haller S, Bartsch AJ. Pitfalls in FMRI. Eur Radiol 2009; 19 (11) 2689-2706
- 9 Church JA, Petersen SE, Schlaggar BL. The “Task B problem” and other considerations in developmental functional neuroimaging. Hum Brain Mapp 2010; 31 (6) 852-862
- 10 Price CJ, Friston KJ. Scanning patients with tasks they can perform. Hum Brain Mapp 1999; 8 (2–3) 102-108
- 11 Carter CS, Heckers S, Nichols T, Pine DS, Strother S. Optimizing the design and analysis of clinical functional magnetic resonance imaging research studies. Biol Psychiatry 2008; 64 (10) 842-849
- 12 Detre JA. Clinical applicability of functional MRI. J Magn Reson Imaging 2006; 23 (6) 808-815
- 13 Jezzard P, Buxton RB. The clinical potential of functional magnetic resonance imaging. J Magn Reson Imaging 2006; 23 (6) 787-793
- 14 Lieberman MD, Cunningham WA. Type I and Type II error concerns in fMRI research: re-balancing the scale. Soc Cogn Affect Neurosci 2009; 4 (4) 423-428
- 15 Engström M, Karlsson M, Croné M , et al. Clinical fMRI of language function in aphasic patients: reading paradigm successful, while word generation paradigm fails. Acta Radiol 2010; 51 (6) 679-686
- 16 Fernández G, Specht K, Weis S , et al. Intrasubject reproducibility of presurgical language lateralization and mapping using fMRI. Neurology 2003; 60 (6) 969-975
- 17 Gaillard WD, Balsamo L, Xu B , et al. fMRI language task panel improves determination of language dominance. Neurology 2004; 63 (8) 1403-1408
- 18 Jansen A, Sehlmeyer C, Pfleiderer B , et al. Assessment of verbal memory by fMRI: lateralization and functional neuroanatomy. Clin Neurol Neurosurg 2009; 111 (1) 57-62
- 19 Freilich ER, Gaillard WD. Utility of functional MRI in pediatric neurology. Curr Neurol Neurosci Rep 2010; 10 (1) 40-46
- 20 Gaillard WD, Grandin CB, Xu B. Developmental aspects of pediatric fMRI: considerations for image acquisition, analysis, and interpretation. Neuroimage 2001; 13 (2) 239-249
- 21 Leach JL, Holland SK. Functional MRI in children: clinical and research applications. Pediatr Radiol 2010; 40 (1) 31-49
- 22 Holland SK, Plante E, Weber Byars A, Strawsburg RH, Schmithorst VJ, Ball Jr WS. Normal fMRI brain activation patterns in children performing a verb generation task. Neuroimage 2001; 14 (4) 837-843
- 23 Wilke M, Lidzba K, Staudt M, Buchenau K, Grodd W, Krägeloh-Mann I. Comprehensive language mapping in children, using functional magnetic resonance imaging: what's missing counts. Neuroreport 2005; 16 (9) 915-919
- 24 Wilke M, Lidzba K, Staudt M, Buchenau K, Grodd W, Krägeloh-Mann I. An fMRI task battery for assessing hemispheric language dominance in children. Neuroimage 2006; 32 (1) 400-410
- 25 Erberich SG, Friedlich P, Seri I, Nelson Jr MD, Blüml S. Functional MRI in neonates using neonatal head coil and MR compatible incubator. Neuroimage 2003; 20 (2) 683-692
- 26 Guzzetta A, Staudt M, Petacchi E , et al. Brain representation of active and passive hand movements in children. Pediatr Res 2007; 61 (4) 485-490
- 27 Staudt M, Pieper T, Grodd W, Winkler P, Holthausen H, Krägeloh-Mann I. Functional MRI in a 6-year-old boy with unilateral cortical malformation: concordant representation of both hands in the unaffected hemisphere. Neuropediatrics 2001; 32 (3) 159-161
- 28 Yuan W, Altaye M, Ret J , et al. Quantification of head motion in children during various fMRI language tasks. Hum Brain Mapp 2009; 30 (5) 1481-1489
- 29 Yerys BE, Jankowski KF, Shook D , et al. The fMRI success rate of children and adolescents: typical development, epilepsy, attention deficit/hyperactivity disorder, and autism spectrum disorders. Hum Brain Mapp 2009; 30 (10) 3426-3435
- 30 Schapiro MB, Schmithorst VJ, Wilke M, Byars AW, Strawsburg RH, Holland SK. BOLD fMRI signal increases with age in selected brain regions in children. Neuroreport 2004; 15 (17) 2575-2578
- 31 Wilke M, Pieper T, Lindner K , et al. Clinical functional MRI of the language domain in children with epilepsy. Hum Brain Mapp 2011; 32 (11) 1882-1893
- 32 Durston S, Davidson MC, Tottenham N , et al. A shift from diffuse to focal cortical activity with development. Dev Sci 2006; 9 (1) 1-8
- 33 Staudt M, Grodd W, Niemann G, Wildgruber D, Erb M, Krägeloh-Mann I. Early left periventricular brain lesions induce right hemispheric organization of speech. Neurology 2001; 57 (1) 122-125
- 34 Gaillard WD, Sachs BC, Whitnah JR , et al. Developmental aspects of language processing: fMRI of verbal fluency in children and adults. Hum Brain Mapp 2003; 18 (3) 176-185
- 35 Wink AM, Roerdink JB. Denoising functional MR images: a comparison of wavelet denoising and Gaussian smoothing. IEEE Trans Med Imaging 2004; 23 (3) 374-387
- 36 Andersson JL, Hutton C, Ashburner J, Turner R, Friston K. Modeling geometric deformations in EPI time series. Neuroimage 2001; 13 (5) 903-919
- 37 Macey PM, Macey KE, Kumar R, Harper RM. A method for removal of global effects from fMRI time series. Neuroimage 2004; 22 (1) 360-366
- 38 Friston KJ, Holmes AP, Worsley KJ , et al. Statistical parametric maps in functional imaging: A general linear approach. Hum Brain Mapp 1994; 2: 189-210
- 39 Ashburner J, Friston KJ. Unified segmentation. Neuroimage 2005; 26 (3) 839-851
- 40 Wilke M, Holland SK, Altaye M, Gaser C. Template-O-Matic: a toolbox for creating customized pediatric templates. Neuroimage 2008; 41 (3) 903-913
- 41 Staudt M, Lidzba K, Grodd W, Wildgruber D, Erb M, Krägeloh-Mann I. Right-hemispheric organization of language following early left-sided brain lesions: functional MRI topography. Neuroimage 2002; 16 (4) 954-967
- 42 Lidzba K, Staudt M, Wilke M, Grodd W, Krägeloh-Mann I. Lesion-induced right-hemispheric language and organization of nonverbal functions. Neuroreport 2006; 17 (9) 929-933
- 43 Staudt M, Grodd W, Gerloff C, Erb M, Stitz J, Krägeloh-Mann I. Two types of ipsilateral reorganization in congenital hemiparesis: a TMS and fMRI study. Brain 2002; 125 (Pt 10) 2222-2237
- 44 Staudt M. (Re-)organization of the developing human brain following periventricular white matter lesions. Neurosci Biobehav Rev 2007; 31 (8) 1150-1156
- 45 Wilke M, Staudt M, Juenger H, Grodd W, Braun C, Krägeloh-Mann I. Somatosensory system in two types of motor reorganization in congenital hemiparesis: topography and function. Hum Brain Mapp 2009; 30 (3) 776-788
- 46 Wilke M, Lidzba K. LI-tool: a new toolbox to assess lateralization in functional MR-data. J Neurosci Methods 2007; 163 (1) 128-136
- 47 Davison AC, Hinkley DV, Young GA. Recent Developments in Bootstrap Methodology. Stat Sci 2003; 18: 141-157
- 48 Wilke M, Schmithorst VJ. A combined bootstrap/histogram analysis approach for computing a lateralization index from neuroimaging data. Neuroimage 2006; 33 (2) 522-530
- 49 Bellec P, Rosa-Neto P, Lyttelton OC, Benali H, Evans AC. Multi-level bootstrap analysis of stable clusters in resting-state fMRI. Neuroimage 2010; 51 (3) 1126-1139
- 50 Bizzi A, Blasi V, Falini A , et al. Presurgical functional MR imaging of language and motor functions: validation with intraoperative electrocortical mapping. Radiology 2008; 248 (2) 579-589
- 51 Liégeois F, Cross JH, Gadian DG, Connelly A. Role of fMRI in the decision-making process: epilepsy surgery for children. J Magn Reson Imaging 2006; 23 (6) 933-940
- 52 Voets NL, Adcock JE, Flitney DE , et al. Distinct right frontal lobe activation in language processing following left hemisphere injury. Brain 2006; 129 (Pt 3) 754-766
- 53 Mbwana J, Berl MM, Ritzl EK , et al. Limitations to plasticity of language network reorganization in localization related epilepsy. Brain 2009; 132 (Pt 2) 347-356
- 54 Rosenberger LR, Zeck J, Berl MM , et al. Interhemispheric and intrahemispheric language reorganization in complex partial epilepsy. Neurology 2009; 72 (21) 1830-1836
- 55 Staudt M, Braun C, Gerloff C, Erb M, Grodd W, Krägeloh-Mann I. Developing somatosensory projections bypass periventricular brain lesions. Neurology 2006; 67 (3) 522-525
- 56 Wellmer J, Weber B, Urbach H, Reul J, Fernandez G, Elger CE. Cerebral lesions can impair fMRI-based language lateralization. Epilepsia 2009; 50 (10) 2213-2224
- 57 Alkadhi H, Crelier GR, Boendermaker SH, Golay X, Hepp-Reymond MC, Kollias SS. Reproducibility of primary motor cortex somatotopy under controlled conditions. AJNR Am J Neuroradiol 2002; 23 (9) 1524-1532
- 58 Uylings HB, Rajkowska G, Sanz-Arigita E, Amunts K, Zilles K. Consequences of large interindividual variability for human brain atlases: converging macroscopical imaging and microscopical neuroanatomy. Anat Embryol (Berl) 2005; 210 (5–6) 423-431
- 59 Kadis DS, Iida K, Kerr EN , et al. Intrahemispheric reorganization of language in children with medically intractable epilepsy of the left hemisphere. J Int Neuropsychol Soc 2007; 13 (3) 505-516
- 60 Krings T, Erberich SG, Roessler F, Reul J, Thron A. MR blood oxygenation level-dependent signal differences in parenchymal and large draining vessels: implications for functional MR imaging. AJNR Am J Neuroradiol 1999; 20 (10) 1907-1914
- 61 Ruff IM, Petrovich Brennan NM, Peck KK , et al. Assessment of the language laterality index in patients with brain tumor using functional MR imaging: effects of thresholding, task selection, and prior surgery. AJNR Am J Neuroradiol 2008; 29 (3) 528-535
- 62 Beisteiner R, Klinger N, Höllinger I , et al. How much are clinical fMRI reports influenced by standard postprocessing methods? An investigation of normalization and region of interest effects in the medial temporal lobe. Hum Brain Mapp 2010; 31 (12) 1951-1966
- 63 Wilke M, Schmithorst VJ, Holland SK. Assessment of spatial normalization of whole-brain magnetic resonance images in children. Hum Brain Mapp 2002; 17 (1) 48-60