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Physiological Neuroimaging: Emerging Clinical Applications

Colin P. Derdeyn, MD
JAMA. 2001;285(24):3065-3068. doi:10.1001/jama.285.24.3065.
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Physiological imaging tools have provided a window for the study of central nervous system physiology and pathophysiology in living humans, particularly in the areas of cerebral ischemia and cognitive neuroscience. The first studies in living humans were performed nearly 50 years ago and involved measurements of whole brain blood flow using radiotracers.1 It is now possible to measure many dynamic physiological processes within small regions of the brain. These processes include blood flow, oxygen and glucose metabolism, electrical activity, nuclear magnetic spectra, and neurotransmitter receptor sites.

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Figure 3. Functional Magnetic Resonance (FMR) Imaging
Graphic Jump Location
Language function (blue regions) adjacent to a tumor (arrow). The FMR data are superimposed on an anatomical MR image. These regions became active when the patient was asked to decide whether words presented represent living or inanimate objects. (Image courtesy of Jeffrey Ojemann, MD.)
Figure 2. Positron Emission Tomography With Severe Hemodynamic Impairment in a Neurologically Asymptomatic Patient
Graphic Jump Location
Cerebral blood volume is increased (top left, arrows), indicating vasodilation. Cerebral blood flow has decreased despite autoregulatory vasodilation (top right, arrows). However, the fraction of oxygen the brain extracts from the blood has increased (oxygen extraction fraction, bottom left, arrows) to maintain normal oxygen metabolism (cerebral metabolic rate for oxygen, bottom right) and function.
Figure 1. Magnetic Resonance (MR) Study of Acute Stroke With Recanalization Resulting in Improved Blood Flow
Graphic Jump Location
The initial MR study at 3 hours after symptom onset (A) shows absent flow in the right middle cerebral artery on the MR angiogram (top left, arrow). This is associated with a small area of reduced diffusion, indicated by the bright signal on the diffusion-weighted image (top middle, arrow) and a larger area of reduced cerebral blood flow (top right, arrows). A later study at 3 days (B) shows interval recanalization (bottom left, arrow) and improved cerebral blood flow (bottom right, arrow). The area of final infarction, indicated by the bright signal on the diffusion-weighted image (bottom middle), is smaller than the original perfusion abnormality. (Images courtesy of Katie Vo, MD, and Weili Lin, PhD.)



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