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Functional MRI

basic principles and emerging clinical applications for anaesthesiology and the neurological sciences

European Journal of Anaesthesiology (EJA): September 2019 - Volume 36 - Issue 9 - p 716–717
doi: 10.1097/EJA.0000000000001051
Book review

Editor: Ramachandran Ramani

ISBN-13: 9780190297763 (eBook)

Oxford University Press Inc. 2018, 264 pages

This review focuses on the first edition of the e-book ‘Functional MRI: Basic principles and emerging clinical applications for anaesthesiology and the neurological sciences’, previously published in a print version.

This book follows technical advances in functional MRI (fMRI) techniques, highlighting the importance of these for clinical anaesthesiological and neurological practice. The expertise and experience of the editor and authors give the book a strong scaffold on the basic functions of fMRI without, however, overlooking the clinical importance of the emerging application of these functions.

Brain function in neuroscience is broadly investigated through fMRI with BOLD (Blood Oxygen Level Dependent). In the last 25 years, fMRI has represented the research choice among neuroimaging techniques and was mostly used to map out the location and intensity of brain activity in association with different mental activities and in response to several tasks. However, recently, the fluctuations in blood flow in the brain, which create the BOLD signal, were observed also in a new approach to fMRI called resting-state. Considering that brain activity is intrinsic and continuous, any brain region seems to have spontaneous changes in BOLD signal, without any external goal-directed task. In the brain at rest, low-frequency fluctuations in fMRI signal have been observed which, despite originating from spatially distinct and functionally related brain regions, exhibit coherent time-synchronisation. Since the discovery of these signal fluctuations, several brain networks have been identified and grouped into what is known as resting-state networks. These networks convey the intensity of the functional connectivity between different functionally related brain areas and they are broadly studied as markers of neurological and psychiatric diseases, as well as consciousness-related issues. Nowadays, one of the main challenges for neuroimaging techniques is provision of clinical applications with increasing quality of time and spatial resolution of brain functions, integrating other discoveries from clinical fields.

The basis of this book is laid on these focuses. It is clearly structured in two sections and 12 chapters. The first section explores and explains the basic concepts of fMRI, while the second is focused on its new clinical applications. The opening chapter explains the historical course that led to the development of fMRI. The authors clarify how, since X-rays were discovered over 100 years ago, scientific progress has moved on development of high quality and noninvasive functional imaging techniques. This chapter also explores how the appearance of these imaging instruments allowed researchers to start to investigate complex constructs belonging to different clinical disciplines, such as memory, emotions and consciousness, allowing integration of knowledge of brain functions with psychological and philosophical dimensions and theories. Moreover, the author explains how, in parallel, the development of fMRI techniques brought about the progress of data acquisition and analysis methodologies. The following chapters of the first section examine in depth the fundamentals of fMRI data analysis, starting from the neurobiological and haemodynamic phenomena associated with neuronal activity to the principal models used to perform fMRI data analysis, dealing with low temporal resolution, signal drop out, spatial distortion and other critical aspects of fMRI data analysis.

The second section provides, in a detailed and informative way, an overview of the basics of fMRI in several clinical applications. The authors begin by illustrating the relationship between neuroimaging and the care of patients with neurosurgical and neurological disorders, highlighting how fMRI could be a valuable tool to test and monitor treatment efficacy in neurological diseases. Beside the description of the key role of fMRI in neurology and neurosurgery, in the successive chapter, the basics of fMRI including fundamentals of MR physics are highlighted. Authors give illustrative research examples, providing interesting direction for future studies in the fruitful field of integration between neuroimaging and clinical application. In the light of this multidisciplinary approach, recent findings in the main psychopathologies are discussed, where the use of the fMRI tool allows study of large-scale neural systems which are supposed to underlie behavioural symptoms in psychiatric conditions. Subsequent chapters explore how cognitive changes could be studied using fMRI and how the default mode network (DMN) was introduced as a method to monitor age-related modification in cognitive processes, but also altered activity in children with neurodevelopmental and behavioural disorders. Moreover, as well described in this e-book, fMRI could be a noninvasive way to detect acute and chronic pain, where ‘functional connectivity’ MRI (fcMRI) can predict the development of the treatment and can reduce the pain itself, using fMRI-based biofeedback method.

In addition to the clinical implications of the use of fMRI imaging, in the last chapters, the authors explain the intriguing relationship between neuroimaging advances and the brain resting-state networks (RSNs) that sustain consciousness, and the effects of hypnosis on RSNs. New technological innovations of functional data analysis, such as Granger causality and dynamic causal modelling, can be a cutting-edge technology for a more in-depth exploration of the complex interactions between brain regions, their modulation by anaesthesia and their role in information processing by the brain.

In my opinion, this e-book is particularly exhaustive and useful for researchers interested in neuroscience, as well for clinical practitioners who are approaching fMRI techniques. This dissertation offers an in-depth point of view for experts in neuroscience, who have as their main purpose to manage the complexity of human sciences, medical approaches and neuroimaging data analysis. The e-book's strength is the emphasis on the importance of integrating the growing complexity of diagnostic procedures with the knowledge of many clinical fields interconnected in the common objective of human brain comprehension. The fact that the core of the book aims at the integration between different specialists is also expressed by the multidisciplinary and multiculturality of contributors, which certainly represents a strength that gives value to the whole stimulating text.

Gaia Romana Pellicano

Department of Dynamic and Clinical Psychology, Sapienza, University of Rome, Italy

© 2019 European Society of Anaesthesiology