Functional brain MR imaging: Clinical Application Experience at Tri-Service General Hospital

Cheng-Yu Chen

Department of Radiology,

Tri-Service General Hospital and National Defense Medical Center, Taipei

Since the first installation of a middle-field magnetic resonance (MR) scanner at Tai-Chung in 1989, most complicated central nervous system diseases are now routinely evaluated by MR imaging method. Up to now there are more than 70 MR scanners in this island and most of the magnets are of high-field (1.5 Tesla). Current high-field magnets are capable of executing echoplanar imaging, including diffusion and perfusion images, diffusion tensor imaging, BOLD-based functional brain imaging, and MR spectroscopy all of which are ideal tools both for clinical practice and researches, in addition to other routine fast imaging for brain morphological evaluation.

This lecture features the state-of-art clinical functional MR imaging on brain study, introduces its current status in clinical practice at a medical center in Taiwan, and discusses their possible role on brain imaging researches. The lecture will deliver in-depth illustrations of two common neurological diseases, i.e. cerebral ischemic stroke and glioma, to demonstrate the importance of imaging researches that ultimately have heavy impacts on clinical management of the patients. For instance, the mismatch concept formed by the use of MR diffusion and perfusion maps help to establish the treatment target, the penumbra, for acute intervention of ischemic stroke. MR imaging allows a more specific indication for acute management and for follow-up evaluation of the cerebral ischemia. As for cerebral gliomas, a combination of MR perfusion imaging with computation of relative cerebral blood volume map and mapping with proton MR spectroscopy is a useful tool for guiding the stereotactic biopsy for tumor angiogenesis and activity. Other functional tools such as 2D phase contrast imaging for cerebrospinal fluid motion study, MR spectroscopy as a diagnostic adjunct for various neurological diseases, BOLD-based functional MR imaging for presurgical mapping of “eloquent” cortices. , and diffusion tensor imaging for motor tract mapping, developmental tract abnormality evaluation and others are now being actively used in daily basis at Tri-Service General Hospital and will be briefly reviewed.