Neuroscience for neurologists: functional magnetic resonance imaging

Blood oxygenation level dependent (BOLD) functional magnetic resonance imaging (fMRI) is a powerful approach to defining activity in the healthy and diseased human brain. BOLD fMRI detects local increases in relative blood oxygenation that are most probably a direct consequence of neurotransmitter action and thus reflect local neuronal signalling. The method allows localisation to volumes of the order of a few to several cubic millimetres and can be used in serial studies of individual subjects. Basic approaches to experimental design and analysis are reviewed briefly, as well as potential clinical applications. The latter include three broad areas: anatomical characterisation of normal or pathological patterns of brain functioning; distinguishing pathological traits; and monitoring treatment responses. New research is emphasising the integration of fMRI with other techniques, particularly electrophysiological. In conjunction with MRI methods for characterising pathological load, fMRI promises a refined understanding of when disease processes begin and how they can be modified by new treatments. See end of article fo