Neuroimaging

In contrast to neuroimaging, neuroradiology is qualitative (based on subjective impressions and extensive clinical training) but sometimes uses basic quantitative methods.

Dandy also observed that air introduced into the subarachnoid space via lumbar spinal puncture could enter the cerebral ventricles and also demonstrate the cerebrospinal fluid compartments around the base of the brain and over its surface.

[citation needed] In 1927, Egas Moniz introduced cerebral angiography, whereby both normal and abnormal blood vessels in and around the brain could be visualized with great precision.

In the early 1970s, Allan McLeod Cormack and Godfrey Newbold Hounsfield introduced computerized axial tomography (CAT or CT scanning), and ever more detailed anatomic images of the brain became available for diagnostic and research purposes.

More or less concurrently, magnetic resonance imaging (MRI or MR scanning) was developed by researchers including Peter Mansfield and Paul Lauterbur, who were awarded the Nobel Prize for Physiology or Medicine in 2003.

In the early 1980s MRI was introduced clinically, and during the 1980s a veritable explosion of technical refinements and diagnostic MR applications took place.

Scientists soon learned that the large blood flow changes measured by PET could also be imaged by the correct type of MRI.

In the early 2000s, the field of neuroimaging reached the stage where limited practical applications of functional brain imaging have become feasible.

[2] The spatial world record of a whole human brain of any method was an X-ray tomography scan performing at the ESRF (European synchrotron radiation facility), which had a resolution of about 25 microns and requiring about 22 hours.

Another indication for neuroradiology is CT-, MRI- and PET-guided stereotactic surgery or radiosurgery for treatment of intracranial tumors, arteriovenous malformations and other surgically treatable conditions.

A computer uses the data gathered by the sensors to create multicolored 2- or 3-dimensional images that show where the compound acts in the brain.

Especially useful are a wide array of ligands used to map different aspects of neurotransmitter activity, with by far the most commonly used PET tracer being a labeled form of glucose (see Fludeoxyglucose (18F) (FDG)).

The greatest benefit of PET scanning is that different compounds can show blood flow and oxygen and glucose metabolism in the tissues of the working brain.

PET scans were superior to all other metabolic imaging methods in terms of resolution and speed of completion (as little as 30 seconds) when they first became available.

The biggest drawback of PET scanning is that because the radioactivity decays rapidly, it is limited to monitoring short tasks.

[14]: 60  Before fMRI technology came online, PET scanning was the preferred method of functional (as opposed to structural) brain imaging, and it continues to make large contributions to neuroscience.

PET is probably most useful in early cases of certain dementias (with classic examples being Alzheimer's disease and Pick's disease) where the early damage is too diffuse and makes too little difference in brain volume and gross structure to change CT and standard MRI images enough to be able to reliably differentiate it from the "normal" range of cortical atrophy which occurs with aging (in many but not all) persons, and which does not cause clinical dementia.

Uptake of SPECT agent is nearly 100% complete within 30 to 60 seconds, reflecting cerebral blood flow (CBF) at the time of injection.

These properties of SPECT make it particularly well-suited for epilepsy imaging, which is usually made difficult by problems with patient movement and variable seizure types.

[17][18] Like PET, SPECT also can be used to differentiate different kinds of disease processes which produce dementia, and it is increasingly used for this purpose.

Advantages include the absence of ionising radiation and the possibility of bedside scanning, but the lack of soft-tissue detail means MRI is preferred for some conditions.

This allows images to be generated that reflect which brain structures are activated (and how) during the performance of different tasks or at resting state.

The resolution of fMRI is about 2-3 millimeters at present, limited by the spatial spread of the hemodynamic response to neural activity.

High-density diffuse optical tomography (HD-DOT) has been compared directly to fMRI using response to visual stimulation in subjects studied with both techniques, with reassuringly similar results.

In June 2021, researchers reported the development of the first modular quantum brain scanner which uses magnetic imaging and could become a novel whole-brain scanning approach.

The magnetic resonance (MR) emitted from the equipment can cause failure of medical devices and attract metallic objects in the body if not properly screened for.

PET radioisotopes have limited exposure time in the body as they commonly have very short half-lives (~2 hours) and decay rapidly.

[33] The high temporal resolution of MEG and EEG allow these methods to measure brain activity down to the millisecond.

Structural magnetic resonance imaging (structural MRI) of a head, from top to base of the skull
Sagittal MRI slice at the midline
Axial MRI slice at the level of the basal ganglia , showing fMRI BOLD signal changes overlaid in red (increase) and blue (decrease) tones