Clinical applications of functional magnetic resonance imaging

Blood oxygenation level-dependent (BOLD) functional magnetic resonance imaging (fMRI) provides a new tool for neuroradiology. The BOLD fMRI allows functional changes to be distinguished, even in the absence of structural changes in the brain. Up until now, routine clinical applications largely have been limited to localizing eloquent brain regions in pre-surgical planning. However, in exploratory applications, the method has allowed new insights into mechanisms of brain plasticity, helping clinicians better appreciate its importance in recovery after brain injury. Several new areas of application may be anticipated based on current research work, including for pre-symptomatic disease detection, testing drug dose-activity relationships, and the diagnosis and characterization of somatization disorders. A major direction of methodological research is towards integration of fMRI with other techniques, particularly electrophysiological methods. The emphasis that these new approaches to imaging will place on understanding functional changes associated with disease challenges current neuroradiological training and service delivery models. They emphasize the need to develop closer relationship between neuroradiology and the traditional clinical neurosciences.