Blood oxygen level dependent functional MRI, or BOLD fMRI, is an advanced MRI technique in which level of oxygen present in an area of the brain is used to map out what parts of the brain are activated in specific tasks. In this method, repeated imaging of the brain can be performed while the patient performs a task, and the level of oxygenation changes, showing which parts of the brain are most activated.

A key application of fMRI is mapping of language areas, or language localization, for surgical planning. The patient will perform more than 1 language task while in the scanner, and the activation data is overlaid on anatomic imaging (like conventional T1 or T1 postcontrast imaging). This is used to determine which side of the brain is language dominant as well as where exactly important language areas, including Broca's and Wernicke's areas, are located. This way they can be avoided in complex surgical procedures. However, sometimes results can be difficult to interpret because of the high number of images and high amounts of noise.

There are a number of processing suites that you can use to process fMRI data, including  Brainlab  and  Dynasuite. The processing can be slightly different depending on which software package you are using, but the general principles are the same. To begin, you take each functional paradigm and overlay it on anatomical imaging, selecting statistical parameters and colormapping as you go.

In this video, Dr. Michael Hoch demonstrates the use of Brainlab to process fMRI data for language processing. He goes through the step-by-step process of generating each set of overlay imaging and how to interpret the results. In the second part of the video, he demonstrates conjunction overlay technique to increase sensitivity for mapping language areas by showing only the areas which have overlapping results on multiple paradigms, increasing reader confidence.

The level of this lecture is appropriate for radiology residents, radiology fellows, and trainees in other specialties who have an interest in advanced MRI techniques such as diffusion tensor imaging (DTI) tractography, functional MRI (fMRI), and surgical planning.

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