Functional MRI

Description

1. Functional MRI (fMRI) is an imaging study that aids in identifying regions of the brain activated by
particular stimuli and tasks. Imaging is performed during presentation of a stimulus or performance of a
specific task and during rest periods. A statistical comparison is performed with images obtained during
the stimulus/task periods compared with those performed during the rest periods by evaluating the
conversion of oxyhemoglobin to deoxyhemoglobin and utilization of glucose, which occurs during
normal brain activity. Involves IV administration of contrast material that lowers signal intensity on MRI
in relation to blood flow as the material passes through the brain.

2. Advantages of fMRI: Does not use ionizing radiation and can be applied repeatedly in the same
patient without risk. Offers potential in early detection of patients with prodromal dementia. It is also
useful in preoperative evaluation of patients with lesions (tumors, seizure foci) adjacent to eloquent
areas of the brain (speech center, premotor and motor cortex, and memory centers).

3. Disadvantages of fMRI:

1. It is expensive.

2. It can only capture a clear image if the person being scanned stays completely still.

3. Researchers still do not completely understand how it works.

Nursing and Patient Care Considerations

1. Instruct patient as for MRI. Full cooperation of the patient is vital for head motion and task
performance reasons. Global cognitive impairment, aphasia, neglect, substantial sensory disturbances,
and severe depression are usually exclusion criteria. The performance of motor tasks during imaging
should be monitored.

2. Medications that may interfere with performance of tasks during the procedure should be avoided, if
possible, including benzodiazephines, sedatives, and opioids.

Positron-Emission Tomography

Description

1. Positron-emission tomography (PET) is a computer-based imaging technique that permits study of the
brain’s function by evaluating the metabolism, blood flow, and chemical processes within the brain. PET
measures emissions of particles of injected radioisotopes—called positrons—and converts them to an
image of the brain.

2. PET scanners are not frequently used or widely available due to their high cost, and PET requires
sophisticated equipment to produce its radioisotopes, or positron emitter.

3. A glucose-like solution and mildly radioactive tracers are combined for injection or inhalation. After
injection into the arterial bloodstream or inhalation of this radioactive compound, pairs of gamma rays
are emitted into adjacent tissue during radioactive decay. The PET scanner measures the gamma rays to
determine how quickly the tissues absorb the radioactive isotopes. A computer processes the data into
an image that shows where the radioactive material is located, corresponding to cellular metabolism.

4. Advantages of PET: Provides information on patterns of glucose and oxygen metabolism. Areas of
decreased metabolism indicate dysfunction. PET is useful for early detection of Alzheimer’s disease and
other dementias, Parkinson’s disease, amyotrophic lateral sclerosis (ALS), Huntington’s disease, multiple
sclerosis, and psychiatric disorders, such as depression or schizophrenia. PET can also help
locate/identify abnormal brain activity, such as seizure foci, and assess brain function after stroke.

5. Disadvantages of PET: Ionizing radiation, high initial cost.

Nursing and Patient Care Considerations

1. Inform patient that this procedure requires injection or inhalation of a radioactive substance that
emits positively charged particles. Explain that the image is created when the negative particles found in
the body combine with the positive particles of the imaging substance.

2. Explain that, after injection of the radioisotope, the patient will be asked to rest quietly on a stretcher
for about 45 minutes to allow the substance to circulate.

3. Reassure the patient that radiation exposure is minimal.

4. Encourage patient to void before the test because the scan and associated procedures may take
several hours.

5. Advise patient to increase fluid intake after the procedure to flush out the radioisotope and to resume
meals.

6. Tell patient that it may take a few days to get results of the PET scan because it requires processing
before it is available for interpretation