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Resting-State fMRI: Potential Clinical Applications

Resting-State fMRI: Potential Clinical Applications. Michael D. Greicius, MD Functional Imaging in Neuropsychiatric Disorders (FIND) Lab Department of Neurology and Neurological Sciences Stanford University School of Medicine. Functional Connectivity. r = 0.80. BOLD Signal. r = 0.59.

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Resting-State fMRI: Potential Clinical Applications

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  1. Resting-State fMRI: Potential Clinical Applications Michael D. Greicius, MD Functional Imaging in Neuropsychiatric Disorders (FIND) Lab Department of Neurology and Neurological Sciences Stanford University School of Medicine

  2. Functional Connectivity r = 0.80 BOLD Signal r = 0.59 Time r = 0.75

  3. Exponential Growth of Resting State fMRI Studies Disorders Studied Autism Schizophrenia Alzheimer’s Disease Parkinson’s Disease Multiple Sclerosis ADHD PTSD TBI OCD Depression/Bipolar Anxiety Disorder … Birn, Neuroimage, 2012

  4. Potential Roles of Resting-State fMRI in Neuropsychiatric Disorders • Disease mechanisms (group-level) • Diagnostics (single subject-level) • Prognostics (single subject-level) • Treatment efficacy (single subject or group) • Disease-specific roles (single subject-level) • seizure focus localization in epilepsy • pre-op cortical mapping

  5. Presurgical Mapping Liu et al., J Neurosurg, 2009

  6. Epilepsy: Seizure Focus Localization Increased remote and local connectivity Stufflebeam et al., J Neurosurg, 2011

  7. Prognosis for Coma Recovery Vanhaudenhuyse et al., Brain, 2010

  8. Single-Patient Level Soddu et al., Hum Brain Mapp, 2011

  9. Single-Patient Level Soddu et al., Hum Brain Mapp, 2011

  10. The Subgenual Cingulate in Depression Mayberg et al., Neuron, 2005

  11. Increased Subgenual Cingulate Connectivity in Depression n = 28 n = 20 Greicius et al., Biol Psychiatry, 2007

  12. BA25 Connectivity Correlates with Current Episode Duration r = 0.49 p < 0.05 Greicius et al., Biol Psychiatry, 2007

  13. Starting from BA25 controls n = 17 age 30.9 depressed n = 18 age 35.9 dep > con Sheline et al., PNAS, 2010

  14. Early Childhood Depression n = 18 age 9 n = 21 age 9.5 dep > con Gaffrey et al., J Child Psychol Psychiatry, 2012

  15. Network-Based Neurodegeneration Fire Together, Wire Together, Expire Together “Resting” BOLD amplitude Gray matter volume S1 S2 S3 S4 S7 Time (sec) S5 S6 Single subject Seeley et al., Neuron, 2009

  16. Inter-Network Interactions Fox et al., PNAS, 2005 Greicius et al., PNAS, 2003 Fransson, Hum Brain Mappp, 2005

  17. FTD vs AD = Salience vs DMN Zhou et al., Brain , 2010

  18. FTD vs AD = Salience vs DMN Zhou et al., Brain , 2010

  19. Test-Retest Reliability Shehzad et al., Cereb Cortex, 2009

  20. Conclusions • Resting-state fMRI has single-subject potential • Relatively easy for patients to undergo • Can be repeated frequently • Potentially more dynamic than other markers • More data needed • ADNI, Human Connectome Project will help • Tougher clinical questions • Specificity against disease mimics (rather than controls) • Epilepsy patients without iEEG sources • Early scan in coma predicting long-term outcome • Test-retest reliability needs shoring up

  21. Acknowledgments Stanford FIND Lab • Jeske Damoiseaux • Anna Milazzo • Matt White • Heidi Jiang • Will Shirer • Rich Joseph • Chris Hemond Stanford Lucas Center • Gary Glover UCSF • Bill Seeley • Bruce Miller • Helen Zhou Funding The Dana Foundation The John Douglas French Foundation NIH: 1RO1NS073498

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