A window into the living brain
Seven-year-old Eitan Shaulson loves school and is an avid swimmer, baseball player and Lego builder. Yet his
parents, Michele and Yosi, take no accomplishment for granted. Two years ago, Children's Hospital Boston neurosurgeons performed a delicate operation to repair a cavernous malformation (a rare disorder of the brain's capillaries and smallest veins) in Eitan's brain. Causing seizures and hemorrhaging, the malformation occupied the area regulating hand motor and sensory function, so identifying the exact spot to operate was critical.
Fortunately, neurosurgeon Joseph Madsen, MD, and neurologist Michael Rivkin, MD, had at their disposal a neuroimaging tool with no equalófunctional magnetic resonance imaging (fMRI). "Planning the operation to remove the malformation, which shows up on regular MRI, without hurting motor areas, which do not, without fMRI would be like throwing darts at a blank dart board," says Madsen. "The fMRI pinpointed the lesion in relation to the motor area, allowing us maximum surgical precision."
Eitan Shaulson's surgery went so well he was ready to go back to school in a week, with no loss of function. Says his dad, Yosi, "We thank God for guiding us to Children's. The combination of the best doctors and fMRI's amazing technology saved our son."
An fMRI scanner helps patients like Eitan by creating three-dimensional images of the brain's response to stimulation in real time—for example, when Eitan taps his fingers, the part of his brain responsible for the movement lights up on the fMRI (see image on next page). This allows scientists to observe brain structure and function in exquisite detail, showing structures as tiny as hair-thin arteries. In less than an hour, this noninvasive tool reveals the neural mechanisms behind movement, cognition or behavior in a child's brain—all without X-ray exposure.
And the hospital's fMRI scanners are intensely busy, diagnosing and treating neurologic disorders like epilepsy, stroke, cerebral palsy, brain tumors, and brain injury, as well as mental retardation, autism and learning disabilities.
But the fMRI is not just for clinicians. Children's researchers also have urgent brain imaging needs. "Sometimes we have to wait to get research time on the clinical scanners," says Rivkin, who directs Children's Developmental Neuroimaging Laboratory (DNL). The DNL uses MR scanning to characterize brain development in typically healthy children, from newborns to teenagers.
Armed with these benchmarks, Rivkin is pursuing a learning disabilities and pediatric epilepsy study in collaboration with the Departments of Psychiatry and Radiology. He and his team have already observed brain activity differences between children who have dyslexia and those who do not. "We hope to apply these tools to understand more about brain function in epileptic children," says Rivkin. "Acquiring our own research scanner for fMRI and other MR imaging would advance our knowledge of epilepsy and other disorders, leading to better treatment."
At the same time, Madsen is capitalizing on fMRI's ability to visualize brain structure, blood flow and pulsation to help understand hydrocephalus, a condition where cerebrospinal fluid (CSF) buildup creates dangerous pressure on the brain. Madsen is investigating whether certain CSF circulation patterns are associated with hydrocephalus development in children.
A dedicated fMRI scanner would also speed the work of Charles Nelson, PhD, director of research in the Developmental Medicine Center. He is examining long-term outcomes of very premature infants who experienced prolonged oxygen deprivation and are at risk for learning disabilities. Another study will investigate the neural systems involved in face processing among autistic children.
The DNL is also collaborating with the Department of Cardiology. Jane Newberger, MD, associate cardiologist-in-chief, is using MR neuroimaging and fMRI to investigate differences in brain structure and cognitive function in children who received life-saving surgery for congenital cardiac disease. This information may enhance long-term outcomes for future cardiac surgery patients.
For more information on supporting fMRI research at
Children's
Hospital Boston, contact Sara Kelly in the
Children's Hospital Trust at (617) 355-2562 or sara.kelly@chtrust.org.
A view like no other
Functional MRI identifies the regions of brain used to perform a particular task, detecting increased blood flow accompanying increased regional brain activity. This view of Eitan Shaulson's brain shows his vascular malformation (blue circle) in relation to the motor cortex activated when Eitan tapped his finger (yellow area). The scan helped Eitan's neurosurgeon avoid an important motor function region when repairing the
vascular malformation.
Tools and technologyóurgent needs
Children's Hospital Boston has launched a visionary program uniting neuroscience research with genomics, bioinformatics and developmental medicine. With a large patient base, Children's can provide more on-target diagnoses and develop new therapies to better treat kids with cognitive disabilities—autism, attention deficit disorders and mental retardation, among others—as well as neurologic disorders like epilepsy and brain injury. Supporting Children's clinicians and researchers is a third factor—the latest technologies like the functional MRI scanner.
Children's $250 million Cause for Wonder campaign, now in its final year, is
creating many opportunities to advance research at the hospital. Generous donors at every level are helping speed the translation of laboratory discoveries into new
treatments, train tomorrow's pediatric leaders and broaden services to at-risk kids in our community.
To learn more about opportunities for giving, contact David Kinahan in the Children's Hospital Trust at (617) 355-2416 or david.kinahan@chtrust.org.
