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Interpreting fMRI Brain Images

The first thing to be aware of when viewing brain images is that the orientation of the images are in standard radiological format or an inferior view, which is not looking down onto a patient’s head but rather looking up through a patient’s feet and into the brain. This means that the left side of the image on your screen is actually the right side of the patient’s brain, and vice versa. Generally speaking, the fMRI images are only supplemental to the statistical reports (described below) and offer a visual to go along with the statistical performance measure. The brightness of the color on the fMRI overlays indicates the degree of confidence that the signal change is not due to chance. (Or put simply, the brighter the color, the more activation there is in that area)

Sample fMRI Brain Images – arrows show brain activation

Interpreting fMRI Statistical Reports

Each of the 6 tests in Notus NeuroCogs™ produces a statistical report consisting of several columns that represent specific Regions of Interest (ROIs) in the brain important for performing each exam. Each ROI indicates a brain region that was found to be reliably activated in normal control subjects, who were used as a comparison sample. These ROI sets are also highly consistent with outcomes found in the vast majority of fMRI research studies using these cognitive tasks. The following diagram provides a visual example of how each ROI listed for a given test represents a relevant area in the brain related to the functional abilities being measured.


The following is a breakdown example of just one Region of Interest, along with what the corresponding line chart represents. A simple summary is that a tick mark located in the middle, or 0 location, means perfectly normal activation for that area when compared to normative population statistics for activation in that brain region:

It is important to note that significantly low activation and also significantly high activation can indicate deficits in cognitive function, so a functional scan that would indicate “normal” would be a chart with tick marks straight across the middle, or not too far above or below the middle line.

It is also important to keep in mind that some Regions of Interest might be considered more central to the major cognitive components of the task than others. The findings sections are thus organized roughly by regions of greater to lesser essential contribution to each cognitive task, organized from left to right respectively. Also, in each individual test report, ROIs are grouped together by cognitive function and color-coded with a descriptive heading for that function (e.g., Executive Functioning, Visual Processing, etc.).

For example:

In this example, all major Regions of Interest are very “normal” and fall well within 1 standard deviation (some almost exactly on the mean) with the exception of the last ROI with the arrow over it, which shows significantly less activation at about 2.5 standard deviations below the mean. Because this is the right-most ROI, it is less of a concern than if it were any of the ROIs listed further to the left as they are ordered by the level of contribution importance to the task being tested.

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