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Research ArticleNeuroimaging Physics/Functional Neuroimaging/CT and MRI Technology
Open Access

Imaging and Anesthesia Protocol Optimization in Sedated Clinical Resting-State fMRI

Elmira Hassanzadeh, Alyssa Ailion, Masoud Hassanzadeh, Alena Hornak, Noam Peled, Dana Martino, Simon K. Warfield, Zhou Lan, Taha Gholipour and Steven M. Stufflebeam
American Journal of Neuroradiology February 2025, 46 (2) 293-301; DOI: https://doi.org/10.3174/ajnr.A8438
Elmira Hassanzadeh
aFrom the Department of Radiology (E.H., Z.L.), Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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  • ORCID record for Elmira Hassanzadeh
Alyssa Ailion
bDepartment of Neurology (A.A., A.H., D.M.), Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
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Masoud Hassanzadeh
cDepartment of Surgery (S.K.W.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Alena Hornak
bDepartment of Neurology (A.A., A.H., D.M.), Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
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Noam Peled
dDepartment of Radiology(N.P., S.M.S.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Dana Martino
bDepartment of Neurology (A.A., A.H., D.M.), Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
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Simon K. Warfield
eDepartment of Radiology (S.K.W.), Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
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Zhou Lan
aFrom the Department of Radiology (E.H., Z.L.), Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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Taha Gholipour
fComprehensive Epilepsy Center (T.G.), University of California San Diego, San Diego, California
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Steven M. Stufflebeam
dDepartment of Radiology(N.P., S.M.S.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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  • FIG 1.
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    FIG 1.

    Flow diagram of patient selection.

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    FIG 2.

    Examples of robust RSNs in our study population. Network activations are depicted in red-yellow spectrum. A, Robust motor network activation is seen (both visually and quantitatively) in an 8-year-old boy with epilepsy who underwent a 10.4-minute rs-fMRI with acceleration under propofol anesthesia. Structural images showed chronic right MCA infarction. B, Robust visual network activation is seen in a 9-year-old boy with epilepsy who underwent a 7.25-minute rs-fMRI without acceleration under propofol anesthesia. No structural abnormality was detected. C, Robust language network activation is seen (both visually and quantitatively) in a 5-year-old girl with seizure who underwent a 6.75-minute rs-fMRI without acceleration under propofol, sevoflurane, and fentanyl anesthesia. Subacute infarction in the right MCA territory was seen on structural images.

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    FIG 3.

    Example of weak RSNs in a 9-year-old boy with seizure who underwent 7-minute rs-fMRI under propofol, sevoflurane, and N2O anesthesia. Structural images showed mesial temporal sclerosis, and chronic left germinal matrix hemorrhage. No meaningful activation (depicted in red) is seen in motor network (A) or language network (B) boundaries, shown as blue template masks.

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    Table 1:

    Demographics, clinical, and imaging characteristics of study population

    Variablesn = 69
    Age (yr)
     Mean (SD)6.9 (4.26)
     Range1–17
    Sex
     Girl30 (43%)
    Indication for the examination
     Seizure35 (51%)
     Tumor7 (10%)
     Other27 (39%)
    rs-fMRI with multiband28 (41%)
    fMRI scan length (minute)
     Mean (SD)7.7 (2.01)
     Range4.5–10.4
    Number of BOLD volumes
     Mean (SD)271.3 (167.8)
     Range90–550
    Framewise displacement (mm)
     Mean (SD)0.05 (0.04)
     Range0.02–0.2
    MRI with structural abnormality39 (57%)
    Anesthesia with propofol58 (84%)
    Anesthesia with sevoflurane34 (49%)
    Anesthesia with N2O12 (17%)
    Anesthesia with other agents15 (22%)
    • View popup
    Table 2:

    ORs and CIs from multivariable logistic regression analysis of predictive factors in robust rs-fMRI overall networks with qualitative assessment

    VariableOR (Exp (B))95% CI for Exp (B)P Value
    rs-fMRI with multiband2.370.44–12.65.31
    Anesthesia with propofol1.410.27–7.29.68
    Anesthesia with sevoflurane0.200.05–0.79.02a
    Anesthesia with N2O0.800.16–4.11.79
    Anesthesia with other agents1.420.32–6.42.65
    Abnormality on structural MRI1.020.34–3.09.97
    Sex = boy0.970.32–2.91.96
    Age0.930.81–1.06.27
    Scan length in minutes1.060.73–1.53.76
    • ↵a Indicates statistical significance at the .05 level.

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    Table 3:

    ORs and CIs from multivariable logistic regression analysis of predictive factors in robust rs-fMRI motor-language networks with quantitative assessment

    VariableOR (Exp (B))95% CI for Exp (B)P Value
    rs-fMRI with multiband1.110.21–5.97.90
    Anesthesia with propofol2.510.44–14.32.30
    Anesthesia with sevoflurane0.180.04–0.80.02a
    Anesthesia with N2O0.410.08–2.13.29
    Anesthesia with other agents2.150.40–11.52.37
    Abnormality on structural MRI1.570.47–5.26.46
    Sex = boy1.960.55–6.92.29
    Age0.930.81–1.07.31
    Scan length in minutes1.150.79–1.67.47
    • ↵a Indicates statistical significance at the .05 level.

    • View popup
    Table 4:

    ORs and CIs from multivariable logistic regression analysis of predictive factors in robust rs-fMRI motor network with quantitative assessment

    VariableOR (Exp (B))95% CI for Exp (B)P Value
    rs-fMRI with multiband3.290.41–26.63.26
    Anesthesia with propofol5.390.84–34.75.08
    Anesthesia with sevoflurane0.100.02–0.64.02a
    Anesthesia with N2O1.040.16–6.54.97
    Anesthesia with other agents1.720.26–11.14.57
    Abnormality on structural MRI1.540.38–6.23.55
    Sex = boy2.830.63–12.70.17
    Age0.940.81–1.10.47
    Scan length in minutes1.060.68–1.65.81
    • ↵a Indicates statistical significance at the .05 level.

    • View popup
    Table 5:

    ORs and CIs from multivariable logistic regression analysis of predictive factors in robust rs-fMRI language network with quantitative assessment

    VariableOR (Exp (B))95% CI for Exp (B)P Value
    rs-fMRI with multiband0.970.13–7.49.98
    Anesthesia with propofol0.410.05–3.40.41
    Anesthesia with sevoflurane0.340.06–2.01.23
    Anesthesia with N2O0.220.03–1.35.10
    Anesthesia with other agents1.680.26–11.03.59
    Abnormality on structural MRI0.910.21–3.98.89
    Sex = boy1.720.38–7.69.48
    Age1.000.85–1.19.97
    Scan length in minute1.410.91–2.20.13
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American Journal of Neuroradiology: 46 (2)
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Elmira Hassanzadeh, Alyssa Ailion, Masoud Hassanzadeh, Alena Hornak, Noam Peled, Dana Martino, Simon K. Warfield, Zhou Lan, Taha Gholipour, Steven M. Stufflebeam
Imaging and Anesthesia Protocol Optimization in Sedated Clinical Resting-State fMRI
American Journal of Neuroradiology Feb 2025, 46 (2) 293-301; DOI: 10.3174/ajnr.A8438

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Optimizing fMRI Protocols with Anesthesia
Elmira Hassanzadeh, Alyssa Ailion, Masoud Hassanzadeh, Alena Hornak, Noam Peled, Dana Martino, Simon K. Warfield, Zhou Lan, Taha Gholipour, Steven M. Stufflebeam
American Journal of Neuroradiology Feb 2025, 46 (2) 293-301; DOI: 10.3174/ajnr.A8438
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