fMRI has been around for over 15 years as a research tool, with occasional use in pre-surgical planning. fMRI detects changes in neural activation while a patient is performing a cognitive test, providing a three dimensional map of brain regions that are used to perform the test. Because fMRI measures brain function rather than just giving an image of brain structure alone, it has the potential as a very powerful diagnostic and assessment tool, especially for more subtle pathology, such as mild TBI or mild cognitive impairment, where standard brain imaging rarely detects abnormality in visible tissue.
Despite these advantages, standard fMRI has certain limitations that need to be overcome for full clinical use. fNCI is an integrated system of fMRI development, administration, analysis, and clinical interpretation that overcomes these limitations. Among other strengths, the two most prominent accomplishments of fNCI are first that it ensures that brain activations are accurate and reliable across patients, time (test-retest stability), and scanning facilities (cross-platform stability)—and second that it uses large scale normative data from healthy control subjects in order to determine precise, objective measures of deviation from normal brain activation in patients.
The fNCI system provided by Notus consists of six cognitive tests performed in the MRI scanner while activation images are collected in real-time. These tests cover the widest range of cognitive functions/brain regions possible in the shortest amount of scan time—4 minutes per test.
Tests include executive functioning, attention, processing speed, long-term memory, short term memory, verbal ability and visuospatial skills.
By directly assessing brain activation, clinicians find that fNCI provides more information about brain function in 24 minutes of patient testing than 6-10 hours of traditional neuropsychological testing.
As mentioned above, fNCI is particularly valuable in mTBI/post-concussion assessment. Having had hundreds of concussion referrals over the last 6 years, we now have reliable concussion biomarkers based on brain activation profiles from these patients. These biomarkers have a proven diagnostic sensitivity and specificity of over 90%. Because of this reliability, fNCI is becoming the new gold standard for making important clinical decisions such as prescribing treatment protocols, assessing treatment outcomes, and determining return-to-play readiness.