Regional cerebral blood flow during volitional breathing in man.

1. Positron emission tomographic imaging of brain blood flow was used to identify areas of motor activation associated with volitional inspiration in six normal male subjects. 2. Scans were performed using intravenous infusion of H2(15)O during voluntary targeted breathing and positive pressure passive ventilation at the same level. 3. Regional increases in brain blood flow, due to active inspiration, were derived using a pixel by pixel comparison of images obtained during the voluntary and passive ventilation phases. 4. Pooling data from all subjects revealed statistically significant increases in blood flow bilaterally in the primary motor cortex (left, 5.4%; right, 4.3%), in the right pre-motor cortex (7.6%), in the supplementary motor area (SMA; 3.1%) and in the cerebellum (4.9%). 5. The site of increased neural activation in the motor cortex, associated with volitional inspiration, is consistent with an area which when stimulated, either directly during neurosurgery or transcranially with a magnetic stimulus, results in activation of the diaphragm. 6. The presence of additional sites of neural activation in the pre-motor cortex and SMA appears analogous to the results of studies on voluntary limb movement. The site of the increase in the SMA was posterior to that previously reported for arm movements. These areas are believed to have a role 'upstream' of the motor cortex in the planning and organization of movement. 7. This technique provides a means of studying the volitional motor control of respiratory related tasks in man.