Mizutani-Tiebel Yuki, Tik Martin, Chang Kai-Yen, Padberg Frank, Soldini Aldo, Wilkinson Zane, Voon Cui Ci, Bulubas Lucia, Windischberger Christian, Keeser Daniel
Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany.
Neuroimaging Core Unit Munich - NICUM, University Hospital LMU, Munich, Germany.
Front Psychiatry. 2022 Apr 21;13:825205. doi: 10.3389/fpsyt.2022.825205. eCollection 2022.
Transcranial magnetic stimulation (TMS) is a promising treatment modality for psychiatric and neurological disorders. Repetitive TMS (rTMS) is widely used for the treatment of psychiatric and neurological diseases, such as depression, motor stroke, and neuropathic pain. However, the underlying mechanisms of rTMS-mediated neuronal modulation are not fully understood. In this respect, concurrent or simultaneous TMS-fMRI, in which TMS is applied during functional magnetic resonance imaging (fMRI), is a viable tool to gain insights, as it enables an investigation of the immediate effects of TMS. Concurrent application of TMS during neuroimaging usually causes severe artifacts due to magnetic field inhomogeneities induced by TMS. However, by carefully interleaving the TMS pulses with MR signal acquisition in the way that these are far enough apart, we can avoid any image distortions. While the very first feasibility studies date back to the 1990s, recent developments in coil hardware and acquisition techniques have boosted the number of TMS-fMRI applications. As such, a concurrent application requires expertise in both TMS and MRI mechanisms and sequencing, and the hurdle of initial technical set up and maintenance remains high. This review gives a comprehensive overview of concurrent TMS-fMRI techniques by collecting (1) basic information, (2) technical challenges and developments, (3) an overview of findings reported so far using concurrent TMS-fMRI, and (4) current limitations and our suggestions for improvement. By sharing this review, we hope to attract the interest of researchers from various backgrounds and create an educational knowledge base.
经颅磁刺激（TMS）是一种用于治疗精神疾病和神经疾病的很有前景的治疗方式。重复经颅磁刺激（rTMS）被广泛用于治疗精神疾病和神经疾病，如抑郁症、运动性中风和神经性疼痛。然而，rTMS介导的神经元调节的潜在机制尚未完全明确。在这方面，同步或同时进行的TMS-fMRI（即在功能磁共振成像（fMRI）期间施加TMS）是一种可行的工具，有助于深入了解相关情况，因为它能够研究TMS的即时效应。在神经成像过程中同时应用TMS通常会由于TMS引起的磁场不均匀性而产生严重伪影。然而，通过仔细地将TMS脉冲与磁共振信号采集交错进行，使它们之间的间隔足够远，我们可以避免任何图像失真。虽然最早的可行性研究可追溯到20世纪90年代，但线圈硬件和采集技术的最新发展增加了TMS-fMRI的应用数量。因此，同步应用需要在TMS和MRI机制及序列方面都具备专业知识，而且初始技术设置和维护的门槛仍然很高。本综述通过收集以下内容对同步TMS-fMRI技术进行了全面概述：（1）基本信息；（2）技术挑战与发展；（3）迄今为止使用同步TMS-fMRI报告的研究结果概述；（4）当前的局限性以及我们的改进建议。通过分享本综述，我们希望吸引来自不同背景的研究人员的兴趣，并创建一个教育知识库。
