Fredrik Brekke: Auditory and visual fMRI

Functional MRI is increasingly used to support clinical decision-making, particularly for presurgical planning. Despite its adoption into clinical routines, auditory and visual fMRI research still suffers from a lack of methodological consistency. At our 2025 fMRI User Meeting, PhD candidate Fredrik Brekke presented a systematic review examining how auditory and visual paradigms are currently implemented across the literature – and why greater standardization is urgently needed.

–          This project aims to shed light on the variation in methodologies used for auditory and visual fMRI paradigms, Fredrik explained.

Mapping the methodological landscape

By reviewing more than 100 peer-reviewed studies, Fredrik identified substantial variation in how audible and visual fMRI paradigms are designed and analyzed. Even when studies targeted the same (language) functions, they differed widely in paradigm structure, the content of the conditions, and in measurement and analysis characteristics. It was state that this diversity makes it difficult to compare findings across studies and limits the broader utility of the results.

–          We found that even within studies targeting the same functionand/or brain regions, the design, stimuli, and analysis pipelines varied significantly, he noted.

Implications for presurgical planning

These inconsistencies become particularly problematic when using fMRI clinically, particularly when there is a need for adjusting paradigms due to impaired sensory capacities. Fredrik emphasized that localization of functions prior to neurosurgery requires paradigms that are not only sensitive, but also robust and reproducible across scanners, sites, and patient populations. Without standardized approaches, activation maps may vary for methodological rather than neurobiological reasons.

–          For fMRI to be a reliable tool in presurgical planning, paradigms must be both robust and repeatable across scanners andinstitutions, he argued.

Moving toward best practices

Rather than prescribing a single “correct” paradigm, multiple paradigms, and possibly multi-sensory paradigms, should be applied for mapping functions pre-operatively. Fredrik emphasized the importance of transparencyand consistency in research and clinics for instructing best practices within the field. Standardizing the approaches to paradigm decisions and stimulus presentation - not necessarily the specific content of the stimuli - and, open reporting of protocols, would contribute to making clinical fMRI easier todeliver, interpret and replicate. Together, these practices could strengthen both basic research and clinical applications.

Toward more reliable sensory fMRI

Fredrik’s review underscores a central challenge in advanced neuroimaging: balancing individual patient needs with the need for reproducibility. As auditory and visual fMRI continue to be adopted more widely into routine clinical use, methodological clarity becomes increasingly critical. His work highlights the importance of shared standards and careful reporting to ensure that fMRI can deliver individualized but also reliable and clinically meaningful insights.

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Watch the whole presentation here:
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