The standard technique for brain activation functional MRI (fMRI) is the BOLD sequence. Two new techniques have emerged: arterial spin labeling (ASL) MRI and diffusion MRI. Both have the theoretical advantage of more accurately directly demonstrating neuronal activation compared to BOLD imaging, resulting in improved spatial and temporal resolution. ASL is a perfusion sequence using labeled arterial protons as an endogenous perfusion agent. In spite of methodological difficulties, quantitative CBF measurements are possible. ASL is less susceptible to venous contamination than BOLD and more reproducible. Diffusion MRI evaluates neuronal activation at the cellular level with the prospect of excellent spatial resolution. The main limitations for both techniques are the technical difficulties in the acquisition and the low SNR. AS such, ASL is not widely used clinically and diffusion remains in the field of research. However, the increasing availability of 3T MR systems coupled with multi-channel surface coils and improved postprocessing techniques should improve the detection of the brain activation signal. It is thus possible that these techniques could become clinically available either in complement to or as a replacement for BOLD imaging.
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