Response to Scholkmann Commentary: Effect of wearing a face mask on fMRI BOLD contrast

International spread of the coronavirus SARS-CoV-2 has prompted many MRI scanning facilities to require scan subjects to wear a facial covering (mask) during scanning as a precaution against transmission of the virus. Because wearing a mask mixes expired air with the subject's inspired air stream, the concentration of inspired carbon dioxide [CO2] is elevated, resulting in mild hypercapnia. Changes in the inspired gas mixture have been demonstrated to alter R2*-weighted Blood Oxygen Dependent (BOLD) contrast. In this study, we investigate a potential for face masking to alter BOLD contrast during a sensory-motor task designed to activate visual, auditory, and sensorimotor cortices in 8 subjects. We utilize a nasal cannula to supply air to the subject wearing a surgical mask in on-off blocks of 90s to displace expired CO2, while the subject performs the sensory-motor task. While only a small fraction (2.5%) of the sensory-motor task activation is related to nasal air modulation, a 30.0% change in gray matter BOLD signal baseline is found due to air modulation. Repeating the scan with mask removed produces a small subject-specific bias in BOLD baseline signal from nasal air supply, which may be due to cognitive influence of airflow or cannula-induced hypoxia. Measurements with capnography demonstrate wearing a mask induces an average increase in ETCO2 of 7.4%. Altogether, these results demonstrate that wearing a face mask during gradient-echo fMRI can alter BOLD baseline signal but minimally affects task activation.