Determination of language dominance using functional MRI: a comparison with the Wada test

Language representation in the human brain: evidence from cortical mapping

The manner in which the human brain processes grammatical-syntactic and lexical-semantic functions has been extensively debated in neurolinguistics. The discreteness and selectivity of the representation of syntactic-morphological properties in the dominant frontal cortex and the representation of the lexical-semantics in the temporo-parietal cortex have been questioned. Three right-handed adult male neurosurgical patients undergoing left craniotomy for intractable seizures were evaluated using various grammatical and semantic tasks during cortical mapping. The sampling of language tasks consisted of trials with stimulation (experimental) and without stimulation (control) from sites in the dominant fronto-temporo-parietal cortex The sampling of language implicated a larger cortical area devoted to language (syntactic-morphological and lexical-semantic) tasks. Further, a large part of the fronto-parieto-temporal cortex was involved with syntactic-morphological functions. However, only the parieto-temporal sites were implicated with the ordering of lexicon in sentence construction. These observations suggest that the representation of language in the human brain may be columnar or multilayered.

Language hemispheric dominance in patients with congenital lesions of eloquent brain

OBJECTIVE

In 90% of normal subjects, the left hemisphere is dominant for language function. We investigated whether congenital lesions of the left perisylvian regions altered cortical language representation in right-handed individuals.

METHODS

Using functional magnetic resonance imaging, we studied language hemispheric dominance in five right-handed adult patients with congenitally acquired arteriovenous malformations (AVMs) originating from left hemispheric cortical language regions. The AVMs had not caused neurological symptoms during early development, but patients presented as adults with migraine, seizure, or minor hemorrhage. Results obtained from the AVM patients were contrasted to those from right-handed brain-injured stroke patients recovering from aphasia and to those from right-handed normal subjects.

RESULTS

During silent picture naming and verb generation tasks, cortical language networks lateralized primarily to the right hemisphere in the AVM group, compared with the left hemisphere in the normal group. This right hemisphere-shifted language network in the AVM group exceeded the shifts toward right hemispheric dominance found in the stroke group.

CONCLUSION

Patients with AVMs affecting the left perisylvian regions recruited the right hemisphere into language processing networks during early development, presumably in response to congenitally aberrant circulation. This early right hemisphere recruitment in the AVM patients exceeded the similar process in the brains of stroke patients whose left cortical language networks were damaged in adulthood. Our data provide evidence of effective plasticity in the developing human brain compared with the mature brain response to injury. Knowledge of cortical language representation should assist presurgical planning in patients with developmental anomalies affecting apparently language-dominant brain regions.

Language mapping in pretreatment planning of patients with cerebral arteriovenous malformation: a PET study

PURPOSE

Three patients who had cerebral arteriovenous malformations underwent language mapping by positron emission tomography (PET) to identify the dominant hemisphere for language and the spatial relation of lesions to language areas.

METHODS

Mapping was performed to assess the risk that surgery could cause neurologic deficits and to plan other therapeutic strategies.

RESULTS

The information obtained by PET language mapping changed the course of management for these patients. Two patients were treated with stereotactic radiosurgery and one patient with surgical resection.

CONCLUSIONS

PET imaging can be a valuable noninvasive tool for mapping the functional cortex and for preoperative planning of different treatment options in patients with arteriovenous malformations.

The effect of sequence repeat time on auditory cortex stimulation during phonetic discrimination

Acoustic noise generated by the MR scanner gradient system during fMRI studies of auditory function is a very significant potential confound. Despite these deleterious effects, fMRI of the auditory cortex has been successful and numerous practitioners have circumvented the problem of acoustic masking noise. In the context of auditory cortex fMRI, the sequence repeat time (TR) has the effect of altering the length of time during which the scanner is quiet. Indeed, the move to whole-brain fMRI makes the problem of acoustic noise more acute and points to the need to examine the role of TR and its influence on the BOLD signal. The aim of this study was to examine the effect of varying the TR time on activation of auditory cortex during presentation and performance of a phonetic discrimination task. The results presented here demonstrate that the influence of sequence repeat time is considerable. For a short repeat time it is likely that the noise from the scanner is a significant mask and hinders accurate task performance. At the other extreme, a repeat time of 9 s is also suboptimal, probably due to attentional effects and lack of concentration and not least because of the longer overall measurement times. The results of this study point to a complicated interplay between psychophysical factors as well as physical parameters; attention, acoustic noise, total duration of the experiment, consideration of the volume of acquisition, and overall difficulty of the task have to be assessed and balanced. For the paradigm used here, the results suggest an optimal TR of around 6 s for a 16-slice acquisition.

Cortical language lateralization in right handed normal subjects using functional magnetic resonance imaging

In 95% of right handed individuals the left hemisphere is dominant for speech and language function. The evidence for this is accumulated primarily from clinical populations. We investigated cortical topography of language function and lateralization in a sample of the right handed population using functional magnetic resonance imaging and two lexical-semantic paradigms. Activated cortical language networks were assessed topographically and quantitatively by using a lateralization index. As a group, we observed left hemispheric language dominance. Individually, the lateralization index varied continuously from left hemisphere dominant to bilateral representation. In males, language primarily lateralized to left, and in females, approximately half had left lateralization and the other half had bilateral representation. Our data indicate that a previous view of female bilateral hemispheric dominance for language (McGlone, 1980. Sex differences in human brain asymmetry: a critical survey. Behav Brain Sci 3:215-263; Shaywitz et al., 1995. Sex differences in the functional organization of the brain for language. Nature 373:607-609) simplifies the complexity of cortical language distribution in this population. Analysis of the distribution of the lateralization index in our study allowed us to make this difference in females apparent.

Cortical function in epilepsy

Recent work with functional neuroimaging that relies on blood flow techniques, (15)O water positron emission tomography and functional magnetic resonance imaging has identified the lateralization and location of language functions. These technologies are increasingly being explored as alternatives to the more invasive intracarotid amytal procedure. Paradigms and sequences have been designed to identify the capacity of the hippocampus and mesial structures to support memory. Magnetoelectroencephalography offers the prospect of mapping language function in real time. Event-related data acquisition has also been employed to localize blood flow changes that are associated with interictal activity.

Beyond speech lateralization: a review of the variability, reliability, and validity of the intracarotid amobarbital procedure and its nonlanguage uses in epilepsy surgery candidates

While the intracarotid amobarbital procedure (IAP) was originally utilized to lateralize speech functions as an aid in the surgical treatment of epilepsy, additional uses for the IAP have emerged including: (1) the use of the IAP to predict post-surgical memory changes, including both global amnesia and smaller, yet significant, material-specific memory deficits; (2) the use of the IAP to provide confirmatory evidence of lateralization of seizure focus; and (3) the use of the IAP to predict post-surgical relief from seizures. While the literature on the IAP is extensive and growing, its utility is marred by the wide variability associated with the procedure itself from epilepsy center to center. This variability renders comparisons among IAP studies problematic and conclusions about IAP efficacy difficult. The variability associated with the amobarbital procedures, as well as the reliability and the validity of the IAP in its nonlanguage uses is reviewed here. A special emphasis is devoted to research conducted in the last decade. Also discussed is the future of the IAP including anticipated research directions.

Assessment of hemispheric language lateralization: a comparison between fMRI and fTCD

The cerebral blood flow velocity (CBFV) in the basal arteries during a word-generation task was assessed by functional transcranial Doppler ultrasonography (fTCD) and by functional magnetic resonance imaging (fMRI). The study investigates how event-related CBFV modulations in the middle cerebral artery (MCA) relate to regional cerebral blood flow (rCBF) changes. Both fMRI and fTCD were used in 13 subjects (7 men, 6 women, aged 21 to 44 years). The maximum difference of relative CBFV changes between the left and right MCA during the word-generation task was used as the language laterality index (LIfTCD). For the fMRI examination during the nearly identical language task, the corresponding index was defined by LIfMRI = 100(N(L) - N(R))/(N(L) + N(R)), where N(L) and N(R) refer to the numbers of voxels activated in the left and right hemisphere, respectively. The evoked CBFV changes expressed by LIfTCD and the corresponding laterality index, LIfMRI, estimated by fMRI showed a close linear relation (regression analysis: r = 0.95, p < 0.0001). The results of this study demonstrate that language-related velocity changes in the MCAs relate to rCBF increases in a linear fashion. Since the laterality indices assessed by fMRI and fTCD are in such close agreement both techniques can therefore be used in a complementary way.

Functional brain mapping using positron emission tomography scanning in preoperative neurosurgical planning for pediatric brain tumors

Object

The purpose of this report is to demonstrate the value of functional brain mapping using the positron emission tomography (PET) method for preoperative neurosurgical planning in children with brain tumors. Brain maps were used to characterize the relationship between potentially resectable tumors and functionally eloquent brain areas.

Methods

Five children, ranging in age from 3 to 13 years, with hemispheric brain tumors adjacent to eloquent cortex were studied. Magnetic resonance (MR) imaging was used to identify the brain tumors; PET imaging after injection of [18F]fluorodeoxyglucose (FDG), [11C]l-methionine (CMET), or a combination of the two was performed to grade the tumors; and a [15O] H2O uptake study was used to characterize the anatomical relationships of the tumors to functional cortex. The cortical activation maps were obtained during control periods and during behavioral tasks and were used to document motor, visual, and speech and language organizational areas. Wada tests were performed in two patients. Language and speech activation was concordant with the results of Wada testing.

Conclusions

Functional brain mapping using PET scans and coregistered MR images provided the neurosurgeon with precise definitions of structural and functional cortical areas; this altered surgical management in some cases and/or was used to predict outcome. The combination of PET imaging with FDG and/or CMET and measurements of [15O] water uptake was useful in characterizing and grading tumors and instrumental in achieving effective neurosurgical planning. Postoperative results in the five cases suggest that preoperative functional brain mapping has the potential to improve outcome by defining a surgical plan to maximize resection and minimize the risk of neurological sequelae.

Language lateralization in healthy right-handers

Our knowledge about the variability of cerebral language lateralization is derived from studies of patients with brain lesions and thus possible secondary reorganization of cerebral functions. In healthy right-handed subjects 'atypical', i.e. right hemisphere language dominance, has generally been assumed to be exceedingly rare. To test this assumption we measured language lateralization in 188 healthy subjects with moderate and strong right-handedness (59% females) by a new non-invasive, quantitative technique previously validated by direct comparison with the intracarotid amobarbital procedure. During a word generation task the averaged hemispheric perfusion differences within the territories of the middle cerebral arteries were determined. (i) The natural distribution of language lateralization was found to occur along a bimodal continuum. (ii) Lateralization was equivalent in men and women. (iii) Right hemisphere dominance was found in 7.5% of subjects. These findings indicate that atypical language dominance in healthy right-handed subjects of either sex is considerably more common than previously suspected.

Anatomical and functional imaging of the auditory cortex in awake mustached bats using magnetic resonance technology

The auditory cortex of mustached bats, Pteronotus parnellii, has been studied extensively using neuroanatomical tract-tracing and electrophysiological techniques to elucidate the functional organization and neural mechanisms important for auditory processing. While these techniques have identified several cortical maps involved in processing auditory information, there has been no direct observation of the dynamics of simultaneous activation of several discrete areas. We applied magnetic resonance (MR) imaging techniques for visualizing brain structures in awake bats using a 7-Tesla magnet system; we also investigated functional MR imaging by measuring changes in stimulus-correlated blood oxygenation levels to detect cortical areas exhibiting evoked neural activity. High resolution (100 microm) anatomical images were successfully acquired without any motion artifacts. It was possible to reconstruct the whole brain image and analyze brain surface structures with three dimensional (3D) MR imaging data. These data provide detailed morphometric measurements that will allow localization of stimulus specific neural activity patterns using modified functional magnetic-resonance-imaging (fMRI) protocols. Motion artifacts is the primary disadvantage of using awake bats; our study shows that fMRI of a bat's brain is feasible and may prove to be an important advancement for a further understanding of auditory processing in this species.Themes: Sensory systems, Neural basis of behavior.

Language dominance in neurologically normal and epilepsy subjects: a functional MRI study

Language dominance and factors that influence language lateralization were investigated in right-handed, neurologically normal subjects (n = 100) and right-handed epilepsy patients (n = 50) using functional MRI. Increases in blood oxygenation-dependent signal during a semantic language activation task relative to a non-linguistic, auditory discrimination task provided an index of language system lateralization. As expected, the majority of both groups showed left hemisphere dominance, although a continuum of activation asymmetry was evident, with nearly all subjects showing some degree of right hemisphere activation. Using a categorical dominance classification, 94% of the normal subjects were considered left hemisphere dominant and 6% had bilateral, roughly symmetric language representation. None of the normal subjects had rightward dominance. There was greater variability of language dominance in the epilepsy group, with 78% showing left hemisphere dominance, 16% showing a symmetric pattern and 6% showing right hemisphere dominance. Atypical language dominance in the epilepsy group was associated with an earlier age of brain injury and with weaker right hand dominance. Language lateralization in the normal group was weakly related to age, but was not significantly related to sex, education, task performance or familial left-handedness.

Cortical language activation in stroke patients recovering from aphasia with functional MRI

BACKGROUND AND PURPOSE

Two mechanisms for recovery from aphasia, repair of damaged language networks and activation of compensatory areas, have been proposed. In this study, we investigated whether both mechanisms or one instead of the other take place in the brain of recovered aphasic patients.

METHODS

Using blood oxygenation level-dependent functional MRI (fMRI), we studied cortical language networks during lexical-semantic processing tasks in 7 right-handed aphasic patients at least 5 months after the onset of left-hemisphere stroke and had regained substantial language functions since then.

RESULTS

We found that in the recovered aphasic patient group, functional language activity significantly increased in the right hemisphere and nonsignificantly decreased in the left hemisphere compared with that in the normal group. Bilateral language networks resulted from partial restitution of damaged functions in the left hemisphere and activation of compensated (or recruited) areas in the right hemisphere. Failure to restore any language function in the left hemisphere led to predominantly right hemispheric networks in some individuals. However, better language recovery, at least for lexical-semantic processing, was observed in individuals who had bilateral rather than right hemisphere-predominant networks.

CONCLUSIONS

The results indicate that the restoration of left-hemisphere language networks is associated with better recovery and inversely related to activity in the compensated or recruited areas of the right hemisphere.

Localization of language-specific cortex by using magnetic source imaging and electrical stimulation mapping

OBJECT

In this paper the authors demonstrate the concordance between magnetic source (MS) imaging and direct cortical stimulation for mapping receptive language cortex.

METHODS

In 13 consecutive surgical patients, cortex specialized for receptive language functions was identified noninvasively by obtaining activation maps aided by MS imaging in the context of visual and auditory word-recognition tasks. Surgery was then performed for treatment of medically intractable seizure disorder (eight patients), and for resection of tumor (four), or angioma (one). Mapping of language areas with cortical stimulation was performed intraoperatively in 10 patients and extraoperatively in three. Cortical stimulation mapping verified the accuracy of the MS imaging-based localization in all cases.

CONCLUSIONS

Information provided by MS imaging can be especially helpful in cases of atypical language representation, including bihemispheric representation, and location of language in areas other than those expected within the dominant hemisphere, such as the anterior portion of the superior temporal gyrus, the posteroinferior portion of the middle temporal gyrus, the basal temporal cortex, and the lateral temporooccipital cortex.

Functional brain mapping using positron emission tomography scanning in preoperative neurosurgical planning for pediatric brain tumors

OBJECT

The purpose of this report is to demonstrate the value of functional brain mapping using the positron emission tomography (PET) method for preoperative neurosurgical planning in children with brain tumors. Brain maps were used to characterize the relationship between potentially resectable tumors and functionally eloquent brain areas.

METHODS

Five children, ranging in age from 3 to 13 years, with hemispheric brain tumors adjacent to eloquent cortex were studied. Magnetic resonance (MR) imaging was used to identify the brain tumors; PET imaging after injection of [18F] fluorodeoxyglucose (FDG), [11C]L-methionine (CMET), or a combination of the two was performed to grade the tumors; and a [15O] H2O uptake study was used to characterize the anatomical relationships of the tumors to functional cortex. The cortical activation maps were obtained during control periods and during behavioral tasks and were used to document motor, visual, and speech and language organizational areas. Wada tests were performed in two patients. Language and speech activation was concordant with the results of Wada testing.

CONCLUSIONS

Functional brain mapping using PET scans and coregistered MR images provided the neurosurgeon with precise definitions of structural and functional cortical areas; this altered surgical management in some cases and/or was used to predict outcome. The combination of PET imaging with FDG and/or CMET and measurements of [15O] water uptake was useful in characterizing and grading tumors and instrumental in achieving effective neurosurgical planning. Postoperative results in the five cases suggest that preoperative functional brain mapping has the potential to improve outcome by defining a surgical plan to maximize resection and minimize the risk of neurological sequelae.

The theory of an agnosic right shift gene in schizophrenia and autism

The right shift (RS) theory (Annett, M., 1972. The distribution of manual asymmetry. Br. J. Psychol. 63, 343-358; Annett, M., 1985. Left, Right, Hand and Brain: The Right Shift Theory. Lawrence Erlbaum, London) suggests that the typical pattern of human cerebral and manual asymmetries depends on a single gene (RS+) which impairs speech-related cortex of the right hemisphere. The theory offers solutions to several puzzles, including the distribution of handedness in families (Annett, M., 1978. A Single Gene Explanation of Right and Left Handedness and Brainedness. Lanchester Polytechnic, Coventry; Annett, M., 1996. In defense of the right shift theory. Percept. Motor Skills 82, 115-137), relations between handedness and cerebral speech laterality (Annett, M., 1975. Hand preference and the laterality of cerebral speech. Cortex 11, 305-328; Annett, M., Alexander, M.P., 1996. Atypical cerebral dominance: predictions and tests of the right shift theory. Neuropsychologia 34, 1215-1227) and handedness and dyslexia (Annett, M. et al., 1996. Types of dyslexia and the shift to dextrality. J. Child Psychol. Psychiatry 37, 167-180). If Crow's (Crow, T.J. et al., 1989. Schizophrenia as an anomaly of development of cerebral asymmetry. A postmortem study and a proposal concerning the genetic basis of the disease. Arch. Gen. Psychiatry 46, 1145-1150; Crow, T.J., 1997. Is schizophrenia the price that Homo sapiens pays for language? Schizophr. Res. 28, 127-141) theory that schizophrenia is due to an anomaly of cerebral dominance is correct, and if the RS theory is correct, schizophrenia could be due to an anomaly of the RS+ gene. If the RS+ gene were at risk for a mutation which caused a loss of directional coding, the mutant could be described as 'agnosic' for left and right. Such a gene would impair either hemisphere at random. When paired with another RS+ gene, both hemispheres would be impaired in 50% of cases. The other 50% and people in whom the agnosic gene is paired with an RS-allele (neutral for asymmetry and not giving hemisphere impairment) would have one unaffected hemisphere and, thus, normal development. Quantitative predictions based on the RS genetic theory as previously developed, plus an agnosic mutant with frequency required to give schizophrenia in 1% of the population, are consistent with estimates of concordance for schizophrenia in relatives. Homozygotes of the agnosic mutant would occur at about the rate estimated for autism.

Comparative localization of auditory comprehension by using functional magnetic resonance imaging and cortical stimulation

OBJECT

The authors previously described a functional magnetic resonance (fMR) imaging task for the localization of auditory comprehension in which focal activation of posterior temporal and inferior frontal regions of the left hemisphere was reliably demonstrated. Because this study was conducted in neurologically normal volunteers, it was not possible to determine whether the activated regions were critical to the performance of language tasks; that is, whether the fMR imaging activations provided a valid measure of language processing. A direct comparison of fMR imaging language activation with cortical stimulation must be completed before it can be used with confidence in presurgical planning, and this comparison is performed in the present study.

METHODS

The authors report on a series of 33 consecutive patients who underwent dominant hemisphere resection and in whom fMR imaging mapping of auditory comprehension was performed at the Yale neurosurgical program. In 23 of the 33 patients fMR imaging activation was consistent with the typical results obtained in normal participants in the earlier study. In 16 of these 23 patients language mapping was performed using either intra- or extraoperative cortical stimulation. Cortical stimulation failed to localize language areas in two of the 16 patients. Electrical stimulation that was performed in proximity to the fMR image activations interfered with auditory comprehension, object naming, or speech production in 12 of the remaining 14 patients. Five of the 10 cases in which evocation of reliable fMR imaging activation failed were attributable to technical problems and/or patient head movement.

CONCLUSIONS

Cortical stimulation results and fMR imaging findings were consistent in all but two patients. However, the spatial extent of the activation produced by fMR imaging and the spatial extent of stimulation-induced language disruption that was caused by direct cortical stimulation did not always correspond. Problems in defining the extent of activation by both methods are discussed.

Broca's region revisited: cytoarchitecture and intersubject variability

The sizes of Brodmann's areas 44 and 45 (Broca's speech region) and their extent in relation to macroscopic landmarks and surrounding areas differ considerably among the available cytoarchitectonic maps. Such variability may be due to intersubject differences in anatomy, observer-dependent discrepancies in cytoarchitectonic mapping, or both. Because a reliable definition of cytoarchitectonic borders is important for interpreting functional imaging data, we mapped areas 44 and 45 by means of an observer-independent technique. In 10 human brains, the laminar distributions of cell densities were measured vertical to the cortical surface in serial coronal sections stained for perikarya. Thousands of density profiles were obtained. Cytoarchitectonic borders were defined as statistically significant changes in laminar patterns. The analysis of the three-dimensional reconstructed brains and the two areas showed that cytoarchitectonic borders did not consistently coincide with sulcal contours. Therefore, macroscopic features are not reliable landmarks of cytoarchitectonic borders. Intersubject variability in the cytoarchitecture of areas 44 and 45 was significantly greater than cytoarchitectonic differences between these areas in individual brains. Although the volumes of area 44 differed across subjects by up to a factor of 10, area 44 but not area 45 was left-over-right asymmetrical in all brains. All five male but only three of five female brains had significantly higher cell densities on the left than on the right side. Such hemispheric and gender differences were not detected in area 45. These morphologic asymmetries of area 44 provide a putative correlate of the functional lateralization of speech production.

fMRI assessment of hemispheric language dominance using a simple inner speech paradigm

Hemispheric language dominance (HLD) has been determined by means of functional MRI (fMRI) using a simple, inner speech, word fluency paradigm. During the task periods, subjects perform mental imagery of visual scenes and generate silently the nouns of all objects visualized. During the control periods, subjects attend to the scanner noise. Activated areas have been identified by means of cross-correlation analysis. HLD indices have been determined by comparing the number of activated pixels detected in both hemispheres within predefined cortical areas (Brodmann areas 6, 9, 10, 39, 40 and 44-47). The paradigm has been assessed on 10 healthy, right-handed volunteers. A volume 35 mm thick, centered on the inferior frontal gyrus, was imaged. A conventional GRE MR sequence was used on a 1.5 T clinical MR scanner. HLD indices were compared with those determined for overt speech. Robust fMRI responses were obtained. HLD indices indicated left hemispheric language dominance for all subjects examined. They correlated well with those obtained for overt speech (R(2) = 0.93, regression coefficient = 0.998, with p < 10(-4)). Thus, an inner speech paradigm based on visual imagery is well adapted for assessment of HLD by means of fMRI.

A large-scale distributed network for covert spatial attention: further anatomical delineation based on stringent behavioural and cognitive controls

Functional MRI was used to examine cerebral activations in 12 subjects while they performed a spatial attention task. This study applied more stringent behavioural and cognitive controls than previously used for similar experiments: (i) subjects were included only if they showed evidence of attentional shifts while performing the task in the magnet; (ii) the experimental task and baseline condition were designed to eliminate the contributions of motor output, visual fixation, inhibition of eye movements, working memory and the conditional (no-go) component of responding. Activations were seen in all three hypothesized cortical epicentres forming a network for spatial attention: the lateral premotor cortex (frontal eye fields), the posterior parietal cortex and the cingulate cortex. Subcortical activations were seen in the basal ganglia and the thalamus. Although the task required attention to be equally shifted to the left and to the right, eight of 10 subjects showed a greater area of activation in the right parietal cortex, consistent with the specialization of the right hemisphere for spatial attention. Other areas of significant activation included the posterior temporo-occipital cortex and the anterior insula. The temporo-occipital activation was within a region broadly defined as MT+ (where MT is the middle temporal area) which contains the human equivalent of area MT in the macaque monkey. This temporo-occipital area appears to constitute a major component of the functional network activated by this spatial attention task. Its activation may reflect the 'inferred' shift of the attentional focus across the visual scene.

Functional magnetic resonance imaging: clinical applications and potential

Demonstration that contrast in magnetic resonance images can be generated based on differences in blood oxygenation has led to an explosion of interest in so-called functional magnetic resonance imaging (FMRI). FMRI can be used to map increases in blood flow that accompany local synaptic activity in the brain. The technique has proved remarkably sensitive and has been used to map a broad range of cognitive, motor and sensory processes in the brain entirely non-invasively. More recently, efforts have been made to extend this technique to the analysis of clinical problems. A major application is for presurgical localization of cerebral functions, e.g. in the surgical treatment of epilepsy. The technique also is beginning to provide information on functional consequences of abnormal brain development. Perhaps most exciting are applications to neurological impairments that are not associated with structural abnormalities, such as learning problems, dyslexia and movement disorders. It is possible that useful applications of FMRI may be found for directly mapping sites of action of CNS-active drugs. Although the extent of the potential clinical applications of this new brain mapping technique is not clear, the widespread availability of MRI scanners suggests that the technique should in some form soon become a routine tool in major neuroradiological centres.

Functional magnetic resonance imaging in children

Functional magnetic resonance imaging (fMRI) allows for the noninvasive mapping of the anatomical location of disparate functional brain activities. The means for carrying out fMRI involves the use of existing MR technology coupled with a special software image acquisition program or the use of a specially designed head coil. Thus far in pediatric neurology, fMRI has assisted in the presurgical localization of critical functions and the investigation of various developmental activities. The technique of fMRI, its applications in pediatric neuroscience, and future potential are outlined in this article.

Localization and characterization of speech arrest during transcranial magnetic stimulation

OBJECTIVE

To determine the anatomic and physiologic localization of speech arrest induced by repetitive transcranial magnetic stimulation (rTMS), and to examine the relationship of speech arrest to language function.

METHODS

Ten normal, right-handed volunteers were tested in a battery of language tasks during rTMS. Four underwent mapping of speech arrest on a 1 cm grid over the left frontal region. Compound motor action potentials from the right face and hand were mapped onto the same grid. Mean positions for speech arrest and muscle activation were identified in two subjects on 3-dimensional MRI.

RESULTS

All subjects had lateralized arrest of spontaneous speech and reading aloud during rTMS over the left posterior-inferior frontal region. Writing, comprehension, repetition, naming, oral praxis, and singing were relatively spared (P < .05). Stimulation on the right during singing abolished melody in two subjects, but minimally affected speech production. The area of speech arrest overlay the caudal portion of the left precentral gyrus, congruous with the region where stimulation produced movement of the right face.

CONCLUSIONS

The site of magnetic speech arrest appears to be the facial motor cortex. Its characteristics differ from those of classic aphasias, and include a prominent dissociation among different types of speech output.

Determination of language dominance: Wada test confirms functional transcranial Doppler sonography

OBJECTIVE

To determine the efficacy of the invasive Wada test in determining language dominance, and to validate the functional transcranial Doppler sonography (fTCD) examination in patients.

BACKGROUND

Previous work shows that simultaneous bilateral fTDC may identify cognitive hemispheric dominance in healthy individuals.

METHOD

fTDC and the Wada test were performed prospectively in 14 patients with various diseases (tumors, cerebrovascular events, head injury, intractable epilepsy). fTDC hemispheric dominance was determined based on the hemispheric blood flow velocity shift for language and visuospatial tasks.

RESULTS

fTDC was performed easily in patients. One patient could not be examined by fTDC because of absent temporal bone window for ultrasonic transmission. Two Wada tests were inconclusive due to patient somnolence. One of these patients suffered from right frontal tumor and had aphasia remitted under steroids when examined. fTDC indicated a bilateral language dominance. In the remaining 11 patients the correlation between fTDC and Wada language lateralization indices was 0.75 (p = 0.008). If a post hoc cutoff score was taken for the fTDC language lateralization index, in eight patients, both fTDC and Wada testing determined the left hemisphere to be dominant for language; in the other three patients, language function was bilateral in both examinations.

CONCLUSION

Although the current results are preliminary and require replication in a larger sample, fTDC seems to be able to assess hemispheric language dominance not only in healthy individuals, but also in patients. It might become an alternative noninvasive or complementary tool to the Wada test, particularly in patients in whom the Wada test is impractical or gives inconclusive results.

(15)O water positron emission tomography in language localization: a study comparing positron emission tomography visual and computerized region of interest analysis with the Wada test

We compared (15)O water positron emission tomography (PET) auditory and visual confrontational naming activation with an intracarotid amobarbital (Amytal) injection procedure (IAP) for language lateralization in 12 patients with intractable epilepsy. PET scans were evaluated by three raters experienced in functional imaging as well as by a region of interest (ROI) approach. Compared with IAP, raters' positive predictive value for language lateralization ranged from 88 to 91%. ROI analysis had a positive predictive value of 80%. Six patients had surgery; 1 with right-sided IAP language dominance but left-sided PET activation had dysphasia for 6 months after left temporal lobectomy.

Processing of visually presented sentences in Mandarin and English studied with fMRI

Comprehension of visually presented sentences in fluent bilinguals was studied with functional magnetic resonance imaging (fMRI) using a set of conceptually similar sentences in two orthographically and phonologically distinct languages, Mandarin and English. Responses were monitored during scanning. Sentence comprehension in each language was compared to fixation in nine subjects and Tamil-like pseudo-word strings in five subjects. Spatially congruent activations in the prefrontal, temporal, and superior parietal regions and in the anterior supplementary motor area were observed for both languages and in both experiments at the individual and group levels of analysis. Proficient bilinguals exposed to both languages early in life utilize common neuroanatomical regions during the conceptual and syntactic processing of written language irrespective of their differences in surface features.

Determination of cognitive hemispheric lateralization by "functional" transcranial Doppler cross-validated by functional MRI

BACKGROUND AND PURPOSE

Changes of blood flow velocity in the right and left middle cerebral artery (MCA) induced by cognitive demands are detectable by means of "functional" transcranial Doppler sonography (fTCD). Functional MRI (fMRI) is an alternative method for mapping brain activity. The purpose of this study was to determine whether fTCD can detect hemispheric lateralization and to cross-validate fTCD with fMRI.

METHODS

Bilateral continuous MCA monitoring of 14 healthy, right-handed subjects with TCD was performed while the subjects underwent a visuospatial task, and the hemispheric blood flow velocity shift was calculated. Identical stimulus and response patterns were used in fMRI. Blood oxygenation level-dependent fMRI was performed with the use of a gradient-echo echo-planar sequence on a 1.5-T scanner. Statistical maps were computed on a voxel-by-voxel basis, hemispheric ratios for activated pixels were computed, and a group study was performed separately for the male and female subgroups.

RESULTS

Statistical analyses (t test) showed a significantly higher mean peak blood flow velocity increase (P<0.05) of the right MCA (111.3+/-7.0%) compared with the left MCA (107.1+/-6.1%). fMRI demonstrated bilateral activation in the superior parietal lobulus (Brodmann area 7) with a right/left ratio of 1.95. Concordant differences between the female and male subgroups could be visualized with both methods.

CONCLUSIONS

Both methods succeeded in discriminating a blood flow shift to the right hemisphere induced by a complex cognitive visuospatial task. fMRI cross-validates the findings of fTCD. Our study suggests that fTCD can investigate the close relationship between brain activity and blood flow and lateralize higher cognitive functions reliably.

Mandarin and English single word processing studied with functional magnetic resonance imaging

The cortical organization of language in bilinguals remains disputed. We studied 24 right-handed fluent bilinguals: 15 exposed to both Mandarin and English before the age of 6 years; and nine exposed to Mandarin in early childhood but English only after the age of 12 years. Blood oxygen level-dependent contrast functional magnetic resonance imaging was performed while subjects performed cued word generation in each language. Fixation was the control task. In both languages, activations were present in the prefrontal, temporal, and parietal regions, and the supplementary motor area. Activations in the prefrontal region were compared by (1) locating peak activations and (2) counting the number of voxels that exceeded a statistical threshold. Although there were differences in the magnitude of activation between the pair of languages, no subject showed significant differences in peak-location or hemispheric asymmetry of activations in the prefrontal language areas. Early and late bilinguals showed a similar pattern of overlapping activations. There are no significant differences in the cortical areas activated for both Mandarin and English at the single word level, irrespective of age of acquisition of either language.

Language dominance determined by whole brain functional MRI in patients with brain lesions

BACKGROUND

Functional MRI (fMRI) is of potential value in determining hemisphere dominance for language in epileptic patients.

OBJECTIVE

To develop and validate an fMRI-based method of determining language dominance for patients with a wide range of potentially operable brain lesions in addition to epilepsy.

METHODS

Initially, a within-subjects design was used with 19 healthy volunteers (11 strongly right-handed, 8 left-handed) to determine the relative lateralizing usefulness of three different language tasks in fMRI. An automated, hemispheric analysis of laterality was used to analyze whole brain fMRI data sets. To evaluate the clinical usefulness of this method, we compared fMRI-determined laterality with laterality determined by Wada testing or electrocortical stimulation mapping, or both, in 23 consecutive patients undergoing presurgical evaluation of language dominance.

RESULTS

Only the verb generation task was reliably lateralizing. fMRI, using the verb generation task and an automated hemispheric analysis method, was concordant with invasive measures in 22 of 23 patients (12 Wada, 11 cortical stimulation). For the single patient who was discordant, in whom a tumor involved one-third of the left hemisphere, fMRI became concordant when the tumor and its reflection in the right hemisphere were excluded from laterality analysis. No significant negative correlation was obtained between lesion size and strength of laterality for the patients with lesions involving the dominant hemisphere.

CONCLUSION

This fMRI method shows potential for evaluating language dominance in patients with a variety of brain lesions.

Integration of preoperative and intraoperative functional brain mapping in a frameless stereotactic environment for lesions near eloquent cortex. Technical note

The authors present a method of incorporating preoperative noninvasive functional brain mapping data into the frameless stereotactic magnetic resonance (MR) imaging dataset used for image-guided resection of brain lesions located near eloquent cortex. They report the use of functional (f)MR imaging and magnetic source (MS) imaging for preoperative mapping of eloquent cortex in difficult cases of brain tumor resection such as those in which there are large expansive masses or in which reoperations are required and the anatomy is distorted from prior treatments. To correlate methods of preoperative and intraoperative mapping localization directly, the authors have developed techniques of importing preoperative MS and fMR imaging data into an image-guided frameless stereotactic computer workstation. The data appear as a seamless overlay on the same preoperative volumetric MR imaging dataset used for stereotactic guidance during the operation. Intraoperatively identified functional locations mapped by cortical stimulation are recorded as digitally registered points. This approach should prove useful in assessing the accuracy and reliability of various preoperative functional brain mapping techniques.

Hemispheric language dominance in children demonstrated by functional magnetic resonance imaging

The objective of this study was to demonstrate hemispheric language dominance in normal children. Fifteen normal children were evaluated with functional magnetic resonance imaging (MRI) using an age-related silent word spelling paradigm. The data were analyzed with the cross-correlation method, and lateralization indices were calculated in language regions as determined by Talairach coordinates. Activation foci were detected in the left inferior frontal area and were strongly lateralized, with language lateralization indices of 0.74 +/- 0.21 (age 7-12 years, nine subjects), and 0.79 +/- 0.18 (13-18 years, six subjects). The indices were similar to those for adults (0.83 +/- 0.21, four subjects). Our study established that language is strongly lateralized to the left hemisphere in children as young as 7 years of age.

Influence of acoustic masking noise in fMRI of the auditory cortex during phonetic discrimination

The application of functional magnetic resonance imaging (fMRI) to study activation of auditory cortex suffers from one significant confounding factor, namely, that of the acoustic noise generated by the gradient system, which is an integral part of the imaging process. Earlier work has shown that it is indeed possible to distinguish cortical activation resulting from presentation of auditory stimuli despite the presence of background noise from the gradient system. The influence of acoustic noise from the gradient system of the MRI scanner on the blood oxygen level-dependent (BOLD) response during functional activation of the auditory cortex has been investigated in six healthy subjects with no hearing difficulties. Experiments were performed using gradient-echo echoplanar imaging (EPI) and a verbal, auditory discrimination paradigm, presented in a block-wise manner, in which carefully aligned consonant-vowel syllables were presented at a rate of 1 Hz. For each volunteer the experiment was repeated three times with all parameters fixed, except slice number, which was 4, 16, or 64. The positioning of the central four slices in each experiment was common. Thus, the fraction of TR during which the stimulus is on but no imaging is being performed, varies from almost zero, in the case of 64 slices, to over 8 seconds, in the case of four slices. Only the central four slices were of interest; additional slices simply generated acoustic noise and were discarded. During the four-slice experiment, all subjects showed a robust BOLD response in the superior temporal gyrus covering the primary and secondary auditory cortex. The spatial extent and the z-scores of the activated regions decreased with longer duration of gradient noise from the scanner. For a phonetic discrimination task, the results indicate that presentation of the stimulus during periods free from scanner noise leads to a more pronounced BOLD response.

Is speech arrest during wada testing a valid method for determining hemispheric representation of language?

BACKGROUND AND OBJECTIVE

The intracarotid amobarbital procedure, or Wada test, is the method of choice to determine hemispheric representation of language, and is routinely used in the presurgical evaluation for intractable epilepsy. Some investigators perform comprehensive language assessments, but others base language lateralization solely on speech arrest. This study sought to determine whether speech arrest alone during Wada testing provides valid data regarding language lateralization.

METHODS

The subjects (previously reported) were 21 patients evaluated for intractable epilepsy, who underwent language lateralization by Wada testing and functional MRI (FMRI). For each patient, language representation was determined by calculating: (1) a Wada laterality index based exclusively on speech arrest; (2) a Wada laterality index based on comprehensive language assessment; and (3) an FMRI laterality quotient. Correlation coefficients and categorical classifications were analyzed.

RESULTS

There was no significant correlation between the Wada laterality quotient derived from duration of speech arrest and either the comprehensive Wada language laterality score (r =.35, p =.12) or FMRI language laterality score (r =.32, p =.16). Categorical classification as left, right or bilateral language also showed marked discordance between speech arrest and the other two methods.

CONCLUSION

Duration of speech arrest during Wada testing is not a valid measure of language dominance.

Non-invasive assessment of language dominance with near-infrared spectroscopic mapping

Hemispheric dominance for language is usually assessed by means of the Wada test where amobarbital is injected into the carotid artery. Recently, positron emission tomography and functional MRI have been used as non-invasive alternatives to this method. We have applied 24-channel near-infrared spectroscopic topography (NIRS) as another non-invasive method to detect the unilateral cerebral activation during a language task. We used 11 healthy volunteers and six patients with intractable epilepsy. A word-generation task was applied for 17 s, followed by an extinction/resting period of 60 s. In healthy volunteers, the inferior frontal region was activated on the side opposite to the subject's handedness in infancy. In the epilepsy cases, the activated side agreed with the dominance determined by the Wada test. Our results demonstrate that NIRS is a feasible non-invasive alternative to the Wada test.

Magnetic resonance imaging and temporal lobe epilepsy

Surgical treatment is a well established option for patients with medically refractory temporal lobe epilepsy. Magnetic resonance imaging (MRI) has revolutionized the evaluation of these patients. New techniques can identify structural, metabolic and functional abnormalities associated with the epileptogenic zone. Mesial temporal sclerosis is the most common pathological finding and presents as hippocampal atrophy, which can be detected by visual inspection in most cases. Volumetric analysis of medial temporal structures offers the advantage of detecting bilateral abnormalities. Magnetic resonance spectroscopy can detect metabolic abnormalities associated with the epileptogenic focus. Functional MRI allows for the non-invasive evaluation of cognitive function, allowing for the localization of the neuroanatomic substrate of motor, sensory and cognitive functions. Intraoperative MRI-based image guided systems are a useful adjunct in the surgical treatment of this epileptic syndrome.

Intensity coding of auditory stimuli: an fMRI study

The effect of stimulus intensity (sound pressure level, SPL) of auditory stimuli on the BOLD response in the auditory cortex was investigated in 14 young and healthy subjects, with no hearing abnormalities, using echo-planar, functional magnetic resonance imaging (fMRI) during a verbal and a non-verbal auditory discrimination task. The stimuli were presented block-wise at three different intensities: 95, 85 and 75 dB (SPL). All subjects showed fMRI signal increases in superior temporal gyrus (STG) covering primary and secondary auditory cortex. Most importantly, the spatial extent of the fMRI response in STG increased with increasing stimulus intensity. It is hypothesized that spreading of excitation is associated with the encoding of increasing stimulus intensity levels. In addition, we found bifrontal activation supposedly evoked by the auditory-articulary loop of working memory. The results presented here should assist in the design of optimal activation strategies for studying the auditory cortex with fMRI paradigms and may help in understanding intensity coding of auditory stimuli.

Brain activation during silent word generation evaluated with functional MRI

This is a study of word generation during functional MRI (fMRI). Eleven normal healthy subjects were instructed to generate words covertly, (i.e., silently) that began with particular letters. Images were acquired on a conventional 1.5T scanner at three contiguous axial planes encompassing language-related areas of the temporal and frontal lobe. The data were analyzed at the level of a Talairach box, after individually fitting the proportional Talairach grid system to each slice. The main variable of interest was the number of activated pixels within a Talairach box. Boxes with a significant increase in the proportion of activated pixels were located in three regions of the left neocortex: (1) Brodmann areas 44 and 45 in the dorsolateral frontal cortex (Broca's area), (2) areas 21 and 37 in the temporal cortex, (3) and the striate/extrastriate cortex (areas 17 & 18). The results are discussed in terms of a cognitive model of word generation and are compared, in detail, with the results of prior relevant imaging studies.

Functional anatomy of dominance for speech comprehension in left handers vs right handers

In order to study the functional anatomy of hemispheric dominance for language comprehension we compared the patterns of activations and deactivations with PET and H(2)15O during a story-listening task in two groups of normal volunteers selected on the basis of their handedness. The reference task was a silent rest. The results showed asymmetrical temporal activations favoring the left hemisphere in right handers (RH) together with Broca's area and medial frontal activations. A rightward lateralization of deactivations located in the parietal and inferior temporal gyrus was also observed. In left handers (LH) the temporal activations were more symmetrical as were the parietal and inferior frontal deactivations. Broca's area and medial frontal gyrus activations were present in LH. The direct comparison of RH and LH activations revealed larger activations in the left superior temporal, in particular in the left planum temporale and temporal pole of RH, while LH activated an additional right middle temporal region. Individual analysis of LH differences images superimposed on individual MRI planes demonstrated an important variability of functional dominance, with two LH leftward lateralized, two symmetrical, and one showing a rightward lateralization of temporal activations. There was no relationship between functional dominance and handedness scores. These results are in accordance with data from aphasiology that suggest a greater participation of the right hemisphere in language processing in LH. In addition, the presence of bilateral deactivations of the dorsal route could support the assumption that LH ambilaterality concerns, in addition to language, other cognitive functions such as visuospatial processing.

Assessment of functional cerebral laterality for language using magnetoencephalography

The purpose of the study was to examine the feasibility of using magnetoencephalography (MEG), a noninvasive functional brain imaging technique, to assess cerebral laterality for language. The magnetic flux normal to the scalp surface was measured with a whole-head neuromagnetometer while subjects (n = 16) were engaged in a word-matching and a tone-matching task. The effect of hemisphere and task on the number of satisfactory equivalent current dipole (ECD) solutions obtained during the late portion of the responses to the word and tone stimuli was examined. An interhemispheric ECD laterality index was also computed. Satisfactory ECD solutions were localized in perisylvian cortices during both tasks. A greater number of ECDs was found in the left hemisphere in 14 (87%) of 16 of the subjects in the word-matching task, a proportion that approaches the reported incidence of left-hemisphere dominance among right-handers. A similar proportion of subjects also showed a clear asymmetry in the number of ECDs favoring the left hemisphere in the language task as compared to the nonlanguage task. These findings suggest that MEG is a promising tool for laterality assessment. Magnetoencephalography-based functional asymmetry data are currently being compared against invasive presurgical procedures (i.e., intracarotid amobarbital procedure).

Cerebral functional magnetic resonance imaging of vestibular, auditory, and nociceptive areas during galvanic stimulation

Cerebral activation was investigated with functional magnetic resonance imaging (fMRI) during galvanic stimulation of the mastoid in 6 normal volunteers. Cutaneous stimulation at the neck C4-5 level served as a control. During mastoid stimulation, bilateral vestibular activation occurred in the posterior insula (parietoinsular vestibular cortex, PIVC), the transverse temporal (Heschl's) gyrus, and thalamic pulvinar. The cutaneous pain elicited by galvanic stimulation caused bilateral activity of the medial part of the insula and the anterior median thalamus. Thus, galvanic stimulation at the mastoid level activates cortical areas of three different sensory systems in the insulathalamic region, the vestibular, the auditory, and the nociceptive systems.

Functional magnetic resonance imaging of human brain activity in a verbal fluency task

OBJECTIVES

Functional MRI (fMRI) holds the promise of non-invasive mapping of human brain function in both health and disease. Yet its sensitivity and reliability for mapping higher cognitive function are still being determined. Using verbal fluency as a task, the objective was to ascertain the consistency of fMRI on a conventional scanner for determining the anatomic substrate of language between subjects and between sexes. Comparison was made with previous PET studies.

METHODS

Using a 1.5 Tesla magnet and an echoplanar pulse sequence, whole brain fMRI was obtained from 12 normal right handed subjects (6 males and 6 females) as they performed a verbal fluency task.

RESULTS

A broadly consistent pattern of response was seen across subjects. Areas showing activation changes included the left prefrontal cortex and right cerebellum, in agreement with previous PET 15O-H2O studies. In addition, significantly decreased responses were seen in the posterior cingulate and over an extensive area of mesial and dorsolateral parietal and superior temporal cortices. The male cohort showed a slight asymmetry of parietal deactivation, with more involvement on the right, whereas the female cohort showed a small region of activation in the right orbitofrontal cortex. There were individual task related regional changes in all 12 subjects with the area showing the most significant change being the left prefrontal cortex in all cases.

CONCLUSIONS

Magnetic resonance scanners of conventional field strength can provide functional brain mapping data with a sensitivity at least that of PET. Activation was seen in left prefrontal and right cerebellar regions, as with PET. However, decremental responses were seen over a much larger area of the posterior cortex than had been anticipated by prior studies. The ability to see a response in each subject individually suggests that fMRI may be useful in the preinterventional mapping of pathological states, and offers a non-invasive alternative to the Wada test for assessment of hemispheric dominance. There were no gross differences in the pattern of activation between male and female subjects.