Magnetic resonance imaging functional activation of left frontal cortex during covert word production

Cognitive Biomarkers in the Clinic: Lessons From Presurgical fMRI

SUMMARY

Cognitive biomarkers are vital and uniquely challenging clinical tools. There has been marked growth in neuroimaging-based cognitive biomarkers across the past 40 years with more in development (e.g., clinical cognitive EEG). The challenges involved in developing cognitive biomarkers and key milestones in their development are reviewed here using clinical functional MRI's evolution as a case study. It is argued that indexing cognition is uniquely challenging because it requires patients to consistently use specific cognitive processes, and it is difficult or impossible to independently verify this occurred. This limitation can be successfully managed through careful analysis of standardized protocols for acquisition and interpretation, and ensuring the clinical application of biomarkers integrates disciplines with complementary expertise. Factors beneficial to the adoption of a novel cognitive biomarker include a clinical need and inadequate alternatives. Key milestones in the development of functional MRI included (1) demonstration that its performance was equivalent to its predecessor; (2) demonstration it predicted a clinically meaningful outcome; and (3) the establishment of infrastructure for both its execution and billing. Review of functional MRI and its predecessors suggest a cycle whereby successful cognitive biomarkers are validated, experience widespread adoption and customization/fragmentation, go through a period of review, and finally are refined and standardized. Those applying future cognitive biomarkers in the clinic can avoid some of the failures of clinical functional MRI by defining the skills and disciplines the method requires and routinely evaluating patient outcomes.

Neural representations of imagined speech revealed by frequency-tagged magnetoencephalography responses

Speech mental imagery is a quasi-perceptual experience that occurs in the absence of real speech stimulation. How imagined speech with higher-order structures such as words, phrases and sentences is rapidly organized and internally constructed remains elusive. To address this issue, subjects were tasked with imagining and perceiving poems along with a sequence of reference sounds with a presentation rate of 4 Hz while magnetoencephalography (MEG) recording was conducted. Giving that a sentence in a traditional Chinese poem is five syllables, a sentential rhythm was generated at a distinctive frequency of 0.8 Hz. Using the frequency tagging we concurrently tracked the neural processing timescale to the top-down generation of rhythmic constructs embedded in speech mental imagery and the bottom-up sensory-driven activity that were precisely tagged at the sentence-level rate of 0.8 Hz and a stimulus-level rate of 4 Hz, respectively. We found similar neural responses induced by the internal construction of sentences from syllables with both imagined and perceived poems and further revealed shared and distinct cohorts of cortical areas corresponding to the sentence-level rhythm in imagery and perception. This study supports the view of a common mechanism between imagery and perception by illustrating the neural representations of higher-order rhythmic structures embedded in imagined and perceived speech.

Recruiting the right hemisphere: Sex differences in inter-hemispheric communication during semantic verbal fluency

Sex differences in cognitive functions are heavily debated. Recent work suggests that sex differences do stem from different processing strategies utilized by men and women. While these processing strategies are likely reflected in different brain networks, so far the link between brain networks and processing strategies remains speculative. In the present study we seek for the first time to link sex differences in brain activation patterns to sex differences in processing strategies utilizing a semantic verbal fluency task in a large sample of 35 men and 35 women, all scanned thrice. For verbal fluency, strategies of clustering and switching have been described. Our results show that men show higher activation in the brain network supporting clustering, while women show higher activation in the brain network supporting switching. Furthermore, converging evidence from activation results, lateralization indices and connectivity analyses suggests that men recruit the right hemisphere more strongly during clustering, but women during switching. These results may explain findings of differential performance and strategy-use in previous behavioral studies.

Review : Mapping Brain Pathophysiology and Higher Cortical Function with Magnetic Resonance Imaging

Advances in magnetic resonance imaging (MRI) have moved the technology beyond its application solely as a diagnostic test to become a tool for addressing questions of in vivo pathophysiology and higher cortical function in humans. Diffusion-weighted MRI measures the apparent rate of translational movement of water molecules through brain parenchyma. This measurement can be used to determine axonal orientation within white matter, to define regions of tissue edema, and to permit early identification of ischemic neuronal injury related to impairment of Na+-K +-ATPase activity in experimental and human stroke. Changes in various aspects of cerebral perfusion—blood volume, blood flow, and hemoglobin oxygen saturation—can be mea sured with MRI, and altered cerebrovascular circulation and regional brain activation can thereby be inves tigated. Echo planar imaging is a method of ultrafast data acquisition with MRI—individual images are ac quired on the order of 100 msec. Echo planar imaging makes diffusion and perfusion measurements more practicable for diverse applications and allows for the study of temporal characteristics of regional brain responses to stimuli. Diffusion and perfusion MRI, generally termed functional MRI, are tools for studying in vivo brain physiology with MRI and are being applied to a broad range of questions in neuroscience. The Neuroscientist 1:221-235, 1995

Mapping Language in Epilepsy with Functional Imaging

Surgery is an important therapeutic alternative for patients with uncontrolled epilepsy. Preoperative identification of brain regions important for language is important to reduce the risk of functional impairment after surgery. The Wada test suffers from several technical and clinical disadvantages and provides hemispheric data at best. More invasive methods such as intraoperative or chronic subdural cortical mapping have more limited application. New approaches using neuroimaging methods offer the opportunity to localize, as well as lateralize, language. In addition, normal volunteers can be studied with the same techniques, providing comparative and control data. Although most normal studies have been reported as group data, it is important for individual scans to be available for comparison with patient studies to understand the normal range of interindividual variability. Two techniques, PET with 15O-water-PET and fMRI, have been used. Both detect signal changes associated with increased regional blood flow during neuronal activity. Usually, scans performed during a language task are compared with those obtained during control conditions. It is important to choose activation tasks carefully, to make sure one is imaging activation associated with the particular process of interest. PET has advantages, including a fully diffusible tracer, standardized analytic methods, a more comfortable environment, and less sensitivity to movement artifact. On the other hand, it involves a cyclotron-produced tracer, radiation exposure, and is more difficult to repeat. FMRI over represents the effects of large vascular structures and is very sensitive to movement but uses widely available equipment and has no limitation on the number of studies. For both studies, it is important to understand the potential effects of such factors as attention, fatigue, and familiarity with the material. Several studies comparing 15O-water-PET and fMRI to the Wada test found that the former are at least as accurate for language lateralization. In addition, we compared 15O-water-PET to direct subdural electrode cortical stimulation and found that regions showing increased cerebral blood flow during naming tasks co-registered with subdural electrodes that disrupted language during electrical stimulation. In this and other studies, PET detected more regions than electrical stimulation techniques. The whole brain cannot be covered with electrodes, but some areas participating in a task may not be crucial for it. FMRI is particularly useful for children. We compared cortical activation patterns in normal children, adolescents, and adults. The activation patterns, and laterality of language dominance, in children 8 years and above, were similar to adults, although some differences could reflect maturation and evolving focality of cognitive processes. In children with epilepsy, fMRI successfully identified language laterality and provided data on intrahemispheric localization. Studies also showed the effects of the epileptic focus on normal activation patterns for several tasks. Neuroimaging functional mapping is an important tool, still in the process of development and evolution. Although potentially of great clinical and scientific value, it should be used and interpreted cautiously.

Neural biomarkers for assessing different types of imagery in pictorial health warning labels for cigarette packaging: a cross-sectional study

OBJECTIVE

Countries around the world have increasingly adopted pictorial health warning labels (HWLs) for tobacco packages to warn consumers about smoking-related risks. Research on how pictorial HWLs work has primarily analysed self-reported responses to HWLs; studies at the neural level comparing the brain's response to different types of HWLs may provide an important complement to prior studies, especially if self-reported responses are systematically biased. In this study we characterise the brain's response to three types of pictorial HWLs for which prior self-report studies indicated different levels of efficacy.

METHODS

Current smokers rated pictorial HWLs and then observed the same HWLs during functional MRI (fMRI) scanning. Fifty 18-50-year-old current adult smokers who were free from neurological disorders were recruited from the general population and participated in the study. Demographics, smoking-related behaviours and self-reported ratings of pictorial HWL stimuli were obtained prior to scanning. Brain responses to HWLs were assessed using fMRI, focusing on a priori regions of interest.

RESULTS

Pictorial HWL stimuli elicited activation in a broad network of brain areas associated with visual processing and emotion. Participants who rated the stimuli as more emotionally arousing also showed greater neural responses at these sites.

CONCLUSIONS

Self-reported ratings of pictorial HWLs are correlated with neural responses in brain areas associated with visual and emotional processing. Study results cross-validate self-reported ratings of pictorial HWLs and provide insights into how pictorial HWLs are processed.

Movement imagery for speech in healthy women: influences on articulation accuracy and fluidity, imagery times, and expectations of success

The use of movement imagery in speech performance has received less attention than it has in many other professional disciplines. 30 healthy monolingual native English speakers participated in this within-subjects study. Participants' speech accuracy and fluidity was compared when they used movement imagery and when they did not. The timing of imagery and articulation were compared using a chronometric paradigm. Participants' expectations of improvement when using movement imagery for speech were compared to their actual performance. The results from this study support the use of movement imagery for speech with a single imaging event for the purpose of improving speech fluidity, but not for improving articulation accuracy. The chronometric system as a tool for monitoring adherence to the movement imagery protocol for speech proved valuable. Finally, while estimation inflation has been reported by some using movement imagery techniques, this was not the case for the participants of this study.

Task-induced deactivation and the "resting" state

Task-induced decreases in blood flow and the widespread use of "resting" baselines produced unexpected and discrepant results in early cognitive imaging studies, especially in language comprehension experiments. Here I describe from a personal perspective some of the events and thought processes leading to the first hypothesis-driven fMRI study of the "resting" state.

Acoustically presented semantic decision-making tasks provide a robust depiction of the temporo-parietal speech areas

Functional MRI (fMRI) is routinely used to depict language areas, for example in the preoperative diagnostic work-up of patients with a brain tumour. The objective of this study was to test whether semantic decision making can activate the temporo-parietal language areas better than phonological generation stimuli. Five fMRI language stimuli were tested in 20 healthy volunteers: (i) word generation to a given letter (WG); (ii) verb generation to a given noun (VG); (iii) generation of groups of words (GW); (iv) detection of a semantic violation in sentences (SV); and (v) detection of pseudowords (PW). The stimuli were presented both visually and acoustically. We used a block design and evaluated the data with SPM5 with predefined regions of interest in the frontal and temporo-parietal language areas. A lateralisation index (LI) was also calculated. We found that WG and VG achieved the best results in frontal language areas; VG, SV and PW presented acoustically achieved the best results in the temporo-parietal language areas; and that LI was most reliably calculated in the frontal language areas. An acoustically presented semantic decision making stimulus should be implemented in the preoperative diagnostic work-up to robustly depict the temporo-parietal language areas. The stimulus is easy to understand and perform, and it achieves robust results.

Functional neuroimaging in obsessive-compulsive disorder

BACKGROUND AND AIM

Obsessive-compulsive disorder (OCD) is a severe, highly prevalent and chronically disabling psychiatric disorder that usually emerges during childhood or adolescence. This paper aims to review the literature on functional neuroimaging in OCD, analysing the reported dysfunctional connectivity in the corticostriatothalamocortical circuitry.

METHOD

This study included papers published in peer-reviewed journals dealing with functional imaging in OCD.

RESULTS

Striatal dysfunction, mainly of the caudate nucleus, leads to inefficient thalamic gating, resulting in hyperactivity within the orbitofrontal cortex (intrusive thoughts) and the anterior cingulate cortex (non-specific anxiety). Compulsions consist of ritualistic behaviours performed to recruit the inefficient striatum and neutralise unwanted thoughts and anxiety. Functional neuroimaging findings are discussed against the background of specific cognitive impairments, mainly regarding visuospatial processing, executive functioning and motor speed. Cognitive deficits are partial and specific, matching imaging data.

CONCLUSIONS

Several studies have targeted brain regions hypothesised to be involved in the pathogenesis of OCD, showing the existence of dysfunctional connectivity in the corticostriatothalamocortical circuitry. Improvements in spatial resolution of neuroimaging techniques may contribute to a better understanding of the neurocircuitry of OCD and other anxiety disorders.

The NIH experience in first advancing fMRI

The introduction of functional MRI at NIH in 1992 was the outcome of research goals first formulated by Turner in 1983. Between 1988 and 1990, Turner worked at NIH on actively-shielded gradient coils and the implementation of EPI-based techniques, especially diffusion-weighted EPI. His work on hypoxia in cat brain in 1990 directly inspired Ken Kwong's demonstration of BOLD contrast in humans at MGH in May 1991. Turner collaborated actively with this MGH team, the first group to map entirely noninvasively human brain activity due to visual stimulation. He introduced BOLD fMRI at NIH in February 1992. This paper reviews the steps that led up to BOLD EPI, and Turner's initial applications of BOLD fMRI at NIH.

Frontal activation and connectivity using near-infrared spectroscopy: verbal fluency language study

Near infrared spectroscopy (NIRS) is an optical technique with high temporal resolution and reasonably good spatial resolution, which allows non invasive measurement of the blood oxygenation of tissue. The current work is focused in assessing and correlating brain activation, connectivity and cortical lateralization of the frontal cortex in response to language-based stimuli, using NIRS. Experimental studies were performed on 15 normal right-handed adults, wherein the participants were presented with a verbal fluency task. The hemodynamic responses in the pre- and anterior frontal cortex were assessed in response to a Word generation task in comparison to the baseline random Jaw movement and Rest conditions. The functional connectivity analysis was performed using zero-order correlations and the cortical lateralization was evaluated as well. An increase in oxy- and a decrease in deoxy-hemoglobin were observed during verbal fluency task in the frontal cortex. Unlike in the pre-frontal cortex, the hemodynamic response in the anterior frontal during verbal fluency task was not significantly different from that during random Jaw movement. Bilateral activation and symmetrical connectivity were observed in the pre-frontal cortex, independent of the stimuli presented. A left cortical dominance and asymmetry connectivity was observed in the anterior frontal during the verbal fluency task. The work is focused to target the pediatric epileptic populations in the future, where understanding the brain functionality (activation, connectivity, and dominance) in response to language is essential as a part of the pre-surgical evaluation in a clinical environment.

Brain activities on fMRI using the shiritori task in normal subjects

Shiritori is a popular Japanese word chain game that resembles verbal fluency tasks used in Western countries. Recently, shiritori has been used to determine the dominant hemisphere for language and as a rehabilitation tool. However, there are few reports of neuroimaging during shiritori. We used functional magnetic resonance imaging (fMRI) to conduct a detailed study of brain activities during shiritori and observed activation not only of the left inferior frontal gyrus (including the pars opecularis, the pars triangularis and the pars orbitalis), which is a language-related area, but also of the left superior and middle frontal gyri, the right pars orbitalis (inferior frontal gyrus), and the right cerebellar hemisphere. Shiritori is a useful tool for psychological study and rehabilitation.

Neural networks of motor and cognitive inhibition are dissociated between brain hemispheres: an fMRI study

Paradigms exploring cognitive inhibition involve motor responses, which may confound the results. We compare cognitive inhibition activation obtained without motor involvement, to motor inhibition alone, in a group of young right-handed volunteers, utilizing a classical color Stroop task (CST), and a Stop Task. Comparison of fMRI activation was performed contrasting lateralization indexes of different Regions of Interest (ROI). Cognitive inhibition showed left brain lateralization, while motor inhibition showed right brain lateralization. Homologue brain areas involved the inferior frontal gyrus, inferior parietal lobule, middle temporal gyrus, and anterior cingulate gyrus. These circuitries appear to support that inhibition is a complicated function involving working memory, attention, semantic decision, and motivation modules.

Structural correlates of semantic and phonemic fluency ability in first and second languages

Category and letter fluency tasks are commonly used clinically to investigate the semantic and phonological processes central to speech production, but the neural correlates of these processes are difficult to establish with functional neuroimaging because of the relatively unconstrained nature of the tasks. This study investigated whether differential performance on semantic (category) and phonemic (letter) fluency in neurologically normal participants was reflected in regional gray matter density. The participants were 59 highly proficient speakers of 2 languages. Our findings corroborate the importance of the left inferior temporal cortex in semantic relative to phonemic fluency and show this effect to be the same in a first language (L1) and second language (L2). Additionally, we show that the pre-supplementary motor area (pre-SMA) and head of caudate bilaterally are associated with phonemic more than semantic fluency, and this effect is stronger for L2 than L1 in the caudate nuclei. To further validate these structural results, we reanalyzed previously reported functional data and found that pre-SMA and left caudate activation was higher for phonemic than semantic fluency. On the basis of our findings, we also predict that lesions to the pre-SMA and caudate nuclei may have a greater impact on phonemic than semantic fluency, particularly in L2 speakers.

Neural mechanisms underlying the processing of Chinese and English words in a word generation task: an event-related potential study

Event-related brain potentials (ERPs) were used to examine the spatiotemporal cortical activation patterns underlying Chinese and English word generation (forming a new word by adding a stroke or a letter to an old Chinese or English word) for low- and high-proficiency Chinese-English bilinguals. The results revealed that early visual perceptual processing and word identification were similar between the two languages for the N120 and P220 waveforms. However, a greater negative potential (N250-350) was associated with Chinese words than with English words between 250 and 350 ms. Subsequently, for fluent Chinese bilinguals, Chinese words elicited a more positive ERP deflection (LPC) than did English words between 350 and 800 ms. The differences in ERP components between Chinese and English words indicates that there might be a real difference in the processing demands between these languages, and that the processing of English might be affected by the proficiency of the second language.

Group independent component analysis of language fMRI from word generation tasks

Language fMRI has been used to study brain regions involved in language processing and has been applied to pre-surgical language mapping. However, in order to provide clinicians with optimal information, the sensitivity and specificity of language fMRI needs to be improved. Type II error of failing to reach statistical significance when the language activations are genuinely present may be particularly relevant to pre-surgical planning, by falsely indicating low surgical risk in areas where no activations are shown. Furthermore, since the execution of language paradigms involves cognitive processes other than language function per se, the conventional general linear model (GLM) method may identify non-language-specific activations. In this study, we assessed an exploratory approach, independent component analysis (ICA), as a potential complementary method to the inferential GLM method in language mapping applications. We specifically investigated whether this approach might reduce type II error as well as generate more language-specific maps. Fourteen right-handed healthy subjects were studied with fMRI during two word generation tasks. A similarity analysis across tasks was proposed to select components of interest. Union analysis was performed on the language-specific components to increase sensitivity, and conjunction analysis was performed to identify language areas more likely to be essential. Compared with GLM, ICA identified more activated voxels in the putative language areas, and signals from other sources were isolated into different components. Encouraging results from one brain tumor patient are also presented. ICA may be used as a complementary tool to GLM in improving pre-surgical language mapping.

Detection of cortical laminar architecture using manganese-enhanced MRI

Changes in manganese-enhanced MRI (MEMRI) contrast across the rodent somatosensory cortex were compared to the cortical laminae as identified by tissue histology and administration of an anatomical tracer to cortex and thalamus. Across the cortical thickness, MEMRI signal intensity was low in layer I, increased in layer II, decreased in layer III until mid-layer IV, and increased again, peaking in layer V, before decreasing through layer VI. The reeler mouse mutant was used to confirm that the cortical alternation in MEMRI contrast was related to laminar architecture. Unlike in wild-type mice, the reeler cortex showed no appreciable changes in MEMRI signal, consistent with absence of cortical laminae in histological slides. The tract tracing ability of MEMRI was used to further confirm assignments and demonstrate laminar specificity. Twelve to 16 h after stereotaxic injections of MnCl(2) to the ventroposterior thalamic nuclei, an overall increase in signal intensity was detected in primary somatosensory cortex compared to other brain regions. Maximum intensity projection images revealed a distinctly bright stripe located 600-700 microm below the pial surface, in layer IV. The data show that both systemic and tract tracing forms of MEMRI are useful for studying laminar architecture in the brain.

Effects of generation mode in fMRI adaptations of semantic fluency: paced production and overt speech

Verbal fluency is a widely used neuropsychological paradigm. In fMRI implementations, conventional unpaced (self-paced) versions are suboptimal due to uncontrolled timing of responses, and overt responses carry the risk of motion artifact. We investigated the behavioral and neurofunctional effects of response pacing and overt speech in semantic category-driven word generation. Twelve right-handed adults (8 females), ages 21-37 were scanned in four conditions each: paced-overt, paced-covert, unpaced-overt, and unpaced-covert. There was no significant difference in the number of exemplars generated between overt versions of the paced and unpaced conditions. Imaging results for category-driven word generation overall showed left-hemispheric activation in inferior frontal cortex, premotor cortex, cingulate gyrus, thalamus, and basal ganglia. Direct comparison of generation modes revealed significantly greater activation for the paced compared to unpaced conditions in right superior temporal, bilateral middle frontal, and bilateral anterior cingulate cortex, including regions associated with sustained attention, motor planning, and response inhibition. Covert (compared to overt) conditions showed significantly greater effects in right parietal and anterior cingulate, as well as left middle temporal and superior frontal regions. We conclude that paced overt paradigms are useful adaptations of conventional semantic fluency in fMRI, given their superiority with regard to control over and monitoring of behavioral responses. However, response pacing is associated with additional non-linguistic effects related to response inhibition, motor preparation, and sustained attention.

The association of macro- and microstructure of the corpus callosum and language lateralisation

The present study aimed to examine how differences in functional lateralisation of language are related to interindividual variations in interhemispheric connectivity. Utilising an fMRI silent word-generation paradigm, 89 left- and right-handed subjects were subdivided into four lateralisation subgroups. Applying morphological and diffusion-tensor MRI, midsagittal cross-sectional area as well as quantitative measures of molecular diffusion (anisotropy, mean diffusion) of the corpus callosum were determined to assess interhemispheric connectivity. Statistical analyses revealed group differences in molecular diffusion but not in callosal size, which may be interpreted to reflect a stronger and/or faster interhemispheric connection in strongly left-lateralised subjects as compared to moderately left-lateralised, bilateral, or moderately right-lateralised subjects.

Cognitive impairment but preservation of sexual dimorphism in cognitive abilities in chronic schizophrenia

Neurocognitive impairment in schizophrenia is well established, though sex differences on cognitive tasks have produced equivocal findings. The present study was designed to examine performance of schizophrenia patients on a sexually dimorphic cognitive battery. The cognitive battery comprising tests of spatial (mental rotation, computerized version of the Benton Judgment of Line Orientation) and verbal abilities (phonological and semantic fluency) was administered to men (n = 22) and women (n = 21) with schizophrenia and healthy controls (n = 21 men and 21 women). A series of multivariate analyses showed that the patient group performed worse than controls on all the cognitive tasks. Cognitive sexual dimorphism on all spatial tasks favoring men and verbal tasks favoring women remained. Within the patient sample, correlational data demonstrated that earlier age at onset of illness related to poorer spatial performance. It is concluded that normal sexual dimorphism is undisturbed on both spatial and verbal tasks by the schizophrenia disease process.

Apraxia of speech: an overview

Apraxia of speech (AOS) is a motor speech disorder that can occur in the absence of aphasia or dysarthria. AOS has been the subject of some controversy since the disorder was first named and described by Darley and his Mayo Clinic colleagues in the 1960s. A recent revival of interest in AOS is due in part to the fact that it is often the first symptom of neurodegenerative diseases, such as primary progressive aphasia and corticobasal degeneration. This article will provide a brief review of terminology associated with AOS, its clinical hallmarks and neuroanatomical correlates. Current models of motor programming will also be addressed as they relate to AOS and finally, typical treatment strategies used in rehabilitating the articulation and prosody deficits associated with AOS will be summarized.

Comparable fMRI activity with differential behavioural performance on mental rotation and overt verbal fluency tasks in healthy men and women

To explicate the neural correlates of sex differences in visuospatial and verbal fluency tasks, we examined behavioural performance and blood-oxygenation-level-dependent (BOLD) regional brain activity, using functional magnetic resonance imaging, during a three-dimensional (3D) mental rotation task and a compressed sequence overt verbal fluency task in a group of healthy men (n=9) and women (n=10; tested during the low-oestrogen phase of the menstrual cycle). Men outperformed women on the mental rotation task, and women outperformed men on the verbal fluency task. For the mental rotation task, men and women activated areas in the right superior parietal lobe and the bilateral middle occipital gyrus in association with the rotation condition. In addition, men activated the left middle temporal gyrus and the right angular gyrus. For verbal fluency, men activated areas in the bilateral superior frontal gyrus, right cingulate gyrus, left precentral gyrus, left medial frontal gyrus, left inferior frontal gyrus, thalamus, left parahippocampal gyrus and bilateral lingual gyrus, and women activated areas in the bilateral inferior frontal gyrus and left caudate. Despite observing task related activation in the hypothesised areas in men and women, no areas significantly differentiated the two sexes. Our results demonstrate comparable brain activation in men and women in association with mental rotation and verbal fluency function with differential performance, and provide support for sex differences in brain-behaviour relationships.

Overt naming in aphasia studied with a functional MRI hemodynamic delay design

The purpose of this study was to develop a functional MRI method to examine overt speech in stroke patients with aphasia. An fMRI block design for overt picture naming was utilized which took advantage of the hemodynamic response delay where increased blood flow remains for 4-8 s after the task [(Friston, K.J., Jezzard, P., Turner, R., 1994. Analysis of functional MRI time-series. Hum. Brain Mapp. 1, 153-171)]. This allowed task-related information to be obtained after the task, minimizing motion artifact from overt speech (Eden, G.F., Joseph, J., Brown, H.E., Brown, C.P., Zeffiro, T.A., 1999. Utilizing hemodynamic delay and dispersion to detect fMRI signal change without auditory interference: the behavior interleaved gradients technique. Magn. Reson. Med. 41, 13-20; Birn, RM., Bandettini, P.A., Cox, R.W., Shaker, R., 1999. Event-related fMRI of tasks involving brief motion. Hum. Brain Mapp. 7, 106-114; Birn, R.M., Cox, R.W., Bandettini, P.A., 2004. Experimental designs and processing strategies for fMRI studies involving overt verbal responses. NeuroImage 23, 1046-1058). Five chronic aphasia patients participated (4 mild-moderate and 1 severe nonfluent/global). The four mild-moderate patients who correctly named 88-100% of the pictures during fMRI, had a greater number of suprathreshold voxels in L supplementary motor area (SMA) than R SMA (P < 0.07). Three of these four mild-moderate patients showed activation in R BA 45 and/or 44; along with L temporal and/or parietal regions. The severe patient, who named no pictures, activated almost twice as many voxels in R SMA than L SMA. He also showed activation in R BA 44, but had remarkably extensive L and R temporal activation. His poor naming and widespread temporal activation may reflect poor modulation of the bi-hemispheric neural network for naming. Results indicate that this fMRI block design utilizing hemodynamic response delay can be used to study overt naming in aphasia patients, including those with mild-moderate or severe aphasia. This method permitted verification that the patients were cooperating with the task during fMRI. It has application for future fMRI studies of overt speech in aphasia.

Covert speech arrest induced by rTMS over both motor and nonmotor left hemisphere frontal sites

Blocking the capacity to speak aloud (overt speech arrest, SA) may be induced by repetitive transcranial magnetic stimulation (rTMS). The possibility, however, of blocking internal speech (covert SA) has not been explored. To investigate this issue, we conducted two rTMS experiments. In the first experiment, we stimulated two left frontal lobe sites. The first was a motor site (left posterior site) and the second was a nonmotor site located in correspondence to the posterior part of the inferior frontal gyrus (IFG) (left anterior site). The corresponding right hemisphere nonmotor SA site was stimulated as a control. In the second experiment, we focused on the right hemisphere and stimulated a right hemisphere motor site (right posterior site), and, as control sites, a right hemisphere nonmotor site corresponding to the IFG (right anterior site) and a left hemisphere anteromedial site (left control). For both experiments, participants performed a syllable counting task both covertly and overtly for each stimulation site. Longer latencies in this task imply the occurrence of an overt and/or covert SA. All participants showed significantly longer latencies when stimulation was either over the left posterior or the left anterior site, as compared with the right hemisphere site (Experiment 1). This result was observed for the overt and covert speech task alike. During stimulation of the posterior right hemisphere site, a dissociation for overt and covert speech was observed. An overt SA was observed but there was no evidence for a covert SA (Experiment 2). Taken together, the results show that rTMS can induce a covert SA when applied to areas over the brain that are pertinent to language. Furthermore, both the left posterior/motor site and the left anterior/IFG site appear to be essential to language elaboration even when motor output is not required.

Functional magnetic resonance imaging studies of schizophrenic patients during word production: effects of D-cycloserine

The objective of the present study was to examine patterns of cortical activation underlying D-cycloserine's therapeutic efficacy in schizophrenic patients using functional magnetic resonance imaging (fMRI). We measured frontal and temporal lobe activation following a word fluency task in 12 subjects meeting DSM-IV criteria for schizophrenia at baseline and after 8 weeks of supervised treatment, using a double-blind, placebo-controlled design. Half of the patients received D-cycloserine (n = 6) as a supplement to their conventional neuroleptic treatment while the other half (n = 6) was augmented with placebo. Patients receiving D-cycloserine, but not placebo, demonstrated a significant increase in temporal lobe activation. This increased activation was significantly associated with a reduction in negative symptoms. These results suggest that the addition of D-cycloserine to conventional neuroleptics may improve negative symptoms through enhanced temporal lobe function.

Functional magnetic resonance imaging of verbal fluency and confrontation naming using compressed image acquisition to permit overt responses

Verbal fluency and confrontation naming, two tests of word retrieval, are of great utility in the field of cognitive neuroscience. However, in the context of functional magnetic resonance imaging (fMRI), movement artefact has necessitated the use of covert paradigms, which has limited clinical application. We developed two overt fMRI paradigms that allowed for performance measurement and hence were appropriate for use with patient groups. The paradigms incorporated a blocked-design and compressed-acquisition methodology where cues were presented and responses made in a "silent" period allowing for performance measurement. The slow response pace was specifically designed for older and potentially cognitively impaired participants. Verbal fluency was associated with activation in the middle frontal gyrus (Brodmann areas 46 and 9), anterior cingulate gyrus and inferior frontal gyrus (area 44 and 45). Confrontation naming activated areas of the temporo-occipital cortices (areas 18, 19, and 37) and the inferior frontal gyrus. The two paradigms successfully activated regions involved in executive and word retrieval processes and overcame the potential artefacts resulting from overt speech during image acquisition, providing useful neuropsychological tools to investigate cognitive deficits in clinical populations.

Linguistic theory and neuroimaging evidence: an fMRI study of Broca's area in lexical semantics

There has been a long debate on the functional characterization of left inferior frontal cortex, including proposals regarding syntactic and lexico-semantic involvement. We studied nine right-handed adults, using functional magnetic resonance imaging (fMRI) during performance on a semantic decision task in which subjects had to determine whether noun-verb pairs were semantically associated. In comparison with a visuoperceptual control task, activation clusters were seen in left inferior frontal and middle temporal regions, as well as the bilateral superior frontal gyrus. In agreement with previous studies, our findings suggest that Broca's area is involved in semantic processing. Findings of lexico-semantic as well as syntactic processing in the inferior frontal lobe may be accounted for in terms of working memory demands.

Magnetic resonance imaging at 3.0 Tesla: challenges and advantages in clinical neurological imaging

MR imaging at very high field (3.0 T) is a significant new clinical tool in the modern neuroradiological armamentarium. In this report, we summarize our 40-month experience in performing clinical neuroradiological examinations at 3.0 T and review the relevant technical issues. We report on these issues and, where appropriate, their solutions. Issues examined include: increased SNR, larger chemical shifts, additional problems associated with installation of these scanners, challenges in designing and obtaining appropriate clinical imaging coils, greater acoustic noise, increased power deposition, changes in relaxation rates and susceptibility effects, and issues surrounding the safety and compatibility of implanted devices. Some of the these technical factors are advantageous (eg, increased signal-to-noise ratio), some are detrimental (eg, installation, coil design and development, acoustic noise, power deposition, device compatibility, and safety), and a few have both benefits and disadvantages (eg, changes in relaxation, chemical shift, and susceptibility). Fortunately solutions have been developed or are currently under development, by us and by others, for nearly all of these challenges. A short series of 1.5 T and 3.0 T patient images are also presented to illustrate the potential diagnostic benefits of scanning at higher field strengths. In summary, by paying appropriate attention to the discussed technical issues, high-quality neuro-imaging of patients is possible at 3.0 T.

Developmental aspects of language processing: fMRI of verbal fluency in children and adults

We examined developmental differences, in location and extent of fMRI language activation maps, between adults and children while performing a semantic fluency task. We studied 29 adults and 16 children with echo planar imaging BOLD fMRI at 1.5 T using covert semantic verbal fluency (generation of words to categories compared to rest) using a block design. Post task testing was administered to assess performance. Individual data were analyzed with an a priori region of interest approach from t maps (t = 4) and asymmetry indices (AI). Group studies were analyzed using SPM 99 (Wellcome, UK; fixed effect, corrected P < 0.0001). We found no significant differences in location or laterality of activation between adults and children for a semantic verbal fluency task. Adults activated more pixels than children in left inferior frontal gyrus and left middle frontal gyrus, but AIs were the similar across ages (r(2) < 0.09). Extent or laterality of activation was not affected by performance (r(2) < 0.15). The brain areas that process semantic verbal fluency are similar in children and adults. The laterality of activation does not change appreciably with age and appears to be strongly lateralized by age 7 years.

Functional MRI of language: new approaches to understanding the cortical organization of semantic processing

Until recently, our understanding of how language is organized in the brain depended on analysis of behavioral deficits in patients with fortuitously placed lesions. The availability of functional magnetic resonance imaging (fMRI) for in vivo analysis of the normal brain has revolutionized the study of language. This review discusses three lines of fMRI research into how the semantic system is organized in the adult brain. These are (a) the role of the left inferior frontal lobe in semantic processing and dissociations from other frontal lobe language functions, (b) the organization of categories of objects and concepts in the temporal lobe, and (c) the role of the right hemisphere in comprehending contextual and figurative meaning. Together, these lines of research broaden our understanding of how the brain stores, retrieves, and makes sense of semantic information, and they challenge some commonly held notions of functional modularity in the language system.

Organization of language areas in bilingual patients: a cortical stimulation study

OBJECT

In an attempt to gain a better understanding of how multiple languages are represented in the human brain, the authors studied bilingual patients who underwent surgery for brain tumors, during which the authors mapped cortical language sites by using electrostimulation.

METHODS

Reading, counting, and word retrieval tasks were studied in 12 right-handed bilingual patients with no language deficit. All bilingual patients were native to France. One patient spoke four languages. The patients constituted a nonhomogeneous group in terms of language proficiency or age of acquisition. Languages were evaluated and classified into three major groups, depending on proficiency and date of acquisition. Strict conditions of language site validation were applied, separating typical anomia sites from speech arrest or other language sites (such as hesitation sites). A total of 30 speech arrest sites, 16 anomia sites, and three sites of language difficulties (not typically classified as speech arrest) were found throughout the 26 language studies performed. Strict overlapping of language areas (for all language tasks) was found in five patients, whereas the remaining seven had at least one area that was language-specific and sometimes task-specific. Specific areas for a particular language were found for word retrieval tasks (anomia) in eight sites (50%) but also in six (20%) of the reading or counting sites (speech arrest), either in frontal (three patients) or in temporoparietal (four patients) regions. Among the four early bilingual patients tested (languages acquired before the age of 7 years), three had language-specific cortical areas. Interestingly, six patients in this series who had a discrepancy between two languages did not have more cortical areas devoted to the less proficient language (with acknowledgment of the limit in cortical exposure available for testing by the craniotomy).

CONCLUSIONS

In this series, the authors found that bilingual patients could have common but also different cortical areas for both languages in temporoparietal areas and in frontal areas. In some cases, the authors found that language tasks such as counting, reading, or word retrieval in different languages can be sustained by language- and task-specific cortical areas. In bilingual patients, cortical mapping should ideally be performed using different language tasks in all languages in which the patient is fluent.

Late plasticity for language in a child's non-dominant hemisphere: a pre- and post-surgery fMRI study

The ability of the right hemisphere to sustain the acquisition or the recovery of language after extensive damage to the left hemisphere has been essentially related to the age at the time of injury. Better language abilities are acquired when the insult occurs in early childhood (perinatal insults) compared with later occurrence. However, while previous studies have described the neuropsychological pattern of language development in typical cases, the neural bases of such plasticity remain unexplored. Non-invasive functional MRI (fMRI) is a unique tool to assess the neural correlates of brain plasticity through repeated studies, but the technique has not been widely used in children because of methodological limitations. Plasticity of language was studied in a boy who developed intractable epilepsy related to Rasmussen's syndrome of the left hemisphere at age 5 years 6 months, after normal language acquisition. The first fMRI study at age 6 years 10 months showed left lateralization of language networks during a word fluency task. After left hemispherotomy at age 9 years, the child experienced profound aphasia and alexia, with rapid recovery of receptive language but slower and incomplete recovery of expressive language and reading. Postoperative fMRI at age 10 years 6 months showed a shift of language-related networks to the right during expressive and receptive tasks. Right activation was seen mainly in regions that could not be detected preoperatively, but mirrored those previously found in the left hemisphere (inferior frontal, temporal and parietal cortex), suggesting reorganization in a pre-existing bilateral network. In addition, neuropsychological data of this case support the hypothesis of innately more bilateral distribution of receptive than expressive language. This first serial fMRI study illustrates the great plasticity of the child's brain and the ability of the right hemisphere to take over some expressive language functions, even at a relatively late age. It also suggests a limit for removal of the dominant hemisphere beyond the age of 6 years, a classical limit for the critical period of language acquisition.

The neurobiological basis of reading

The results from studies using positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) in adults have largely revealed the involvement of left-hemisphere perisylvian areas in the reading process, including extrastriate visual cortex, inferior parietal regions, superior temporal gyrus, and inferior frontal cortex. Although the recruitment of these regions varies with the particular reading-related task, general networks of regions seem to be uniquely associated with different components of the reading process. For example, visual word form processing is associated with occipital and occipitotemporal sites, whereas reading-relevant phonological processing has been associated with superior temporal, occipitotemporal and inferior frontal sites of the left hemisphere. Such findings are evaluated in light of the technical and experimental limitations encountered in functional brain imaging studies, and the implications for pediatric studies are discussed.

Word fluency in relation to severity of closed head injury, associated frontal brain lesions, and age at injury in children

Effects of closed head injury (CHI) severity, focal brain lesions, and age at injury on word fluency (WF) were studied longitudinally in 122 children (78 severe, 44 mild); 112 CHI patients (68 severe, 44 mild CHI) and 104 uninjured normal controls participated in a cross-sectional study. WF was measured by asking the child to generate as many words as possible beginning with a designated letter within 60 s, repeated for three letters. Intellectual ability, receptive vocabulary, narrative discourse, and word list recall were also measured. Results of the cross-sectional study showed a significant group effect with poorer WF in severe CHI than mild CHI and control groups. Growth curve analysis of longitudinal data revealed an interaction of age, follow-up interval, and CHI severity as WF recovery was slower after severe CHI in younger children as compared to severe CHI in older children or mild CHI in younger children. An interaction of left frontal lesion with age and interval indicated a more adverse effect on WF in older children. Right frontal lesion effect was nonsignificant and did not interact with age. Correlations of WF with receptive vocabulary, word list recall, and narrative discourse were moderate and weak with estimated intellectual ability. Differences in focal lesion effects after traumatic versus nontraumatic brain injury in children, the contribution of diffuse white matter injury, reduced opportunity for language development, and functional commitment of left frontal region at time of CHI were discussed.

The anatomy of auditory word processing: individual variability

This study used functional magnetic resonance imaging (fMRI) to investigate the neural substrate underlying the processing of single words, comparing activation patterns across subjects and within individuals. In a word repetition task, subjects repeated single words aloud with instructions not to move their jaws. In a control condition involving reverse speech, subjects heard a digitally reversed speech token and said aloud the word "crime." The averaged fMRI results showed activation in the left posterior temporal and inferior frontal regions and in the supplementary motor area, similar to previous PET studies. However, the individual subject data revealed variability in the location of the temporal and frontal activation. Although these results support previous imaging studies, demonstrating an averaged localization of auditory word processing in the posterior superior temporal gyrus (STG), they are more consistent with traditional neuropsychological data, which suggest both a typical posterior STG localization and substantial individual variability. By using careful head restraint and movement analysis and correction methods, the present study further demonstrates the feasibility of using overt articulation in fMRI experiments.

Combined analysis of language tasks in fMRI improves assessment of hemispheric dominance for language functions in individual subjects

Recent advances in functional neuroimaging techniques have prompted an increase in the number of studies investigating lateralization of language functions. One of the problems in relating findings of various studies to one another is the diversity of reported results. This may be due to differences in the tasks that are used to stimulate language processing regions and in the control tasks, as well as differences in the way imaging data are analyzed,in particular the threshold for significance of signal change. We present a simple method to assess language lateralization that allows for some variation of tasks and statistical thresholding, but at the same time yields reliable and reproducible results. Images acquired during a set of word-comprehension and -production tasks are analyzed conjointly. As opposed to the use of any one particular task, this combined task analysis (CTA) approach is geared toward identifying language regions that are involved in generic language functions rather than regions that are involved in functions that are specific to a single task. In two experiments CTA is compared to single-task analysis in healthy right-handed males. In a third experiment left-handed males were examined. Results indicate that CTA: (1) improves detection of language-related brain activity in individual subjects and (2) yields a high language laterality index (LI) in right-handed males with a small variance across subjects. The high LI matches the strong left-hemisphere dominance for language that is typical for these subjects as reported in neuropsychological and clinical tests in other studies. In the left-handed subjects dominance was found either in the left (n = 4) or the right (n = 1) hemisphere or was absent (n = 3). The LI derived from CTA is more consistent across statistical thresholds for significance of signal change in fMRI analysis than in individual-task analysis. Also, the CTA results are very similar to those obtained with conjunction analysis of the same data.

Interhemispheric transfer of language in patients with left frontal cerebral arteriovenous malformation

Cerebral arteriovenous malformations (AVMs) are frequently evaluated before therapeutic embolization by superselective injection of anesthetics into individual arterial branches so as to determine whether permanent occlusion would affect eloquent function. In Experiment 1, we used this adaptation of the Wada procedure to study three right-handed adult patients with left frontal cerebral AVMs by injecting vessels in Wernicke's and Broca's areas, respectively, and assessing language functions. The results showed that superselective testing in the inferior division of the left MCA in all three patients produced a dense Wernicke's aphasia. Injections into the left frontal regions, however, resulted in right paresis in all patients, but no language deficits including no loss of fluency. In Experiment 2, Patient 2 underwent fMRI activation for spontaneous word-list generation using multi-slice echo planar BOLD techniques at 1.5 Tesla. A voxel-by-voxel comparison of rest vs activation for each task was performed with a Z-score threshold of 2.5 SD for activated voxels. There was activation in the right hemisphere in the insula, frontal operculum pars opercularis, and inferior frontal gyrus, an area homologous to Broca's area in the left hemisphere. There was also activation in the left hemisphere in the Rolandic region, but language function was unaffected during Wada testing in this area. These data suggested that features of expressive language were no longer controlled by the left frontal lobe where the AVM was located, and provided new evidence for interhemispheric re-organization under conditions of chronic neurovascular disease.

Effects of aging on language-activated cerebral blood oxygenation changes of the left prefrontal cortex: Near infrared spectroscopy study

The use of positron-emission tomography (PET) has shown a variety of age-related alterations in neuronal activity in elderly patients. Near infrared spectroscopy (NIRS) has shown a multiplicity of evoked cerebral blood oxygenation (CBO) changes during cognitive performance. To evaluate the effects of aging on the CBO changes, we compared the CBO changes induced by cognitive tasks between young adults and older adults by using NIRS. Twenty-six participants performed 6 cognitive tasks to evaluate differences among young adults (mean age+/-SD, 28.8+/-4.4 years) and older adults (50.7+/-8.0 years). We monitored CBO changes in the left prefrontal cortex. We classified several common patterns of the NIRS parameter change and compared the frequency of each pattern in both groups. In both groups, the most common NIRS parameter change was an increase in oxyhemoglobin (Oxy-Hb) and total-hemoglobin (Total-Hb), with a decrease in deoxyhemoglobin (Deoxy-Hb). The frequency of this pattern in the older group, however, was considerably lower than in the young group (P<.01). In addition, decreases of Oxy-Hb and Total-Hb during the tasks were more common in the older groups, (P<.0001), suggesting a decrease of regional cerebral blood flow during the tasks. Age effects varied for specific tasks, with results being significant for verbal fluency and reading, (P<.05). During all tasks, older subjects were less likely than younger subjects to have the typical pattern of increases in Oxy-Hb and Total-Hb. In addition, compared with younger subjects, older subjects had a greater frequency of decreases in Oxy-Hb and Total-Hb. The overall results, as well as results for specific tasks, suggest that functional reorganization or alteration of CBO responses may occur during aging.

Form and content: dissociating syntax and semantics in sentence comprehension

The distinction between syntax (sentence form) and semantics (sentence meaning) is fundamental to our thinking about language. Whether and where this distinction is represented at the neural level is still a matter of considerable debate. In the present fMRI study, we examined the neural correlates of syntactic and semantic functions using an innovative activation paradigm specifically designed to unequivocally disentangle syntactic from lexicosemantic aspects of sentence processing. Our findings strongly indicate that a part of Broca's area (BA 44, pars opercularis) is critically implicated in processing syntactic information, whereas the lower portion of the left inferior frontal gyrus (BA 47, pars orbitalis) is selectively involved in processing the semantic aspects of a sentence.

Differential effects of overt, covert and replayed speech on vowel-evoked responses of the human auditory cortex

Recent magnetoencephalographic studies showed that speaking dampens voice-evoked activity in the human auditory cortex. To further characterize this audio-vocal interaction, neuromagnetic responses to short tape-recorded probe vowels were measured while subjects were vocalizing long (8 s) 'background' vowels either aloud or silently, or while both probe and background vowels were replayed from tape. Auditory cortex responses peaking at 100 ms (M100) were delayed and dampened bilaterally relative to a background-free control during both overtly spoken and replayed long vowels, identifying auditory interference as the main cause for these modifications. During covert speech M100 peaked later for matching than non-matching probe/background vowels in the speech-dominant left hemisphere. Thus, voiceless 'inner' speaking is sufficient to modify utterance-specific processing in the human auditory cortex.

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.

The role of image-guided technology in the surgical planning and resection of gliomas

Today's image-guided techniques provide the surgeon with new tools to plan and execute surgery on gliomas. When coupled with good judgment, they can extend what is safely operable and may maximize the extent of surgical resection. Intraoperative imaging such as ultrasonography or MRI may expand the utility of these systems in the foreseeable future.

Functional magnetic resonance imaging study of frontal lobe activation during word generation in obsessive-compulsive disorder

BACKGROUND

Functional imaging studies have demonstrated abnormal patterns of brain activity in obsessive-compulsive disorder, which consistently suggest the alteration of frontal lobe functioning. We performed a brain activation study in obsessive-compulsive disorder using a cognitive task involving the frontal lobes.

METHODS

Twenty patients and 20 healthy control subjects were assessed with functional magnetic resonance imaging during a phonologically guided word generation task. The study analysis was based on the comparison of group average time-course functional changes occurring at the site of largest frontal cortex activation during alternating rest and task periods.

RESULTS

In terms of relative signal changes, patients showed a significantly greater activation during word generation and a defective suppression of this activation during the following rest period. Both abnormal imaging findings significantly correlated with the severity of the clinical process assessed by the Yale-Brown Obsessive-Compulsive Scale.

CONCLUSIONS

The results indicate that functional magnetic resonance imaging during cognitive challenge may be useful to reveal distinctive features of latent brain dysfunction in obsessive-compulsive disorder.