Rationale and Objectives
The aim of this study was to assess the intrasubject and intersubject reproducibility of functional magnetic resonance imaging (fMRI) language paradigms on language localization and lateralization.
Materials and Methods
Fourteen healthy volunteers were enrolled prospectively and underwent language fMRI using visually triggered covert and overt sentence generation (SG) and word generation (WG) paradigms. Semiautomated analysis of all functional data was performed using Brain Voyager on an individual basis. Regions of interest for Broca’s area, Wernicke’s area, and their contralateral homologues were drawn. The Euclidean coordinates of the center of gravidity ( x , y , and z ) of the respective blood oxygenation level–dependent (BOLD) activation cluster, and the correlation of the measured hemodynamic response to the applied reference function ( r ), relative BOLD signal change as BOLD signal characteristics were measured in each region of interest. Regional lateralization indexes were calculated for Broca’s area, Wernicke’s area, and their contralateral homologues separately. Wilcoxon’s signed-rank test was applied for statistical comparisons ( P values < .05 were considered significant). Ten of the 14 volunteers had three repeated measurements to test intrasession reproducibility and intersession reproducibility.
Results
Overall activation rates for the four paradigms were 89% for covert SG, 82% for overt SG, 89% for covert WG, and 100% for overt WG. When comparing covert and overt paradigms, language localization was significantly different in 17% (Euclidean coordinates) and 19% (BOLD signal characteristics), respectively. Language lateralization was significantly different in 75%. Intrasubject and intersubject reproducibility was excellent, with 3.3% significant differences among all five parameters for language localization and 0% significant differences for language lateralization using covert paradigms.
Conclusions
Covert language paradigms (SG and WG) provided highly robust and reproducible localization and lateralization of essential language centers for scans performed on the same and different days. Their overt counterparts achieved confirmatory localization but lower lateralization capabilities. Reference data for presurgical application are provided.
The localization and lateralization of essential brain language areas are crucial in the presurgical assessment of patients harboring brain tumors and epilepsy . Noninvasive functional magnetic resonance imaging (fMRI) provides this information prior to treatment and therefore supports the selection of candidates for surgery as well as the planning and performance of function-preserving treatment . fMRI has proven validity for this application but is not standardized yet.
The goal of this study was to investigate the effects of overt paradigms in clinical standardized fMRI compared to covert paradigms in terms of language lateralization and localization. The reproducibility of clinical language fMRI for different measurements performed during the same scanning session and on different days was assessed. Robust reference data are provided for the sentence generation (SG) and word generation (WG) paradigms conducted in a covert as well as an overt manner.
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Materials and methods
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Table 1
Set of Visual Triggers for SG and WG Paradigms
Trigger Defined Sentence (SG) or Instance (WG) Picture (SG) Ashtray Smoking is not healthy. Bodybuilder The bodybuilder is strong. Clown The clown is funny. Sundae The sundae is sweet. Elephant The elephant is heavy. Red racing car The car is fast. Fire The fire is hot. Lion The lion is dangerous. Model The model is beautiful. Pair of scissors The scissors are sharp edged. Lemon The lemon is sour. Snail The snail creeps slowly. Generic term or category (WG) Cars Ford, Porsche, Mercedes Occupations Physician, nurse, engineer Flowers Pink, tulip, rose Colors Green, red, blue Vegetables Tomato, artichoke, potato Countries United States, Switzerland, Canada Months January, December, August Names John, Kate, Cathrin Fruits Apple, banana, apricot Politicians Roosevelt, Jefferson, Thatcher Cities New York, Chicago, Berlin Animals Dog, cat, bee
SG, sentence generation; WG, word generation.
The same sets of triggers were used for covert and overt speech, modified from Stippich et al .
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Results
Comparison of Covert and Overt Paradigms
Data basis
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Activation rates
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Statistical comparisons
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Table 2
Language Localization and Lateralization of B and W Using Covert and Overt Paradigms
ROI Paradigm_n_ ∗ x__y__z__r dS% LI B SG cov 13 −47.69 ± 6.85 12.62 ± 9.70 10.00 ± 10.31 0.70 ± 0.11 2.14 ± 1.74 0.65 ± 0.44 SG ov 11 −41.09 ± 12.14 11.36 ± 8.88 13.82 ± 8.91 0.69 ± 0.10 1.71 ± 1.16 0.24 ± 0.81 WG cov 13 −45.69 ± 7.15 14.46 ± 8.69 16.31 ± 13.83 0.77 ± 0.10 1.63 ± 0.67 0.83 ± 0.37 WG ov 14 −44.36 ± 8.92 15.57 ± 8.54 17.00 ± 7.72 0.71 ± 0.11 1.84 ± 0.70 0.66 ± 0.37 W SG cov 12 −56.50 ± 5.42 −39.75 ± 7.33 15.00 ± 12.88 0.73 ± 0.11 1.72 ± 0.88 0.65 ± 0.72 SG ov 12 −56.17 ± 5.25 −34.58 ± 9.06 8.25 ± 10.14 0.64 ± 0.11 1.70 ± 0.91 −0.06 ± 0.76 WG cov 12 −53.42 ± 6.91 −41.42 ± 7.27 19.75 ± 9.30 0.72 ± 0.12 1.47 ± 0.76 0.58 ± 0.55 WG ov 14 −56.00 ± 7.39 −35.43 ± 9.80 11.14 ± 9.91 0.74 ± 0.10 2.18 ± 1.34 0.06 ± 0.65 BR SG cov 12 45.00 ± 9.21 18.00 ± 10.60 13.17 ± 11.61 0.61 ± 0.11 1.37 ± 1.36 SG ov 11 48.91 ± 11.17 11.09 ± 10.20 11.55 ± 10.66 0.63 ± 0.08 2.04 ± 1.70 WG cov 12 46.33 ± 8.18 14.50 ± 9.10 11.25 ± 10.58 0.63 ± 0.11 1.54 ± 1.34 WG ov 14 47.93 ± 6.96 9.86 ± 7.91 11.36 ± 10.16 0.66 ± 0.11 1.59 ± 0.75 WR SG cov 10 58.10 ± 7.62 −27.70 ± 10.51 15.90 ± 18.27 0.58 ± 0.10 1.44 ± 0.91 SG ov 13 53.08 ± 6.64 −26.69 ± 6.26 4.31 ± 10.77 0.66 ± 0.09 1.37 ± 0.41 WG cov 13 54.46 ± 5.94 −29.31 ± 15.06 7.15 ± 11.44 0.62 ± 0.10 1.17 ± 0.75 WG ov 13 48.15 ± 27.36 −25.54 ± 7.15 6.85 ± 8.69 0.75 ± 0.07 1.89 ± 0.59
B, Broca’s area; BR, right-hemisphere homologue of Broca’s area; dS%, relative blood oxygenation level–dependent signal change; LI, lateralization index; ROI, region of interest; SG cov , covert sentence generation; SG ov , overt sentence generation; W, Wernicke’s area; WG cov , covert word generation; WG ov , overt word generation; WR, right-hemisphere homologue of Wernicke’s area.
Data are expressed as mean ± standard deviation.
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Reproducibility of Language Localization, Lateralization and BOLD Signals
Data basis
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Activation rates
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Statistical comparisons
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Discussion
Comparison of Covert and Overt SG and WG
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Reproducibility of Language Localization, Lateralization and BOLD Signal Characteristics
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Study Limitations
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Conclusions
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