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The utility of preoperative fMRI for identifying language cortices in patients with vascular malformations
Source: Journal of Neurosurgery 2002 Jul;97(1):21-32.
Author: Pouratian N, Bookheimer SY, Rex D, Martin NA, Toga AW.
PubMed ID: 12134916
Abstract:
We evaluated the utility of preoperative functional magnetic resonance imaging (fMRI) for predicting essential language sites as determined by electrocortical stimulation mapping (ESM). We specifically studied patients with vascular malformations (AVMs and cavernous angiomas) who do not have normal blood flow patterns and in whom perfusion-dependent mapping signal may be questionable. 10 subjects were studied (7 AVM, 3 cavernous angioma). We used a battery of linguistic tasks, including visual object naming, word generation, auditory responsive naming, visual responsive naming, and sentence comprehension, in order to identify brain regions that were consistently activated across expression and comprehension linguistic tasks. In comparing ESM and fMRI activations, we varied the matching criteria (overlapping activations, adjacent activations, and deep activations) and the radii of influence of ESM (2.5mm, 5.0mm, 10.0 mm) in order to determine the effect of these factors on the sensitivity/specificity of fMRI. The sensitivity/specificity of fMRI was task, lobe, and matching criterion dependent. For the population studied, we found sensitivity/specificity of fMRI activations during expressive linguistic tasks of up to 100%/66.7% in the frontal lobe and during comprehension linguistic tasks up to 96.2%/69.8% in the parietal/temporal lobes. The sensitivity/specificity of the each disease population (AVM and cavernous angiomas) and of individuals were consistent with those values reported for the entire population studied. We conclude that preoperative fMRI is a highly sensitive preoperative planning tool for identifying essential language sites and for presurgical planning in patients with vascular malformations.
Source: Journal of Neurosurgery 2002 Jul;97(1):21-32.
Author: Pouratian N, Bookheimer SY, Rex D, Martin NA, Toga AW.
PubMed ID: 12134916
Abstract:
We evaluated the utility of preoperative functional magnetic resonance imaging (fMRI) for predicting essential language sites as determined by electrocortical stimulation mapping (ESM). We specifically studied patients with vascular malformations (AVMs and cavernous angiomas) who do not have normal blood flow patterns and in whom perfusion-dependent mapping signal may be questionable. 10 subjects were studied (7 AVM, 3 cavernous angioma). We used a battery of linguistic tasks, including visual object naming, word generation, auditory responsive naming, visual responsive naming, and sentence comprehension, in order to identify brain regions that were consistently activated across expression and comprehension linguistic tasks. In comparing ESM and fMRI activations, we varied the matching criteria (overlapping activations, adjacent activations, and deep activations) and the radii of influence of ESM (2.5mm, 5.0mm, 10.0 mm) in order to determine the effect of these factors on the sensitivity/specificity of fMRI. The sensitivity/specificity of fMRI was task, lobe, and matching criterion dependent. For the population studied, we found sensitivity/specificity of fMRI activations during expressive linguistic tasks of up to 100%/66.7% in the frontal lobe and during comprehension linguistic tasks up to 96.2%/69.8% in the parietal/temporal lobes. The sensitivity/specificity of the each disease population (AVM and cavernous angiomas) and of individuals were consistent with those values reported for the entire population studied. We conclude that preoperative fMRI is a highly sensitive preoperative planning tool for identifying essential language sites and for presurgical planning in patients with vascular malformations.