Pseudo-reorganization of language cortical function at fMR imaging: a consequence of tumor-induced neurovascular uncoupling.
A left-handed patient with a grade II left frontal lobe astrocytoma had spontaneous seizures causing speech arrest and uncontrolled right upper extremity movements. Word-generation functional MR (fMR) imaging showed activity nearly exclusively in the right inferior frontal gyrus. The clinical history of the speech arrest and the intraoperative mapping proved left-hemisphere language dominance. Tumor involvement of the left inferior frontal gyrus caused uncoupling of the blood oxygenation level-dependent (BOLD) and neuronal response, leading to the erroneous fMR imaging appearance of right-hemisphere language dominance. Discrepancies between BOLD and intraoperative mapping in areas near lesions illustrate the complementary nature of these techniques.
Ulmer
John L
JL
Department of Radiology, Division of Neuroradiology, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI 53226, USA.
Krouwer
Hendrikus G
HG
Mueller
Wade M
WM
Ugurel
M Sahin
MS
Kocak
Mehmet
M
Mark
Leighton P
LP
D000328:Adult; D001039:Aphasia, Broca / Q000175:diagnosis / Q000503:physiopathology*; D001254:Astrocytoma / Q000098:blood supply / Q000175:diagnosis / Q000503:physiopathology*; D001931:Brain Mapping; D001932:Brain Neoplasms / Q000098:blood supply / Q000175:diagnosis / Q000503:physiopathology*; D003937:Diagnosis, Differential; D004292:Dominance, Cerebral / Q000502:physiology*; D017352:Echo-Planar Imaging; D005625:Frontal Lobe / Q000098:blood supply / Q000503:physiopathology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008297:Male; D009416:Nerve Regeneration / Q000502:physiology*; D009473:Neuronal Plasticity / Q000502:physiology*; D009474:Neurons / Q000502:physiology; D010101:Oxygen Consumption / Q000502:physiology; D012039:Regional Blood Flow / Q000502:physiology*; D012680:Sensitivity and Specificity