Localizing and lateralizing language in patients with brain tumors: feasibility of routine preoperative functional MR imaging in 81 consecutive patients.
OBJECTIVE
To prospectively assess the feasibility of standardized presurgical functional magnetic resonance (MR) imaging for localizing the Broca and Wernicke areas and for lateralizing language function.


METHODS
The study was approved by the responsible ethics commission, and patients gave written informed consent. Eighty-one patients (36 female and 45 male patients; age range, 7-75 years) with different brain tumors underwent blood oxygen level-dependent functional MR imaging at 1.5 T with two paradigms: sentence generation (SG) and word generation (WG). Functional MR imaging measurements, data processing, and evaluation were fully standardized by using dedicated software. Four regions of interest were evaluated in each patient: the Broca and Wernicke areas and their anatomic homologues in the right hemisphere. Statistics were calculated.


RESULTS
The SG and WG paradigms were successfully completed by all (100%) and 70 (86%) patients, respectively. Success rates in localizing and lateralizing language were 96% for the Broca and Wernicke areas with the SG paradigm, 81% for the Broca area and 80% for the Wernicke area with the WG paradigm, and 98% for both areas when the SG and WG paradigms were used in combination. Functional localizations were consistent for SG and WG paradigms in the inferior frontal gyrus (Broca area) and the superior temporal, supramarginal, and angular gyri (Wernicke area). Surgery was not performed in seven patients (9%) and was modified in two patients (2%) because of functional MR imaging findings.


CONCLUSIONS
Functional MR imaging proved to be feasible during routine diagnostic neuroimaging for localizing and lateralizing language function preoperatively.
Stippich
Christoph
C
Division of Neuroradiology, Department of Neurology, University of Heidelberg Medical School, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany. christoph_stippich@med.uni-heidelberg.de
Rapps
Nora
N
Dreyhaupt
Jens
J
Durst
Anita
A
Kress
Bodo
B
Nennig
Ernst
E
Tronnier
Volker M
VM
Sartor
Klaus
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D001931:Brain Mapping / Q000379:methods; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D002648:Child; D005240:Feasibility Studies; D005260:Female; D007839:Functional Laterality; D006801:Humans; D007806:Language Disorders / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis