title: Language lateralization in epilepsy patients: fMRI validated with the Wada procedure.
abstract: OBJECTIVE
  This work examines the efficacy of functional magnetic resonance imaging (fMRI) for language lateralization using a comprehensive three-task language-mapping approach. Two localization methods and four different metrics for quantifying activation within hemisphere are compared and validated with Wada testing. Sources of discordance between fMRI and Wada lateralization are discussed with respect to specific patient examples.
  
  
  METHODS
  fMRI language mapping was performed in patients with epilepsy (N = 40) using reading sentence comprehension, auditory sentence comprehension, and a verbal fluency task. This was compared with the Wada procedure using both whole-brain and midline exclusion-based analyses. Different laterality scores were examined as a function of statistical threshold to investigate the sensitivity to threshold effects.
  
  
  RESULTS
  For the lateralized patients categorized by Wada, fMRI laterality indices (LIs) were concordant with the Wada procedure results in 83.87% patients for the reading task, 83.33% patients for the auditory task, 76.92% patients for the verbal fluency task, and in 91.3% patients for the conjunction analysis. The patients categorized as bilateral via the Wada procedure showed some hemispheric dominance in fMRI, and discrepancies between the Wada test findings and the functional laterality scores arose for a range of reasons.
  
  
  CONCLUSIONS
  Discordance was dependent upon whether whole-brain or midline exclusion method-based lateralization was calculated, and in the former case the inclusion of the occipital and other midline regions often negatively influenced the lateralization scores. Overall fMRI was in agreement with the Wada test in 91.3% of patients, suggesting its utility for clinical use with the proper consideration given to the confounds discussed in this work.
authors.affiliation: Department of Diagnostic Radiology, Yale University, New Haven, Connecticut 06520, USA. jagriti.arora@yale.edu
authors.forename: Jagriti
authors.initials: J
authors.lastname: Arora
authors.forename: Kenneth
authors.initials: K
authors.lastname: Pugh
authors.forename: Michael
authors.initials: M
authors.lastname: Westerveld
authors.forename: Susan
authors.initials: S
authors.lastname: Spencer
authors.forename: Dennis D
authors.initials: DD
authors.lastname: Spencer
authors.forename: R
authors.initials: R
authors.lastname: Todd Constable
mesh_terms: D000293:Adolescent; D000328:Adult; D000654:Amobarbital / Q000008:administration & dosage / Q000494:pharmacology; D001921:Brain / Q000503:physiopathology*; D001931:Brain Mapping / Q000379:methods; D004569:Electroencephalography; D004827:Epilepsy / Q000175:diagnosis / Q000503:physiopathology*; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D007802:Language; D007807:Language Tests; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011597:Psychomotor Performance / Q000187:drug effects / Q000502:physiology; D014705:Verbal Behavior / Q000187:drug effects / Q000502:physiology
chemical_list: D000654:Amobarbital