title: Clinical standardized fMRI reveals altered language lateralization in patients with brain tumor.
abstract: OBJECTIVE
  Brain tumors affecting language-relevant areas may influence language lateralization. The purpose of this study was to systematically investigate language lateralization in brain tumor patients using clinical language fMRI, comparing the results with a group of healthy volunteers.
  
  
  METHODS
  Fifty-seven strictly right-handed patients with left-hemispheric-space intracranial masses (mainly neoplastic) affecting either the Broca area (n = 19) or Wernicke area (n = 38) were prospectively enrolled in this study. Fourteen healthy volunteers served as a control group. Standardized clinical language fMRI, using visually triggered sentence- and word-generation paradigms, was performed on a 1.5T MR scanner. Semiautomated analyses of all functional data were conducted on an individual basis using BrainVoyager. A regional lateralization index was calculated for Broca and Wernicke areas separately versus their corresponding right-hemisphere homologs.
  
  
  RESULTS
  In masses affecting the Broca area, a significant decrease in the lateralization index was found when performing word generation (P = .0017), whereas when applying sentence generation, the decrease did not reach statistical significance (P = .851). Masses affecting the Wernicke area induced a significant decrease of the lateralization index when performing sentence generation (P = .0007), whereas when applying word generation, the decrease was not statistically significant (P = .310).
  
  
  CONCLUSIONS
  Clinical language fMRI was feasible for patients with brain tumors and provided relevant presurgical information by localizing essential language areas and determining language dominance. A significant effect of the brain masses on language lateralization was observed, with a shift toward the contralesional, nondominant hemisphere. This may reflect compensatory mechanisms of the brain to maintain communicative abilities.
authors.affiliation: Department of Neuroradiology, University Hospital of Basel, Basel, Switzerland. sasanp@gmx.de
authors.forename: S
authors.initials: S
authors.lastname: Partovi
authors.forename: B
authors.initials: B
authors.lastname: Jacobi
authors.forename: N
authors.initials: N
authors.lastname: Rapps
authors.forename: L
authors.initials: L
authors.lastname: Zipp
authors.forename: S
authors.initials: S
authors.lastname: Karimi
authors.forename: F
authors.initials: F
authors.lastname: Rengier
authors.forename: J K
authors.initials: JK
authors.lastname: Lyo
authors.forename: C
authors.initials: C
authors.lastname: Stippich
mesh_terms: D000328:Adult; D001921:Brain / Q000473:pathology / Q000503:physiopathology*; D001931:Brain Mapping / Q000379:methods* / Q000592:standards; D001932:Brain Neoplasms / Q000473:pathology / Q000503:physiopathology*; D005260:Female; D007839:Functional Laterality; D006801:Humans; D007802:Language; D008279:Magnetic Resonance Imaging / Q000379:methods* / Q000592:standards; D008297:Male; D009415:Nerve Net / Q000503:physiopathology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity