title: Crossed cerebrocerebellar language lateralization: an additional diagnostic feature for assessing atypical language representation in presurgical functional MR imaging.
abstract: OBJECTIVE
  Determining language dominance with fMRI is challenging in patients with brain tumor, particularly in cases of suspected atypical language representation. Supratentorial activation patterns must be interpreted with great care when the tumor is in or near the presumed language areas, where tumor tissue or mass effect can lead to false-negative fMRI results. In this study, we assessed cerebrocerebellar language fMRI lateralization in healthy participants and in patients with brain tumors with a focus on atypical language representation.
  
  
  METHODS
  Twenty healthy participants and 38 patients with a brain tumor underwent fMRI with a verb-generation task. Cerebral and cerebellar language lateralizations were separately classified as left-sided, right-sided, or symmetric. Electrocortical stimulation was performed in 19 patients. With the McNemar test, we evaluated the dependency between language lateralization in the cerebrum and cerebellum, and with Pearson correlation analysis, the relationship between the cerebral and cerebellar lateralization indices.
  
  
  RESULTS
  There was a significant dependency between cerebral and cerebellar language activation, with moderate negative correlation (Pearson r = -0.69). Crossed cerebrocerebellar language activation was present in both healthy participants and patients, irrespective of handedness or typical or atypical language representation. There were no discordant findings between fMRI and electrocortical stimulation.
  
  
  CONCLUSIONS
  Language lateralization in the cerebellum can be considered an additional diagnostic feature to determine language dominance in patients with brain tumor. This is particularly useful in cases of uncertainty, such as the interference of a brain tumor with cerebral language activation on fMRI and atypical language representation.
authors.affiliation: From the Departments of Radiology (C.M.O., M.V., S.K., A.v.d.L., M.S.) Neurology (C.M.O., E.V.-B).
authors.forename: C
authors.initials: C
authors.lastname: Méndez Orellana
authors.affiliation: Neurology (C.M.O., E.V.-B) Neurosurgery (E.V.-B., D.S., A.V.), Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: Visch-Brink
authors.affiliation: From the Departments of Radiology (C.M.O., M.V., S.K., A.v.d.L., M.S.).
authors.forename: M
authors.initials: M
authors.lastname: Vernooij
authors.affiliation: From the Departments of Radiology (C.M.O., M.V., S.K., A.v.d.L., M.S.).
authors.forename: S
authors.initials: S
authors.lastname: Kalloe
authors.affiliation: Neurosurgery (E.V.-B., D.S., A.V.), Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
authors.forename: D
authors.initials: D
authors.lastname: Satoer
authors.affiliation: Neurosurgery (E.V.-B., D.S., A.V.), Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Vincent
authors.affiliation: From the Departments of Radiology (C.M.O., M.V., S.K., A.v.d.L., M.S.).
authors.forename: A
authors.initials: A
authors.lastname: van der Lugt
authors.affiliation: From the Departments of Radiology (C.M.O., M.V., S.K., A.v.d.L., M.S.) marion.smits@erasmusmc.nl.
authors.forename: M
authors.initials: M
authors.lastname: Smits
mesh_terms: D000328:Adult; D000368:Aged; D001931:Brain Mapping / Q000379:methods*; D001932:Brain Neoplasms / Q000503:physiopathology*; D002531:Cerebellum / Q000503:physiopathology*; D004292:Dominance, Cerebral / Q000502:physiology*; D005260:Female; D006801:Humans; D007802:Language; D007807:Language Tests; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged