title: Passive fMRI mapping of language function for pediatric epilepsy surgical planning: validation using Wada, ECS, and FMAER.
abstract: In this study we validate passive language fMRI protocols designed for clinical application in pediatric epilepsy surgical planning as they do not require overt participation from patients. We introduced a set of quality checks that assess reliability of noninvasive fMRI mappings utilized for clinical purposes. We initially compared two fMRI language mapping paradigms, one active in nature (requiring participation from the patient) and the other passive in nature (requiring no participation from the patient). Group-level analysis in a healthy control cohort demonstrated similar activation of the putative language centers of the brain in the inferior frontal (IFG) and temporoparietal (TPG) regions. Additionally, we showed that passive language fMRI produced more left-lateralized activation in TPG (LI=+0.45) compared to the active task; with similarly robust left-lateralized IFG (LI=+0.24) activations using the passive task. We validated our recommended fMRI mapping protocols in a cohort of 15 pediatric epilepsy patients by direct comparison against the invasive clinical gold-standards. We found that language-specific TPG activation by fMRI agreed to within 9.2mm to subdural localizations by invasive functional mapping in the same patients, and language dominance by fMRI agreed with Wada test results at 80% congruency in TPG and 73% congruency in IFG. Lastly, we tested the recommended passive language fMRI protocols in a cohort of very young patients and confirmed reliable language-specific activation patterns in that challenging cohort. We concluded that language activation maps can be reliably achieved using the passive language fMRI protocols we proposed even in very young (average 7.5 years old) or sedated pediatric epilepsy patients.
authors.affiliation: Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: Ralph.Suarez@childrens.harvard.edu.
authors.forename: Ralph O
authors.initials: RO
authors.lastname: Suarez
authors.affiliation: Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Vahid
authors.initials: V
authors.lastname: Taimouri
authors.affiliation: Department of Psychology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Katrina
authors.initials: K
authors.lastname: Boyer
authors.affiliation: Department of Psychology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Clemente
authors.initials: C
authors.lastname: Vega
authors.affiliation: Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Rotenberg
authors.affiliation: Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Madsen
authors.affiliation: Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Tobias
authors.initials: T
authors.lastname: Loddenkemper
authors.affiliation: Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Frank H
authors.initials: FH
authors.lastname: Duffy
authors.affiliation: Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Sanjay P
authors.initials: SP
authors.lastname: Prabhu
authors.affiliation: Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Simon K
authors.initials: SK
authors.lastname: Warfield
mesh_terms: D000293:Adolescent; D001307:Auditory Perception / Q000502:physiology; D001921:Brain / Q000503:physiopathology*; D001931:Brain Mapping / Q000379:methods*; D002648:Child; D015331:Cohort Studies; D004558:Electric Stimulation; D004827:Epilepsy / Q000503:physiopathology*; D005071:Evoked Potentials; D005260:Female; D007839:Functional Laterality; D006801:Humans; D021621:Imaging, Three-Dimensional; D007802:Language; D007807:Language Tests; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D015203:Reproducibility of Results; D014796:Visual Perception / Q000502:physiology; D055815:Young Adult
keywords: Functional MRI; Functional mapping; Language; Pediatric epilepsy; Pre-surgical planning