title: The Arcuate Fasciculus and Language Development in a Cohort of Pediatric Patients with Malformations of Cortical Development.
abstract: OBJECTIVE
  Patients with epilepsy and malformations of cortical development have a high prevalence of language deficits. The purpose of this study was to investigate whether the status of the arcuate fasciculus at diffusion tractography could provide a clinically meaningful marker of language function in patients with cortical malformations.
  
  
  METHODS
  Thirty-seven patients 3-18 years of age who had DTI performed at 3T and language evaluation by a pediatric neurologist were retrospectively identified. Twenty-two age-matched children without any neurologic, language, or MR imaging abnormalities who had identical DTI performed for an indication of headache were selected as a control cohort. The arcuate fasciculi were constructed and segmented by deterministic tractography for all subjects.
  
  
  RESULTS
  Twenty-one patients had intact language; 11 had mild-to-moderate and 5, profound language impairment. All patients with normal language and all control subjects had an identifiable left arcuate. The left arcuate was absent in 11 patients; all 11 were language-impaired. Failure to identify the left arcuate was strongly associated with some degree of language impairment (P < .001). Sensitivity, specificity, and positive predictive value for language dysfunction were 65%, 100%, and 100%, respectively. The absence of the arcuate bilaterally was associated with complete failure to develop oral language (P < .015).
  
  
  CONCLUSIONS
  Failure to identify the left arcuate fasciculus at diffusion tractography was a highly specific marker of language dysfunction in a cohort of pediatric patients with malformations of cortical development. Failure to identify the arcuate fasciculus on either side was associated with failure to develop oral language.
authors.affiliation: From the Department of Radiology (M.J.P., K.H.), Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts.
authors.forename: M J
authors.initials: MJ
authors.lastname: Paldino
authors.affiliation: From the Department of Radiology (M.J.P., K.H.), Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts.
authors.forename: K
authors.initials: K
authors.lastname: Hedges
authors.affiliation: Department of Radiology (F.G.), Texas Children's Hospital, Houston, Texas. fxgolriz@texaschildrens.org.
authors.forename: F
authors.identifier: http://orcid.org/0000-0003-4086-7058
authors.initials: F
authors.lastname: Golriz
mesh_terms: D000293:Adolescent; D001111:Arcuate Nucleus of Hypothalamus / Q000002:abnormalities* / Q000473:pathology*; D001932:Brain Neoplasms / Q000150:complications; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D056324:Diffusion Tensor Imaging; D004292:Dominance, Cerebral / Q000502:physiology; D004827:Epilepsy / Q000175:diagnosis* / Q000473:pathology*; D005260:Female; D006801:Humans; D007805:Language Development Disorders / Q000175:diagnosis* / Q000473:pathology*; D008297:Male; D054220:Malformations of Cortical Development / Q000175:diagnosis* / Q000473:pathology*; D012189:Retrospective Studies