title: fMRI activation in the middle frontal gyrus as an indicator of hemispheric dominance for language in brain tumor patients: a comparison with Broca's area.
abstract: BACKGROUND
  Functional MRI (fMRI) can assess language lateralization in brain tumor patients; however, this can be limited if the primary language area-Broca's area (BA)-is affected by the tumor. We hypothesized that the middle frontal gyrus (MFG) can be used as a clinical indicator of hemispheric dominance for language during presurgical workup.
  
  
  METHODS
  Fifty-two right-handed subjects with solitary left-hemispheric primary brain tumors were retrospectively studied. Subjects performed a verbal fluency task during fMRI. The MFG was compared to BA for fMRI voxel activation, language laterality index (LI), and the effect of tumor grade on the LI.
  
  
  RESULTS
  Language fMRI (verbal fluency) activated more voxels in MFG than in BA (MFG = 315, BA = 216, p < 0.001). Voxel activations in the left-hemispheric MFG and BA were positively correlated (r = 0.69, p < 0.001). Mean LI in the MFG was comparable to that in BA (MFG = 0.48, BA = 0.39, p = 0.06). LIs in MFG and BA were positively correlated (r = 0.62, p < 0.001). Subjects with high-grade tumors demonstrate lower language lateralization than those with low-grade tumors in both BA and MFG (p = 0.02, p = 0.02, respectively).
  
  
  CONCLUSIONS
  MFG is comparable to BA in its ability to indicate hemispheric dominance for language using a measure of verbal fluency and may be an adjunct measure in the clinical determination of language laterality for presurgical planning.
authors: Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA.|New York University School of Medicine, New York, NY, USA.
authors: Jian W
authors: JW
authors: Dong
authors: Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA.
authors: Nicole M Petrovich
authors: NM
authors: Brennan
authors: Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA.|Department of Bioimaging and Radiological Sciences, Catholic University of Rome, A. Gemelli Hospital, Rome, Italy.
authors: Giana
authors: G
authors: Izzo
authors: Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA.|Department of Medical Physics and the Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors: Kyung K
authors: KK
authors: Peck
authors: Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA. holodnya@mskcc.org.|Department of Medical Physics and the Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA. holodnya@mskcc.org.
authors: Andrei I
authors: AI
authors: Holodny
mesh_terms: D001931:Brain Mapping / Q000379:methods*; D001932:Brain Neoplasms / Q000503:physiopathology*; D065711:Broca Area / Q000503:physiopathology*; D004292:Dominance, Cerebral; D005260:Female; D006801:Humans; D007802:Language; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009415:Nerve Net / Q000503:physiopathology; D017397:Prefrontal Cortex / Q000503:physiopathology*
keywords: Brain mapping; Functional imaging; Hemispheric dominance; Language lateralization; Middle frontal gyrus