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Two methods of quantifying hemispheric language dominance (HLD) in neurosurgical patients are compared: (1) an average magnitudes (AM) method, which is a calculation of the average signal intensity variation in regions of interest for each patient that were predefined in a group analysis for each task, and (2) a lateralization indices (LI) method, which is based on the number of activated pixels in regions of interest predefined in each individual patient. Four language tasks [a living/nonliving (LNL) judgment, word stem completion (WSC), semantic associate (SA) and a phonological associate (PA) task] were compared with "gold standard" measures such as the Wada test or electrocortical stimulation. Results showed that the LI method was more accurate (73% agreement with gold standard methods) than the AM method (only 40% agreement) across tasks and subjects. Furthermore, by varying the threshold used for determining laterality, the ability of functional magnetic resonance imaging (fMRI) to predict HLD was influenced for the AM method, whereas the LI method was relatively unaffected by changing the threshold. Using the LI method, the SA task was the most accurate for quantifying HLD (100% agreement with gold standard methods) with respect to the other three language tasks (80% accuracy for WSC, 65% for the LNL and 63% for phonological task). Depending on the method and the task, fMRI may be a promising tool for assessing HLD in neurosurgical patients.

We report the case of a patient with frontal lobe epilepsy in whom the Wada test failed to lateralize representation of language (fluent speech was observed after amobarbital injection on both the right and left side). Functional magnetic resonance imaging (fMRI) during a lexical processing task revealed an atypical organization of language represented by an interhemispheric dissociation of language regions with a right frontal dominance and a left temporal dominance. Consistent with the fMRI results, the patient's ability to name pictures was not reliably impaired by electrocortical stimulation (ECS) of left frontal cortex. The findings from Wada, fMRI, and ECS were confirmed by a lack of language impairment after left frontal lobectomy for seizures. This case illustrates that fMRI can precisely map cortical language networks in epileptic patients and that fMRI may be used to help interpret laterality results provided by the Wada procedure.

In fMRI studies of language processing, it would be extremely useful to obtain high-quality images during tasks requiring spoken output. Recent studies have suggested that this may be possible, particularly if event-related fMRI methods are used. This study assesses the feasibility of acquiring interpretable images during speech by applying event-related methods to visual word stem completion, a task that has been studied extensively. On each trial, a different three-letter word stem (e.g., COU) was presented visually and subjects were required to generate a word beginning with that stem (e.g., COUSIN). In covert runs, subjects were instructed to say the word once to themselves, without moving their lips. In overt runs, subjects were instructed to say the word once aloud. Ten subjects were scanned during six overt runs and six covert runs at three presentation rates. Data were analyzed using an implementation of the general linear model making no assumptions about response shape. Images were relatively free of artifacts, and regions demonstrating task-related activation were similar to those reported in previous imaging studies. Regions active during overt task performance were similar to those active during covert task performance, with the addition of several regions commonly associated with motor aspects of speech production. Consistent with other studies, magnitude of activation was greater in the overt condition than in the covert condition, and there was a modest decrease in magnitude at the fastest presentation rate. Together, these results help to validate the use of event-related fMRI during tasks that require spoken output. Press

Functional magnetic resonance imaging (fMRI) was used to compare directly episodic encoding and retrieval. During encoding, subjects studied visually presented words and reported via keypress whether each word represented a pleasant or unpleasant concept (intentional, deep encoding). During the retrieval phase, subjects indicated (via keypress) whether visually presented words had previously been studied. No reliable differences were found during the recognition phase for words that had been previously studied and those that had not been studied. Areas preferentially active during encoding (relative to retrieval) included left superior frontal cortex, medial frontal cortex, left superior temporal cortex, posterior cingulate, left parahippocampal gyrus, and left inferior frontal gyrus. Regions more active in retrieval than encoding included bilateral inferior parietal cortex, bilateral precuneus, right frontal polar cortex, right dorsolateral prefrontal cortex, and right inferior frontal/insular cortex.

Functional magnetic resonance imaging (fMRI) techniques, such as echo-planar imaging, can permit rapid, sensitive, whole-brain measurements of local blood flow-induced MR signal changes seen during cognitive paradigms. Changes in blood oxygenation due to mismatch of flow and oxygen metabolism cause dynamic variations in microscopic susceptibility effects, leading to the blood oxygenation level-dependent (BOLD) signal measured by fMRI techniques. A related static macroscopic susceptibility effect is known to cause artifacts that attenuate the MR signal, leading to "blind spots" in some regions of brain adjacent to bone and air sinuses. The anatomical location, spatial extent, and magnitude of signal loss artifact are quantitated for a common whole-brain fMRI technique. Resting gradient-echo EPI studies were obtained in four healthy volunteers. Signal loss was primarily localized to inferior frontal regions (medial orbital gyri and gyrus rectus) and to inferior lateral temporal lobe (including part of fusiform gyrus) bilaterally. Increased echo time (TE) uniformly produced larger artifacts. The orientation of acquired slices and choice of phase-encoding direction influenced the location, shape, and extent of the artifacts. Regions of the brain with severe artifact may have attenuated activation signal, with potential implications for the design and interpretation of fMRI studies targeting activations in these areas., (Copyright 1997 Academic Press.)

We report a patient with hydrocephalus who developed levodopa responsive parkinsonism and severe bradyphrenia associated with shunt malfunction and revision. Magnetic resonance imaging revealed periaqueductal edema involving medial substantia nigra. [18F]dopa positron emission tomography demonstrated reduced uptake in the caudate and putamen with relative sparing of the posterior putamen. Hydrocephalus associated with shunt malfunction can cause a distinct parkinsonian syndrome with greater dysfunction of projections from the medial substantia nigra to anterior striatum than in idiopathic Parkinson's disease. [ABSTRACT FROM AUTHOR]