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From the Departments of Neurosciences (Drs. Gaillard, Papero, Weinstein, Conry, and Pearl, L. Balsamo, S. Braniecki, and B. Sachs) and Radiology (Dr. Vezina), Children’s National Medical Center, George Washington University School of Medicine, Washington, DC; Epilepsy Research Branch (Drs. Gaillard, Xu, Grandin, Sato, and Theodore, L. Balsamo, S. Braniecki, and B. Sachs), National Institute of Neurological Disorders and Stroke; Speech–Language Pathology Section (Dr. Frattali), Rehabilitation Medicine Department, Clinical Center, NIH; Department of Neurology (Dr. Jabbari), Uniformed Services University, Bethesda, MD; and Department of Radiology (Dr. Grandin), St. Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium.
Address correspondence and reprint requests to Dr. William Davis Gaillard, Department of Neurology, Children’s National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010; e-mail: gaillardw{at}ninds.nih.gov or wgaillar@cnmc.org
Background: fMRI language tasks readily identify frontal language areas; temporal activation has been less consistent. No studies have compared clinical visual judgment to quantitative region of interest (ROI) analysis.
Objective: To identify temporal language areas in patients with partial epilepsy using a reading paradigm with clinical and ROI interpretation.
Methods: Thirty patients with temporal lobe epilepsy, aged 8 to 56 years, had 1.5-T fMRI. Patients silently named an object described by a sentence compared to a visual control. Data were analyzed with ROI analysis from t-maps. Regional asymmetry indices (AI) were calculated ([L-R]/[L+R]) and language dominance defined as >0.20. t-Maps were visually rated by three readers at three t thresholds. Twenty-one patients had intracarotid amobarbital test (IAT).
Results: The fMRI reading task provided evidence of language lateralization in 27 of 30 patients with ROI analysis. Twenty-five were left dominant, two right, one bilateral, and two were nondiagnostic; IAT and fMRI agreed in most patients, three had partial agreement, none overtly disagreed. Interrater agreement ranged between 0.77 to 0.82 (Cramer V; p < 0.0001); agreement between visual and ROI reading with IAT was 0.71 to 0.77 (Cramer V; p < 0.0001). Viewing data at lower thresholds added interpretation to 12 patients on visual analysis and 8 with ROI analysis.
Conclusions: An fMRI reading paradigm can identify language dominance in frontal and temporal areas. Clinical visual interpretation is comparable to quantitative ROI analysis.
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