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A Detailed Analysis of Functional Magnetic Resonance Imaging in the Frontal Language Area: A Comparative Study With Extraoperative Electrocortical Stimulation

Kunii, Naoto MD*; Kamada, Kyousuke MD, PhD*‡; Ota, Takahiro MD, PhD*; Kawai, Kensuke MD, PhD*; Saito, Nobuhito MD, PhD*

doi: 10.1227/NEU.0b013e3182181be1
Research-Human-Clinical Studies

BACKGROUND: Functional magnetic resonance imaging (fMRI) is a less invasive way of mapping brain functions. The reliability of fMRI for localizing language-related function is yet to be determined.

OBJECTIVE: We performed a detailed analysis of language fMRI reliability by comparing the results of 3-T fMRI with maps determined by extraoperative electrocortical stimulation (ECS).

METHODS: This study was performed on 8 epileptic patients who underwent subdural electrode placement. The tasks performed during fMRI included verb generation, abstract/concrete categorization, and picture naming. We focused on the frontal lobe, which was effectively activated by these tasks. In extraoperative ECS, 4 tasks were combined to determine the eloquent areas: spontaneous speech, picture naming, reading, and comprehension. We calculated the sensitivity and specificity with different Z score thresholds for each task and appropriate matching criteria. For further analysis, we divided the frontal lobe into 5 areas and investigated intergyrus variations in sensitivity and specificity.

RESULTS: The abstract/concrete categorization task was the most sensitive and specific task in fMRI, whereas the picture naming task detected eloquent areas most efficiently in ECS. The combination of the abstract/concrete categorization task and a 3-mm matching criterion gave the best tradeoff (sensitivity, 83%; specificity, 61%) when the Z score was 2.24. As for intergyrus variation, the posterior inferior frontal gyrus showed the best tradeoff (sensitivity, 91%; specificity, 59%), whereas the anterior middle frontal gyrus had low specificity.

CONCLUSION: Despite different tasks for fMRI and extraoperative ECS, the relatively low specificity might be caused by a fundamental discrepancy between the 2 techniques. Reliability of language fMRI activation might differ, depending on the brain region.

*Department of Neurosurgery, University of Tokyo, Tokyo, Japan. ‡Now at the Department of Neurosurgery, Asahikawa Medical University, Asahikawa, Japan

Received, August 30, 2010.

Accepted, February 2, 2011.

Published Online, March 23, 2011.

Correspondence: Kyousuke Kamada, MD, PhD, Department of Neurosurgery, Asahikawa Medical University, Asahikawa, Japan, 2-1, Midorigaoka-Higashi, Asahikawa, Hokkaido 078-8510, Japan. E-mail:

Copyright © by the Congress of Neurological Surgeons