Effectiveness of four different clinical fMRI paradigms for preoperative regional determination of language lateralization in patients with brain tumors

Introduction Blood oxygen level-dependent functional magnetic resonance imaging (fMRI) has demonstrated its capability to provide comparable results to gold standard intracarotid sodium amobarbital (Wada) testing for preoperative determination of language hemispheric dominance. However, thus far, no consensus has been established regarding which fMRI paradigms are the most effective for the determination of hemispheric language lateralization in specific categories of patients and specific regions of interest (ROIs). Methods Forty-one brain tumor patients who performed four different language tasks-rhyming (R), silent word generation (SWG) sentence completion, and sentence listening comprehension (LC)-for presurgical language mapping by fMRI were included in this study. A statistical threshold-independent lateralization index (LI) was calculated and compared among the paradigms in four different ROIs for language activation: functional Broca's (BA) and Wernicke's areas (WA) as well as larger anatomically defined expressive (EA) and receptive (RA) areas. Results The two expressive paradigms evaluated in this study are very good lateralizing tasks in expressive language areas; specifically, a significantly higher mean LI value was noted for SWG (0.36±0.25) compared to LC (0.16±0.24, p00.009) and for R (0.40±0.22) compared to LC (0.16± 0.24, p00.001) in BA. SWG LI (0.28±0.19) was higher than LC LI (0.12±0.16, p00.01) also in EA. No significant differences in LI were found among these paradigms in WA or RA. Conclusions SWG and R are sufficient for the determination of lateralization in expressive language areas, whereas new semantic or receptive paradigms need to be designed for an improved assessment of lateralization in receptive language areas.