Karel Deblaere

Multilingualism: an fMRI study

To investigate the hypothesis that in multilingual speakers different languages are represented in distinct brain regions, 12 multilingual right-handed men performed a word fluency task, a picture naming task, a comprehension reading task, and their respective control tasks in three languages (Dutch, French, and English) while whole-head functional magnetic resonance imaging (fMRI) was applied. In general, all language tasks revealed predominantly overlapping regions of activation for the different languages. Cerebral activation during use of the foreign languages showed a tendency toward a more extensive recruitment of the areas activated in the native language and the activation of a greater number of regions. Word generation in the foreign languages elicited additional bilateral inferior frontal activation, including Brocas area and left middle temporal gyrus activation; in the native language, additional postcentral activation was found. Picture naming in the foreign languages recruited additional inferior-lateral and medial frontal regions predominantly on the left, and more posterior right hemispheric activation in the mother tongue. During comprehension reading there was more activation in medial posterior regions in the native language. Our results suggest that the performance of language tasks in different languages engages largely the same cerebral areas but that the brain, to perform at a comparable proficiency level, engages more neural substrates for later acquired languages. Our findings do not support the view that languages learned later in life entail more right hemispheric involvement. Finally, a consequent effect of language exposure was found for reading, where increased familiarity engages more occipital activation whereas decreased familiarity appears to be associated with increased left hemispheric inferior frontal activation.

Preoperative fMRI in tumour surgery

Minimally invasive resection of brain tumours aims at removing as much pathological tissue as possible while preserving essential brain functions. Therefore, the precise spatial relationship between the lesion and adjacent functionally essential brain parenchyma needs to be known. Functional magnetic resonance imaging (fMRI) is increasingly being used for this purpose because of its non-invasiveness, its relatively high spatial resolution and the preoperative availability of the results. In this review, the goals of fMRI at various key points during the management of patients with a brain tumour are discussed. Further, several practical aspects associated with fMRI for motor and language functioning are summarised, and the validation of the fMRI results with standard invasive mapping techniques is addressed. Next, several important pitfalls and limitations that warrant careful interpretations of the fMRI results are highlighted. Finally, two important future perspectives of presurgical fMRI are emphasised.

Age-related differences in metabolites in the posterior cingulate cortex and hippocampus of normal ageing brain: A 1H-MRS study

OBJECTIVE To study age-related metabolic changes in N-acetylaspartate (NAA), total creatine (tCr), choline (Cho) and myo-inositol (Ins). MATERIALS AND METHODS Proton magnetic resonance spectroscopy (1H-MRS) was performed in the posterior cingulate cortex (PCC) and the left hippocampus (HC) of 90 healthy subjects (42 women and 48 men aged 18-76 years, mean±SD, 48.4±16.8 years). Both metabolite ratios and absolute metabolite concentrations were evaluated. Analysis of covariance (ANCOVA) and linear regression were used for statistical analysis. RESULTS Metabolite ratios Ins/tCr and Ins/H2O were found significantly increased with age in the PCC (P<0.05 and P≤0.001, respectively), and in the HC (P<0.01 for both). An increased tCr/H2O was only observed in the PCC (P<0.01). Following absolute quantification based on the internal water signal, significantly increased concentrations of Ins and tCr in the PCC confirmed the relative findings (P<0.01 for both). CONCLUSION Age-related increases of tCr and Ins are found in the PCC, whereas this holds only true for Ins in the HC, indicating possible gliosis in the ageing brain. No age-dependent NAA decreases were observed in the PCC nor the HC. The 1H-MRS results in these specific brain regions can be important to differentiate normal ageing from age-related pathologies such as mild cognitive impairment (MCI) and Alzheimers disease.

Language activation distributions revealed by fMRI in post-operative epilepsy patients: Differences between left- and right-sided resections

OBJECTIVE To reveal differences of cerebral activation related to language functions in post-operative temporal lobe epilepsy (TLE) patients. METHODS Right (RTL) and left temporal lobe (LTL) resected patients, and healthy controls were studied using functional magnetic resonance imaging (fMRI). Only patients with complete left-hemispheric language dominance according to the intracarotid amytal procedure (IAP) were included. Language-related activations were evoked by performing word generation and text reading language tasks. Activation lateralization and temporo-frontal distribution effects were analysed. RESULTS For word generation, only LTL patients showed reduced left lateralized activation compared to controls, due to a decrease in activation in the left prefrontal cortex and an increase in the right prefrontal cortex. For reading, the left-hemispheric lateralization in RTL patients increased because of enhanced activity in the left prefrontal cortex, whereas for LTL patients the activation became bilaterally distributed over the temporal lobes. Lateralization results between pre-operative IAP and post-operative fMRI were highly discordant. Significant temporo-frontal distribution changes manifested from the reading but not from the word generation task. CONCLUSION The cerebral language representation in post-operative LTL epilepsy patients is more bi-hemispherically lateralized than in controls and RTL patients. Post-operative temporo-frontal and interhemispheric redistribution effects, involving contralateral homologous brain areas, are suggested to contribute to the cerebral reorganisation of language function.

Usefulness of language and memory testing during intracarotid amobarbital testing: observations from an fMRI study

Background – Several procedures for testing language lateralization and memory function exist during the intracarotid amobarbital test (IAT). The use of functional magnetic resonance imaging (fMRI) gives the opportunity to assess the validity of some of these procedures, or at least to inspect the neuronal correlates. A comprehensive fMRI protocol was tested, aimed at addressing aspects of lateralization of language, as well as testing memory in relation to activation of mesiotemporal regions. Here we report observations with possible consequences for the current IAT procedures.

Distribution patterns of 18F-labelled fluoromethylcholine in normal structures and tumors of the head: a PET/MRI evaluation.

Purpose To evaluate the distribution of 18F-labelled fluoromethylcholine (FCho) in normal structures and tumors of the head region using positron emission tomography (PET) and magnetic resonance imaging. Materials and Methods We retrospectively reviewed the positron emission tomography, magnetic resonance imaging, and the coregistered images obtained in 17 patients with suspected high-grade gliomas. The accumulation of 18F-FCho in the normal structures and in brain lesions was visually and semiquantitatively assessed. A 4-point grading system was used for the visual analysis. A standardized uptake value (SUV) was used to quantify uptake. Results In the normal brain parenchyma, 18F-FCho uptake was faint (SUVmean, 0.15 ± 0.03 (SD)). Uptake was generally moderate in the choroid plexus (SUVmean, 0.82 ± 0.16), cavernous sinus (SUVmean, 0.87 ± 0.19), extraocular eye muscles (SUVmean, 1.10 ± 0.27), masticatory muscles (SUVmean, 0.99 ± 0.22), and bone marrow (SUVmean, 1.06 ± 0.26), whereas uptake was usually moderately intense in the pituitary gland (SUVmean, 1.90 ± 0.21). Uptake was variable in the lacrimal glands and the mucosa of the nasal cavity (for SUVmean of subgroups see text). Intense uptake was observed in the parotid glands (SUVmean, 3.27 ± 0.73). (Moderately) intense 18F-FCho uptake was observed in glioblastomas (range SUVmax, 2.26–6.37) and typical meningiomas (range SUVmax, 3.75–5.81). Uptake was globally faint in grade II and III gliomas (range SUVmax, 0.33–0.78). 18F-FCho uptake was also demonstrated in benign lesions, such as a tumefactive demyelinating brain lesion. Conclusions 18F-FCho uptake was faint in the normal brain parenchyma and usually moderate in the choroid plexus, cavernous sinus, extraocular eye muscles, masticatory muscles, and bone marrow. Uptake in the pituitary gland was generally moderately intense, whereas uptake in the lacrimal glands and the mucosa of the nasal cavity was variable. Parotid glands had intense uptake. Also, uptake in glioblastomas and meningiomas was usually (moderately) intense, whereas uptake in grade II and III gliomas was globally faint. However, 18F-FCho uptake was not tumor specific.

Stimulus pacing affects the activation of the medial temporal lobe during a semantic classification task: An fMRI study

Our purpose was to explore the influence of stimulus pacing in blocked functional MRI studies on the activation pattern elicited by a semantic retrieval task. Twenty-two participants performed both a fixed-paced and a self-paced functional MR imaging experiment in which a semantic categorization (animal/object) task was contrasted with a perceptual (small/capital letter string) categorization task. Group and single-subject ROI analyses were computed. In both the fixed-paced and self-paced experiments, semantic categorization contrasted with perceptual categorization elicited a cerebral network generally accepted to be involved in semantic processing comprising left inferior prefrontal, left lateral temporal, paracingular and right cerebellar areas. Our main finding was that the self-paced stimulus modality additionally yielded significant activation in the medial temporal lobe (MTL) structures including the hippocampus and the parahippocampal gyrus. More elaborative single-subject ROI analyses revealed MTL activation in 86% of the subjects for the self-paced design, but only in 21% of subjects for the fixed-paced design. The discussion focuses on possible explanations for this finding. We conclude that a self-paced as opposed to a fixed-paced semantic retrieval paradigm is able to detect significant MTL activation in groups as well as in single-subjects. This offers opportunities for the application of such a design in clinical practice.

Lessons for neuropsychology from functional MRI in patients with epilepsy

This contribution aims to review the major findings of pre- and postsurgical functional magnetic resonance imaging (fMRI) in patients with refractory epilepsy from a neuropsychological perspective. We compared the contribution of fMRI with the intracarotid amytal procedure (IAP) with respect to functional mapping of language and memory in patients with therapy-resistant epilepsy. We conclude that using comprehensive language paradigms, fMRI has been able (1) to provide estimates of the degree of language lateralization including the degree of involvement of the nondominant hemisphere, (2) to provide information on the location of its activated network during expressive and receptive language, and (3) to help delineate eloquent language regions in the vicinity of the surgical target, thus preventing postoperative complications. The contribution of the frequently observed nondominant hemisphere activation to language should be explored and its clinical relevance determined. Evidence from fMRI studies is accumulating that reorganization of cognitive and motor function favors the activation of contralateral homotopic areas, although this process is far from understood. The exact functional contribution of atypical areas of activation should be investigated critically. In the presurgical evaluation process, detailed and reliable localization of language and memory functions of the individual patient is mandatory and should be the ultimate goal in the development of comprehensive clinical fMRI protocols.

Intra- and interobserver variability of MRI-based volume measurements of the hippocampus and amygdala using the manual ray-tracing method

Abstract We studied the intra- and interobserver variability of volume measurments of the hippocampus (HC) and the amygdala as applied to the detection of HC atrophy in patients with complex partial seizures (CPE), measuring the volumes of the HC and amygdala of 11 normal volunteers and 12 patients with presumed CPE, using the manual ray-tracing method. Two independent observers performed these measurements twice each using home-made software. The intra- and interobserver variability of the absolute volumes and of the normalised left-to-right volume differences (δV) between the HC (δVHC), the amygdala (δVA) and the sum of both (δVHCA) were assessed. In our mainly right-handed normals, the right HC and amygdala were on average 0.05 and 0.03 ml larger respectively than on the left. The interobserver variability for volume measurements in normal subjects was 1.80 ml for the HC and 0.82 ml for the amygdala, the intraobserver variability roughly one third of these values. The interobserver variability coefficient in normals was 3.6 % for δVHCA, 4.7 % for δVHC and 7.3 % for δVA. The intraobserver variability coefficient was 3.4 % for δVHCA, 4.2 % for δVHC amd 5.6 % for δVA. The variability in patients was the same for volume differences less than 5 % either side of the interval for normality, but was higher when large volume differences were encountered, is probably due to the lack of thresholding and/or normalisation. Cutoff values for lateralisation with the δV were defined. No intra- or interobserver lateralisation differences were encountered with δVHCA and δVHC. From these observations we conclude that the manual ray-tracing method is a robust method for lateralisation in patients with TLE. Due to its higher variability, this method is less suited to measure absolute volumes.

Comparison between functional magnetic resonance imaging at 1.5 and 3 tesla : Effect of increased field strength on 4 paradigms used during presurgical work-up

Objectives:We sought to evaluate the benefit of 3 T compared with 1.5 T during presurgical functional magnetic resonance imaging. Materials and Methods:Six participants performed a motor, a visual, and 2 language paradigms both at 1.5 and 3 T. The number of activated voxels, mean t-value, and assessment of language dominancy were compared between both field strengths. Group analysis was performed to evaluate the influence of field strength on the cortical language activation patterns. Results:The number of activated voxels and mean t-values were significantly higher at 3 T for all paradigms. Using the same statistical threshold, language activation was significantly less lateralized, and more activation zones were depicted at 3 T compared with 1.5 T. Conclusions:Sensitivity associated with visual, motor and language functional magnetic resonance imaging increased significantly at 3 T. Additional cortical areas were depicted during language processing at 3 T. For assessment of language dominancy, usage of more stringent statistical thresholds at 3 T is suggested.