Crossed cerebrocerebellar language lateralization: an additional diagnostic feature for assessing atypical language representation in presurgical functional MR imaging.

BACKGROUND AND PURPOSE: Determining language dominance with fMRI is challenging in patients with brain tumor, particularly in cases of suspected atypical language representation. Supratentorial activation patterns must be interpreted with great care when the tumor is in or near the presumed language areas, where tumor tissue or mass effect can lead to false-negative fMRI results. In this study, we assessed cerebrocerebellar language fMRI lateralization in healthy participants and in patients with brain tumors with a focus on atypical language representation. MATERIALS AND METHODS: Twenty healthy participants and 38 patients with a brain tumor underwent fMRI with a verb-generation task. Cerebral and cerebellar language lateralizations were separately classified as left-sided, right-sided, or symmetric. Electrocortical stimulation was performed in 19 patients. With the McNemar test, we evaluated the dependency between language lateralization in the cerebrum and cerebellum, and with Pearson correlation analysis, the relationship between the cerebral and cerebellar lateralization indices. RESULTS: There was a significant dependency between cerebral and cerebellar language activation, with moderate negative correlation (Pearson r = -0.69). Crossed cerebrocerebellar language activation was present in both healthy participants and patients, irrespective of handedness or typical or atypical language representation. There were no discordant findings between fMRI and electrocortical stimulation. CONCLUSIONS: Language lateralization in the cerebellum can be considered an additional diagnostic feature to determine language dominance in patients with brain tumor. This is particularly useful in cases of uncertainty, such as the interference of a brain tumor with cerebral language activation on fMRI and atypical language representation.

Functional MRI-based identification of brain areas involved in motor imagery for implantable brain-computer interfaces.

For the development of minimally invasive brain-computer interfaces (BCIs), it is important to accurately localize the area of implantation. Using fMRI, we investigated which brain areas are involved in motor imagery. Twelve healthy subjects performed a motor execution and imagery task during separate fMRI and EEG measurements. fMRI results showed that during imagery, premotor and parietal areas were most robustly activated in individual subjects, but surprisingly, no activation was found in the primary motor cortex. EEG results showed that spectral power decreases in contralateral sensorimotor rhythms (8-24 Hz) during both movement and imagery. To further verify the involvement of the motor imagery areas found with fMRI, one epilepsy patient performed the same task during both fMRI and ECoG recordings. Significant ECoG low (8-24 Hz) and high (65-95 Hz) frequency power changes were observed selectively on premotor cortex and these co-localized with fMRI. During a subsequent BCI task, excellent performance (91%) was obtained based on ECoG power changes from the localized premotor area. These results indicate that other areas than the primary motor area may be more reliably activated during motor imagery. Specifically, the premotor cortex may be a better area to implant an invasive BCI.