Auditory word comprehension is a cognitive process that involves the transformation of auditory signals into abstract concepts. Traditional lesion-based studies of stroke survivors with aphasia have suggested that neocortical regions adjacent to auditory cortex are primarily responsible for word comprehension. However, recent primary progressive aphasia and normal neurophysiological studies have challenged this concept, suggesting that the left temporal pole is crucial for word comprehension. Due to its vasculature, the temporal pole is not commonly completely lesioned in stroke survivors and this heterogeneity may have prevented its identification in lesion-based studies of auditory comprehension. We aimed to resolve this controversy using a combined voxel-based—and structural connectome—lesion symptom mapping approach, since cortical dysfunction after stroke can arise from cortical damage or from white matter disconnection. Magnetic resonance imaging (T₁-weighted and diffusion tensor imaging-based structural connectome), auditory word comprehension and object recognition tests were obtained from 67 chronic left hemisphere stroke survivors. We observed that damage to the inferior temporal gyrus, to the fusiform gyrus and to a white matter network including the left posterior temporal region and its connections to the middle temporal gyrus, inferior temporal gyrus, and cingulate cortex, was associated with word comprehension difficulties after factoring out object recognition. These results suggest that the posterior lateral and inferior temporal regions are crucial for word comprehension, serving as a hub to integrate auditory and conceptual processing. Early processing linking auditory words to concepts is situated in posterior lateral temporal regions, whereas additional and deeper levels of semantic processing likely require more anterior temporal regions.

中文翻译：

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颞叶网络支持口语理解

听觉单词理解是一个认知过程，涉及到将听觉信号转换为抽象概念。对患有失语症的中风幸存者进行的基于病变的传统研究表明，与听觉皮层相邻的新皮质区域主要负责单词理解。但是，最近的原发性进行性失语症和正常的神经生理学研究对这一概念提出了挑战，表明左颞极对于单词理解至关重要。由于其脉管系统，中风幸存者通常不会完全破坏颞极，并且这种异质性可能阻止了其在基于病变的听觉理解研究中的识别。我们旨在使用基于体素的结合结构连接体的病变症状映射方法来解决这一争议，因为卒中后皮质功能障碍可能是由皮质损害或白质脱落引起的。磁共振成像（T_1个加权和扩散张量成像为基础的结构连接体），听觉单词理解和对象识别测试是从67位慢性左半球卒中幸存者中获得的。我们观察到，对颞下回，梭状回和包括左后颞区及其与中颞回，颞下回和扣带回皮层的连接的白质网络的损害与单词理解后的困难有关。排除对象识别。这些结果表明，后外侧和颞下区域对于单词理解至关重要，是整合听觉和概念处理的枢纽。将听觉单词与概念联系起来的早期处理位于后外侧颞区，