fMRI Prediction of Naming Change After Adult Temporal Lobe Epilepsy Surgery: Activation Matters. You X, Zachery AN, Fanto EJ, et al. Epilepsia. 2019. doi:10.1111/epi.14656. [Epub ahead of print] PMID: 30740666 . OBJECTIVE We aimed to predict language deficits after epilepsy surgery. In addition to evaluating surgical factors examined previously, we determined the impact of the extent of functional magnetic resonance imaging (fMRI) activation that was resected on naming ability. METHOD Thirty-five adults (mean age: 37.5 ± 10.9 years, 13 males) with temporal lobe epilepsy completed a preoperative fMRI auditory description decision task, which reliably activates frontal and temporal language networks. Patients underwent temporal lobe resections (20 left resection). The Boston Naming Test (BNT) was used to determine language functioning before and after surgery. Language dominance was determined for Broca and Wernicke area (WA) by calculating a laterality index following statistical parametric mapping processing. We used an innovative method to generate anatomic resection masks automatically from pre- and postoperative magnetic resonance imaging tissue map comparison. This mask provided the following: (a) resection volume, (b) overlap between resection and preoperative activation, and (c) overlap between resection and WA. We examined postoperative language change predictors using stepwise linear regression. Predictors included parameters described above as well as age at seizure onset (ASO), preoperative BNT score, and resection side and its relationship to language dominance. RESULTS Seven of 35 adults had significant naming decline (6 dominant-side resections). The final regression model predicted 38% of the naming score change variance (adjusted r2 = 0.28, P = .012). The percentage of top 10% fMRI activation resected (P = .017) was the most significant contributor. Other factors in the model included WA LI, ASO, volume of WA resected, and WA LI absolute value (extent of laterality). SIGNIFICANCE Resection of fMRI activation during a word-definition decision task is an important factor for postoperative change in naming ability, along with other previously reported predictors. Currently, many centers establish language dominance using fMRI. Our results suggest that the amount of the top 10% of language fMRI activation in the intended resection area provides additional predictive power and should be considered when planning surgical resection.

中文翻译：

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fMRI语言激活-如果您看不到它…

fMRI对成人颞叶癫痫手术后命名变化的预测：激活很重要。You X，Zachery AN，Fanto EJ等。癫痫病。2019. doi：10.1111 / epi.14656。[Epub提前发布] PMID：30740666。目的我们旨在预测癫痫手术后的语言缺陷。除了评估先前检查的手术因素外，我们还确定了切除的功能性磁共振成像（fMRI）激活程度对命名能力的影响。方法35例颞叶癫痫成人（平均年龄：37.5±10.9岁，男13例）完成了术前fMRI听觉描述决策任务，该任务可靠地激活了额叶和颞叶语言网络。患者进行颞叶切除术（左切除术20例）。波士顿命名测试（BNT）用于确定手术前后的语言功能。通过计算统计参数映射处理后的横向指数，确定了布罗卡和韦尼克地区（WA）的语言优势。我们使用了一种创新的方法，可以根据术前和术后磁共振成像组织图的比较情况自动生成解剖切除面罩。该面罩提供以下功能：（a）切除体积，（b）切除与术前激活之间的重叠，以及（c）切除与WA之间的重叠。我们使用逐步线性回归研究了术后语言变化的预测因子。预测因素包括上述参数以及癫痫发作的年龄（ASO），术前BNT评分，切除侧及其与语言优势的关系。结果35名成年人中有7名有明显的命名下降（6例优势侧切除）。最终回归模型预测了命名分数变化的38％（调整后的r2 = 0.28，P = 0.012）。切除的前10％fMRI激活百分比最高（P = .017）。模型中的其他因素包括WA LI，ASO，切除的WA体积和WA LI绝对值（侧向程度）。意义单词定义决策任务中fMRI激活的切除是术后以及其他先前报道的预测因素改变命名能力的重要因素。当前，许多中心使用fMRI建立语言优势。