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Mapping of cortical language function by functional magnetic resonance imaging and repetitive navigated transcranial magnetic stimulation in 40 healthy subjects

  • Clinical Article - Neurosurgical Techniques
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Abstract

Background

Functional magnetic resonance imaging (fMRI) is considered to be the standard method regarding non-invasive language mapping. However, repetitive navigated transcranial magnetic stimulation (rTMS) gains increasing importance with respect to that purpose. However, comparisons between both methods are sparse.

Methods

We performed fMRI and rTMS language mapping of the left hemisphere in 40 healthy, right-handed subjects in combination with the tasks that are most commonly used in the neurosurgical context (fMRI: word-generation = WGEN task; rTMS: object-naming = ON task). Different rTMS error rate thresholds (ERTs) were calculated, and Cohen’s kappa coefficient and the cortical parcellation system (CPS) were used for systematic comparison of the two techniques.

Results

Overall, mean kappa coefficients were low, revealing no distinct agreement. We found the highest agreement for both techniques when using the 2-out-of-3 rule (CPS region defined as language positive in terms of rTMS if at least 2 out of 3 stimulations led to a naming error). However, kappa for this threshold was only 0.24 (kappa of <0, 0.01–0.20, 0.21–0.40, 0.41–0.60, 0.61–0.80 and 0.81–0.99 indicate less than chance, slight, fair, moderate, substantial and almost perfect agreement, respectively).

Conclusions

Because of the inherent differences in the underlying physiology of fMRI and rTMS, the different tasks used and the impossibility of verifying the results via direct cortical stimulation (DCS) in the population of healthy volunteers, one must exercise caution in drawing conclusions about the relative usefulness of each technique for language mapping. Nevertheless, this study yields valuable insights into these two mapping techniques for the most common language tasks currently used in neurosurgical practice.

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Abbreviations

3D:

Three-dimensional

AR:

Activation rate

BOLD:

Blood oxygenation level dependent

CPS:

Cortical parcellation system

DCS:

Direct cortical stimulation

DT:

Display time

DTI FT:

Diffusion tensor imaging fiber tracking

ER:

Error rate

ERT:

Error rate threshold

fMRI:

Functional magnetic resonance imaging

IPI:

Inter-picture interval

ITG:

Inferior temporal gyrus

MEG:

Magnetoencephalography

MRI:

Magnetic resonance imaging

ON:

Object naming

PPV:

Positive predictive value

PTI:

Picture-to-trigger interval

RMT:

Resting motor threshold

rTMS:

Repetitive navigated transcranial magnetic stimulation

SD:

Standard deviation

TE:

Echo time

TMS:

Transcranial magnetic stimulation

TR:

Repetition time

WGEN:

Word generation

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Acknowledgments

The first author gratefully acknowledges the support of the TUM Graduate School’s Faculty Graduate Center of Medicine.

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    Authors and Affiliations

    1. Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany

      Nico Sollmann, Sebastian Ille, Florian Ringel, Bernhard Meyer & Sandro M. Krieg

    2. TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany

      Nico Sollmann, Sebastian Ille & Sandro M. Krieg

    3. Section of Neuroradiology, Department of Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany

      Nico Sollmann & Tobias Boeckh-Behrens

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    1. Nico Sollmann
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    Correspondence to Sandro M. Krieg.

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    Conflict of interest

    FR and SK are consultants for BrainLAB AG (Feldkirchen, Germany). SK is a consultant for Nexstim Oy (Helsinki, Finland). The authors declare that they have no conflict of interest.

    Funding

    The study was financed by institutional grants from the Department of Neurosurgery and the Section of Neuroradiology, Klinikum rechts der Isar, Technische Universität München.

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    All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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    Informed consent was obtained from all individual participants included in the study.

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    Nico Sollmann and Sebastian Ille contributed equally to this work.

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    Sollmann, N., Ille, S., Boeckh-Behrens, T. et al. Mapping of cortical language function by functional magnetic resonance imaging and repetitive navigated transcranial magnetic stimulation in 40 healthy subjects. Acta Neurochir 158, 1303–1316 (2016). https://doi.org/10.1007/s00701-016-2819-z

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