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Visualization of subcortical language pathways by diffusion tensor imaging fiber tracking based on rTMS language mapping

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Abstract

Diffusion tensor imaging fiber tracking (DTI FT) is used to visualize subcortical fiber tracts. Yet, there is no standard at hand to visualize language-involved subcortical fibers reliably. Thus, this study investigates the feasibility of using language-related cortical areas identified via repetitive navigated transcranial magnetic stimulation (rTMS) to seed DTI FT of subcortical language tracts. From 2011 to 2014, 37 patients with left-hemispheric perisylvian lesions were examined. Language-positive rTMS stimulation spots were integrated in the deterministic tractography software (BrainLAB, iPlanNet 3.0) as objects and used as seed regions for DTI FT. Tractography was then performed in each patient with 77 different combinations of fiber lengths (40 – 100 mm) and fractional anisotropy (FA; 0.01 – 0.5). The rTMS-based DTI FT identified all commonly known subcortical language tracts, such as the corticonuclear tract, arcuate fascicle, uncinate fascicle, superior longitudinal fascicle, inferior longitudinal fascicle, arcuate fibers, commissural fibers, corticothalamic fibers, and the fronto-occipital fascicle. In 32 patients (86.5 %), each above-named tract could be visualized, while at least 6 out of these 9 tracts were identified in each patient. A fiber length of 100 mm and an FA of 0.1 or 0.15 provided optimal visualization by revealing 125 and 61 individually tracked fibers per visualized language tract and 90 % and 73 % of all language-related tracts, respectively. This study proves the feasibility of rTMS-based DTI FT for subcortical language tracts, provides suitable settings, and shows its easy and standardizable application for the visualization of every language tract in 86.5 % of patients.

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Abbreviations

3D:

Three-dimensional

AF:

Arcuate fascicle

aMFG:

Anterior middle frontal gyrus

aMTG:

Anterior middle temporal gyrus

anG:

Angular gyrus

ANOVA:

Analysis of variance

ArF:

Arcuate fibers

aSTG:

Anterior superior temporal gyrus

CF:

Aommissural fibers

CNT:

Corticonuclear tract

COV:

Coefficient of variation

CST:

Corticospinal tract

CtF:

Corticothalamic fibers

DCS:

Direct cortical stimulation

dPOG:

Dorsal postcentral gyrus

DT:

Display time

DTI:

Diffusion tensor imaging

DTI FT:

Diffusion tensor imaging fiber tracking

FA:

Fractional anisotropy

fMRI:

Functional magnetic resonance imaging

FoF:

Fronto-occipital fascicle

GTR:

Gross total resection

ILF:

Inferior longitudinal fascicle

IPI:

Inter-picture interval

MAX:

Maximum value

MFL:

Minimum fiber length

MIN:

Minimum value

mITG:

Middle inferior temporal gyrus

mMFG:

Middle middle frontal gyrus

mMTG:

Middle middle temporal gyrus

mPrG:

Middle precentral gyrus

MRI:

Magnetic resonance imaging

mSFG:

Middle superior frontal gyrus

mSTG:

Middle superior temporal gyrus

nTMS:

Navigated transcranial magnetic stimulation

opIFG:

Opercular inferior frontal gyrus

pMTG:

Posterior middle temporal gyrus

polIMFG:

Polar inferior middle frontal gyrus

polSTG:

Polar superior temporal gyrus

pSTG:

Posterior superior temporal gyrus

PTI:

Picture-to-trigger interval

RMT:

Resting motor threshold

rTMS:

Repetitive navigated transcranial magnetic stimulation

SD:

Standard deviation

SLF:

Superior longitudinal fascicle

TMS:

Transcranial magnetic stimulation

UF:

Uncinate fascicle

vPrG:

Ventral precentral gyrus

WHO:

World Health Organization

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Authors and Affiliations

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

    Chiara Negwer, Sebastian Ille, Theresa Hauck, Nico Sollmann, Stefanie Maurer, Florian Ringel, Bernhard Meyer & Sandro M. Krieg

  2. TUM-Neuroimaging Center, Munich, Germany

    Chiara Negwer, Sebastian Ille, Theresa Hauck, Nico Sollmann, Stefanie Maurer & Sandro M. Krieg

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

    Jan S. Kirschke

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  1. Chiara Negwer
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  2. Sebastian Ille
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  3. Theresa Hauck
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  4. Nico Sollmann
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  8. Bernhard Meyer
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  9. Sandro M. Krieg
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Correspondence to Sandro M. Krieg.

Ethics declarations

Human Studies

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (registration number: 2793/10) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Before undergoing language mapping by rTMS, all examined patients gave their written informed consent to this study. The study was completely financed by institutional grants from the Department of Neurosurgery and the Section of Neuroradiology. FR and SK are consultants for BrainLAB AG. SK is consultant for Nexstim Oy (Helsinki, Finland). However, all authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this manuscript.

Human and Animal Rights

This article does not contain any studies with animals performed by any of the authors.

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Ethics Committee Registration Number: 2793/10

Highlights

• rTMS maps can be used to base DTI FT of subcortical language pathways on.

• All common language-related pathways can be visualized with this method.

• In 86.4 % of the enrolled patients, every language-related fiber tract could be detected.

• The best DTI FT results were seen using a fiber length of 100 mm and FA values of 0.1 and 0.15.

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Negwer, C., Ille, S., Hauck, T. et al. Visualization of subcortical language pathways by diffusion tensor imaging fiber tracking based on rTMS language mapping. Brain Imaging and Behavior 11, 899–914 (2017). https://doi.org/10.1007/s11682-016-9563-0

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