Language function shows comparable cortical patterns by functional MRI and repetitive nTMS in healthy volunteers

  • Theresa Hauck
  • Monika Probst
  • Claus Zimmer
  • Florian Ringel
  • Bernhard Meyer
  • Afra Wohlschlaeger
  • Sandro M. Krieg
Original Research


In preoperative planning, fMRI and repetitive navigated transcranial magnetic stimulation (rTMS) repeatedly revealed differences in the detected language sites, which can be attributed to tumor-induced oxygenation changes impairing the accuracy of fMRI. We therefore compared the accordance of those techniques in healthy subjects using exactly the same tasks in both investigations. 19 healthy right-handed subjects performed object naming, pseudoword reading, verb generation, and action naming during fMRI at 3 T and rTMS. For rTMS language mapping, we stimulated 46 cortical spots over the left hemisphere; each site was stimulated for three times. Language positive points during rTMS for one, two, or three errors out the three stimulations per spot (1/3, 2/3, 3/3) were exported via DICOM, and compared to the positive fMRI clusters. As a result of this comparison, the best correlation was observed between 3/3 errors and fMRI for pseudoword reading and verb generation with t-values of pu < 0.001, uncorrected for multiple comparisons, on average across the whole rTMS-spot map. We found a close spatial agreement between several rTMS-spots (2/3 and 3/3 errors) and fMRI clusters accentuated in the frontal lobe, followed by the parietal lobe and less in the temporal lobe. Compared to the fMRI clusters, there was a higher congruence for 2/3 and 3/3 errors than for 1/3 errors. Overall, results of language mapping in healthy subjects by fMRI and rTMS correspond well yet depending on the used language task.


Action naming Functional MRI Object naming Pseudoword reading Transcranial magnetic stimulation 



Anterior middle temporal gyrus


Cortical parcellation system


Direct cortical stimulation




Echo planar imaging


Functional magnetic resonance imaging


General linear model


Inferior temporal gyrus




Negative predictive value


Navigated transcranial magnetic stimulation


Orbital part of the inferior frontal gyrus


Positron emission tomography


Polar inferior frontal gyrus


Polar middle frontal gyrus


Polar middle temporal gyrus


Polar superior frontal gyrus


Polar superior temporal gyrus


Picture to trigger interval


Resting Motor Threshold


Repetitive navigated transcranial magnetic stimulation


Standard error of mean


Visual analogue scale



The study was financed by institutional grants from the Department of Neurosurgery and the Section of Neuroradiology.

Compliance with ethical standards

Conflict of interest

SK, FR, and BM are consultants for Brainlab AG (Munich, Germany). SK is consultant for Nexstim Plc (Helsinki, Finland).

Ethical approval

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.

Informed consent

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


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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Neurosurgery, Klinikum rechts der IsarTechnische Universität MünchenMunichGermany
  2. 2.Section of Neuroradiology, Department of Radiology, Klinikum rechts der IsarTechnische Universität MünchenMunichGermany

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