Objective: To develop language functional MRI (fMRI) methods that accurately predict postsurgical naming decline in temporal lobe epilepsy (TLE). Methods: Forty-six patients with TLE (25 left) and 19 controls underwent two overt fMRI paradigms (auditory naming and picture naming, both with active baseline conditions) and one covert task (verbal fluency). Clinical naming performance was assessed preoperatively and 4 months following anterior temporal lobe resection. Preoperative fMRI activations were correlated with postoperative naming decline. Individual laterality indices (LI) were calculated for temporal (auditory and picture naming) and frontal regions (verbal fluency) and were considered as predictors of naming decline in multiple regression models, along with other clinical variables (age at onset of seizures, preoperative naming scores, hippocampal volume, age). Results: In left TLE patients, activation of the left posterior inferior temporal gyrus during auditory naming and activation of left fusiform gyrus during picture naming were related to greater postoperative naming decline. Activation LI were the best individual predictors of naming decline in a multivariate regression model. For picture naming, an LI of higher than 0.34 gave 100% sensitivity and 92% specificity (positive predictive value (PPV) 91.6%). For auditory naming, a temporal lobe LI higher than 0.18 identified all patients with a clinically significant naming decline with 100% sensitivity and 58% specificity (PPV: 58.3%). No effect was seen for verbal fluency. Interpretation: Auditory and picture naming fMRI are clinically applicable to predict postoperative naming decline after left temporal lobe resection in individual patients, with picture naming being more specific. 2186

Auditory and picture naming activated temporal lobe structures, which are resected during ATLR, more frequently than did verbal fluency. Controlling for auditory and visual input resulted in more left-lateralised activations. We hypothesise that these paradigms may be more predictive of postoperative language decline than verbal fluency fMRI.

ObjectiveThe objective of this study was to implement convenient, fast, and accurate Mandarin task paradigms for functional MRI, and to locate the Chinese language functional areas in frontal and temporal lobes.Materials and MethodsNineteen healthy Chinese volunteers participated in this study, which utilized a block design with four language tasks: auditory naming (AN), picture naming (PN), verbal fluency‐character (VFC), and verbal fluency‐letter (VFL). All functional images were preprocessed by SPM 8, followed by first‐ and second‐level analyses and lateralization index calculation.ResultsGroup analyses showed that for AN and PN, maximal responses were located in the right superior temporal gyrus. The picture naming‐scrambled pictures and faces contrast gave maximal responses in the left fusiform gyrus; VFC in the left middle frontal gyrus and the left superior frontal gyrus. For VFL the maximal response was in the left superior temporal gyrus. There was some inconsistency of activations for individual subjects. At a threshold of Z > 2.5, 10 voxels extent, activations were seen in >50% subjects for AN in the right superior temporal gyrus, the right middle frontal gyrus, and the left middle temporal gyrus, for PN in the right superior temporal gyrus and for picture naming‐scrambled pictures and faces in left inferior frontal gyrus. As a group, the lateralization index of all contrasts were left hemisphere dominant in the frontal lobes. In the temporal lobe, the hemispheric dominance differed for different contrasts.ConclusionThese Chinese language stimulus paradigms activated language areas, and the functional regions of brain in different language tasks, and can now be piloted in clinical studies.