Functional magnetic resonance imaging (FMRI) was used to identify candidate language processing areas in the intact human brain. Language was defined broadly to include both phonological and lexical-semantic functions and to exclude sensory, motor, and general executive functions. The language activation task required phonetic and semantic analysis of aurally presented words and was compared with a control task involving perceptual analysis of nonlinguistic sounds. Functional maps of the entire brain were obtained from 30 right-handed subjects. These maps were averaged in standard stereotaxic space to produce a robust "average activation map" that proved reliable in a split-half analysis. As predicted from classical models of language organization based on lesion data, cortical activation associated with language processing was strongly lateralized to the left cerebral hemisphere and involved a network of regions in the frontal, temporal, and parietal lobes. Less consistent with classical models were (1) the existence of left hemisphere temporoparietal language areas outside the traditional "Wernicke area," namely, in the middle temporal, inferior temporal, fusiform, and angular gyri; (2) extensive left prefrontal language areas outside the classical "Broca area"; and (3) clear participation of these left frontal areas in a task emphasizing "receptive" language functions. Although partly in conflict with the classical model of language localization, these findings are generally compatible with reported lesion data and provide additional support for ongoing efforts to refine and extend the classical model.

Localized, task-induced decreases in cerebral blood flow are a frequent finding in functional brain imaging research but remain poorly understood. One account of these phenomena postulates processes ongoing during conscious, resting states that are interrupted or inhibited by task performance. Psychological evidence suggests that conscious humans are engaged almost continuously in adaptive processes involving semantic knowledge retrieval, representation in awareness, and directed manipulation of represented knowledge for organization, problem-solving, and planning. If interruption of such 'conceptual' processes accounts for task-induced deactivation, tasks that also engage these conceptual processes should not cause deactivation. Furthermore, comparisons between conceptual and nonconceptual tasks should show activation during conceptual tasks of the same brain areas that are 'deactivated' relative to rest. To test this model, functional magnetic resonance imaging data were acquired during a resting state, a perceptual task, and a semantic retrieval task. A network of left-hemisphere polymodal cortical regions showed higher signal values during the resting state than during the perceptual task but equal values during the resting and semantic conditions. This result is consistent with the proposal that perceptual tasks interrupt processes ongoing during rest that involve many of the same brain areas engaged during semantic retrieval. As further evidence for this model, the same network of brain areas was activated in two direct comparisons between semantic and perceptual processing tasks. This same 'conceptual processing' network was also identified in several previous studies that contrasted semantic and perceptual tasks or resting and active states. The model proposed here offers a unified account of these findings and may help to explain several unanticipated results from prior studies of semantic processing.

Language dominance and factors that influence language lateralization were investigated in right-handed, neurologically normal subjects (n = 100) and right-handed epilepsy patients (n = 50) using functional MRI. Increases in blood oxygenation-dependent signal during a semantic language activation task relative to a non-linguistic, auditory discrimination task provided an index of language system lateralization. As expected, the majority of both groups showed left hemisphere dominance, although a continuum of activation asymmetry was evident, with nearly all subjects showing some degree of right hemisphere activation. Using a categorical dominance classification, 94% of the normal subjects were considered left hemisphere dominant and 6% had bilateral, roughly symmetric language representation. None of the normal subjects had rightward dominance. There was greater variability of language dominance in the epilepsy group, with 78% showing left hemisphere dominance, 16% showing a symmetric pattern and 6% showing right hemisphere dominance. Atypical language dominance in the epilepsy group was associated with an earlier age of brain injury and with weaker right hand dominance. Language lateralization in the normal group was weakly related to age, but was not significantly related to sex, education, task performance or familial left-handedness.

Article abstract-We performed functional MRI (FMRI) in 22 consecutive epilepsy patients undergoing intracarotid amobarbital (Wada) testing and compared language lateralization measures obtained with the two procedures. FMRI used a single-word semantic decision task previously shown to activate lateralized language areas in normal adults. Correlation between the two tests was highly significant (r = 0.96; 95% CIS 0.90 to 0.98; p < 0.0001). These results validate the FMRI technique and suggest that "active" areas observed with this semantic processing task correspond to those underlying hemispheric dominance for language. The strong correlation observed supports the view that language lateralization is a continuous rather than a dichotomous variable. In addition to lateralization information, FMRI consistently demonstrated focal regions of activity in lateral frontal and temporo-parieto-occipital cortex. These functional maps may be helpful in defining the boundaries of surgical excisions. NEUROLOGY 1996;46:978-984 Localization of cortical functions in patients undergoing excisional brain surgery is useful in three ways: to predict the general level of risk should the planned excision proceed, to guide the surgeon in limiting the boundaries of the excision, and to help determine the location of abnormal brain areas (e.g., seizure foci) preoperatively. One commonly used localization technique is the intracarotid amobarbital, or Wada, test, which measures the relative lateralization of language and memory functions across the two hemispheres. Preoperative determination of language lateralization is important in selecting patients for more invasive and specific localization procedures, such as intraoperative stimulation mapping." Determination of language lateralization is particularly important in the preoperative evaluation of epilepsy patients, because this population may have a higher incidence of atypical language dominance than does the normal p o p~l a t i o n .~?~ Although there are several alternative methods for determining language d~m i n a n c e ,~,~ the Wada test remains the only method used routinely for this purpose.The Wada test, although a proven measure of language lateralization, has several important limitations. First, the required angiographic procedure is invasive, with reported complication rates of up to 3%1.8 Second, the test measures only the relative distribution of language across the two hemispheres. More specific information about localization within a hemisphere, which might be useful for tailoring an excision, must be obtained by other means, such as intraoperative stimulation mapping. Third, validity of the test depends on demonstration of relatively separate and symmetric arterial supply routes for the two hemispheres. Thus, interpretation of the test may not be straightforward or possible in patients with azygous supply patterns or arterial crossflow.!' Other methodologic drawbacks of the Wada test are limitations on the time available for testing distinct functions during the ...

Functional MRI (fMRI) was used to examine gender effects on brain activation during a language comprehension task. A large number of subjects (50 women and 50 men) was studied to maximize the statistical power to detect subtle differences between the sexes. To estimate the specificity of findings related to sex differences, parallel analyses were performed on two groups of randomly assigned subjects. Men and women showed very similar, strongly left lateralized activation patterns. Voxel-wise tests for group differences in overall activation patterns demonstrated no significant differences between women and men. In further analyses, group differences were examined by region of interest and by hemisphere. No differences were found between the sexes in lateralization of activity in any region of interest or in intrahemispheric cortical activation patterns. These data argue against substantive differences between men and women in the large-scale neural organization of language processes.