Correlation between language function and the left arcuate fasciculus detected by diffusion tensor imaging tractography after brain tumor surgery

Clinical article

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Object

Disturbance of the arcuate fasciculus in the dominant hemisphere is thought to be associated with language-processing disorders, including conduction aphasia. Although the arcuate fasciculus can be visualized in vivo with diffusion tensor imaging (DTI) tractography, its involvement in functional processes associated with language has not been shown dynamically using DTI tractography. In the present study, to clarify the participation of the arcuate fasciculus in language functions, postoperative changes in the arcuate fasciculus detected by DTI tractography were evaluated chronologically in relation to postoperative changes in language function after brain tumor surgery.

Methods

Preoperative and postoperative arcuate fasciculus area and language function were examined in 7 right-handed patients with a brain tumor in the left hemisphere located in proximity to part of the arcuate fasciculus. The arcuate fasciculus was depicted, and its area was calculated using DTI tractography. Language functions were measured using the Western Aphasia Battery (WAB).

Results

After tumor resection, visualization of the arcuate fasciculus was increased in 5 of the 7 patients, and the total WAB score improved in 6 of the 7 patients. The relative ratio of postoperative visualized area of the arcuate fasciculus to preoperative visualized area of the arcuate fasciculus was increased in association with an improvement in postoperative language function (p = 0.0039).

Conclusions

The role of the left arcuate fasciculus in language functions can be evaluated chronologically in vivo by DTI tractography after brain tumor surgery. Because increased postoperative visualization of the fasciculus was significantly associated with postoperative improvement in language functions, the arcuate fasciculus may play an important role in language function, as previously thought. In addition, postoperative changes in the arcuate fasciculus detected by DTI tractography could represent a predicting factor for postoperative language-dependent functional outcomes in patients with brain tumor.

Abbreviations used in this paper:BOLD = blood oxygen level–dependent; DTI = diffusion tensor imaging; ROI = region of interest; RRAF = relative ratio of arcuate fasciculus; WAB = Western Aphasia Battery.

Article Information

Address correspondence to: Yutaka Hayashi, M.D., Department of Neurosurgery, Kanazawa University, 13-1 Takaramachi, Kanazawa 920-8641, Japan. email: yuh@ns.m.kanazawa-u.ac.jp.

Please include this information when citing this paper: published online August 31, 2012; DOI: 10.3171/2012.8.JNS12348.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Case 1. Magnetic resonance and tractography images of the arcuate fasciculus. Preoperative images. A: Axial contrast-enhanced T1-weighted image showing a ring-enhancing mass in the left frontal lobe. B: Coronal DTI tractography image demonstrating the right and left hemispheres of the arcuate fasciculus. C: Sagittal DTI tractography image of the right and left hemispheres. Postoperative images. D: Axial contrast-enhanced T1-weighted image showing total tumor resection. E: Coronal DTI tractography image showing the right and left hemispheres of the arcuate fasciculus. F: Sagittal DTI tractography image of the right and left hemispheres. Note that the area of the arcuate fasciculus in the left hemisphere increased postoperatively.

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    Graph of Pearson product-moment correlation coefficient analysis showing a positive correlation between postoperative changes in tractography-based visualization of the arcuate fasciculus and postoperative changes in the WAB score (p = 0.0039). Vertical axis indicates postoperative change in WAB score. Horizontal axis indicates postoperative change in visualization of the arcuate fasciculus depicted by tractography, represented by the postoperative RRAF. Peripheral lines indicate 95% confidence ellipsoid.

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