Introduction: To demonstrate the difference in language cortex reorganization between cerebral AVMs and gliomas by blood oxygen level-dependent (BOLD) functional magnetic resonance (fMR) imaging evaluation..
Methods: We retrospectively reviewed clinical and imaging data of 63 patients with unruptured cerebral AVMs (AVM Group) and 38 patients with gliomas (Glioma Group) who underwent fMR imaging studies. All patients were right-handed and all lesions were located in the left cerebral hemisphere. Patients were further categorized into subgroups according to lesion locations: BA Subgroup: overlying or adjacent to the inferior frontal or middle frontal gyri (Broca area); WA Subgroup: overlying or adjacent to supramarginal, angular, or superior temporal gyri (Wernicke area).
Results: In AVM Group, right-sided lateralization of BOLD signal activations was observed in 23 patients (36.5%), including 6 with right lateralization in the Broca area alone, 12 in the Wernicke area alone, and 5 in both areas. More specifically, in the 34 patients of AVM-BA Subgroup, right lateralization of Broca area was detected in 9 (26.5%) patients and right lateralization of Wernicke area was detected in 4 patients (11.8%); in the 29 patients of AVM-WA Subgroup, 2 (6.9%) had right lateralization of Broca area and 13 (44.8%) had right lateralization of Wernicke area. In Glioma Group, 6 patients (15.8%) showed right lateralization of Wernicke area, including 2 patients in Glioma-BA subgroup and 4 patients in Glioma-WA subgroup. No patient showed right-sided lateralization of Broca area. Moreover, although the incidence of right-sided lateralization is higher in low grade gliomas (5 in 26, 19.2%) than in high grade gliomas (1 in 12, 8.3%), no significant difference was detected between them (p=0.643). Compared with AVM Group, the incidence of aphasia is significantly higher (p<0.001) and right lateralization of language areas is significantly rarer (p=0.026) in Glioma Group.
Conclusions: The potential of reorganization for glioma patients appears to be insufficient compared with AVM patients, suggested by both clinical manifestations and fMR imaging findings. Moreover, our study seems to support that in AVM patients, the nidus near Broca area mainly lead to right-sided lateralization of Broca area, and nidus near Wernicke area mainly lead to right-sided lateralization of Wernicke area.
Patient Care: From this study,we found language cortex reorganization may occur in both AVM and glioma patients.However, the potential of reorganization for glioma patients appears to be insufficient compared with AVM patients.Moreover, our study seems to support that in AVM patients, the nidus near Broca area mainly lead to right-sided lateralization of Broca area, and nidus near Wernicke area mainly lead to right-sided lateralization of Wernicke area.
Learning Objectives: To demonstrate the difference in language cortex reorganization between cerebral AVMs and gliomas by blood oxygen level-dependent (BOLD) functional magnetic resonance (fMR) imaging evaluation.