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Arteriovenous Brain Malformations: Is Functional MR Imaging Reliable for Studying Language Reorganization in Patients? Initial Observations¹

¹ From the Departments of Neuroradiology (S.L., A.B., N.S., E.V., A.C., C.M.), Neurology (L. Cohen), Neurosurgery (M.V., L. Capelle, T.F.), and Biostatistics and Medical Informatics (S.T.d.M.), Hôpital de la Salpêtrière, 47 Boulevard de l’Hôpital, 75013 Paris, France; and Department of Medical Research, Service Hospitalier Frédéric Joliot, Orsay, and the IFR 49, France (S.L., D.L.B.). From the 2000 RSNA scientific assembly. Received April 16, 2001; revision requested May 25; final revision received November 8; accepted December 11. Supported in part by grants from the Délégation à la Recherche Clinique (DRC) and the Assistance Publique-Hôpitaux de Paris (CRC 96067). Address correspondence to S.L. (e-mail: stephane.lehericy@psl.ap-hop-paris.fr).

PURPOSE: To determine whether the blood flow abnormalities frequently associated with arteriovenous malformations (AVMs) can alter functional magnetic resonance (MR) imaging evaluation of language lateralization and whether reorganization of language function occurs in patients with brain AVMs.

MATERIALS AND METHODS: Eleven patients with left-hemisphere brain AVMs and 10 age-matched control subjects were examined with 1.5-T blood oxygen level–dependent (BOLD) functional MR imaging. Verbal fluency, sentence repetition, and story listening tasks were performed. The functional MR imaging laterality index in the frontal and temporal lobes was defined as the (L - R)/(L + R) ratio, where L and R are the numbers of activated pixels in the left and right hemispheres, respectively. Statistical analyses were performed with Wilcoxon signed rank, Fisher exact, and Kruskal-Wallis tests.

RESULTS: Control subjects had left-sided language dominance, although symmetric pixel counts were observed in the frontal lobes in two subjects and in the temporal lobes in one subject. Six patients had left-sided language dominance similar to that observed in control subjects. Five of these patients had AVMs outside frontal or temporal language areas, without flow abnormalities. Five patients had abnormally right-sided asymmetric indexes (below mean control subject value - 2 SDs), which suggested language reorganization (P < .05). Results of Wada examination and/or postembolization functional MR imaging performed in two of these patients showed that the abnormal laterality indexes were at least partly due to severe flow abnormalities that impaired detection of BOLD MR imaging signal intensity.

CONCLUSION: These data suggest that flow abnormalities may interfere with language lateralization assessment with functional MR imaging.

© RSNA, 2002

Index terms: Arteriovenous malformations, cerebral, 13.75, 13.76 • Brain, function • Brain, MR, 13.121412, 13.121413, 13.121416, 13.12144 • Magnetic resonance (MR), functional imaging, 13.12144

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