Introduction Functional MRI (fMRI) can assess language lateralization in brain tumor patients; however, this can be limited if the primary language area—Broca's area (BA)—is affected by the tumor. We hypothesized that the middle frontal gyrus (MFG) can be used as a clinical indicator of hemispheric dominance for language during presurgical workup. Methods Fifty-two right-handed subjects with solitary left-hemispheric primary brain tumors were retrospectively studied. Subjects performed a verbal fluency task during fMRI. The MFG was compared to BA for fMRI voxel activation, language laterality index (LI), and the effect of tumor grade on the LI. Results Language fMRI (verbal fluency) activated more voxels in MFG than in BA (MFG = 315, BA = 216, p < 0.001). Voxel activations in the left-hemispheric MFG and BA were positively correlated (r = 0.69, p < 0.001). Mean LI in the MFG was comparable to that in BA (MFG = 0.48, BA = 0.39, p = 0.06). LIs in MFG and BA were positively correlated (r = 0.62, p < 0.001). Subjects with high-grade tumors demonstrate lower language lateralization than those with low-grade tumors in both BA and MFG (p = 0.02, p = 0.02, respectively). Conclusion MFG is comparable to BA in its ability to indicate hemispheric dominance for language using a measure of verbal fluency and may be an adjunct measure in the clinical determination of language laterality for presurgical planning.

Our results demonstrate that olivary degeneration, with or without hypertrophy, is a relatively frequent consequence of posterior fossa surgery, particularly in children treated for high-grade tumours. Knowledge of this condition can prevent misdiagnoses and unnecessary investigations.

ss-FLAIR sequence may be useful to detect intraventricular anomalies especially when fetal position or maternal obesity prevents adequate visualization by ultrasound.

To assess the role of fetal magnetic resonance imaging (MRI) in detecting associated anomalies in fetuses presenting with isolated severe ventriculomegaly (VM) undergoing multiplanar ultrasound (US) evaluation of fetal brain. Methods: Multicentre, retrospective, cohort study involving eight referral fetal medicine centres in Italy, United Kingdom and Spain. Inclusion criteria were fetuses affected by isolated severe (>15mm) VM on US, defined as VM with normal karyotype and no other additional CNS and extra-CNS anomalies on US, undergoing detailed assessment of fetal brain via a multiplanar approach as suggested by ISUOG guidelines on fetal neurosonogram. The primary outcome of the study was to report the rate of additional CNS anomalies detected exclusively at prenatal MRI and missed at US. Results: 43 fetuses with a prenatal diagnosis of isolated severe VM on US were included in the analysis. Additional structural anomalies were detected at prenatal MRI and missed at US in 23.3% (95% CI 13.1-37.8) of cases. When considering the type of anomalies, midline (mostly hypoplasia of the corpus callosum) and cortical anomalies were both detected only on MRI in 40.0% of fetuses, while supratentorial intracranial hemorrhage was detected on MRI in 20.0% of fetuses, and polymicrogyria and periventricular heterotopia in 10.0%. The results of the logistic regression analysis showed that bilateral rather than unilateral severe VM (OR: 4.3, 95% CI 3.7-5.2, p < 0.001) and the degree of ventricular dilatation (OR: 1.5, 95% CI 1.2-1.5, p < 0.001 each mm of dilatation) were indipendently associated with the probability of detecting associated anomalies only at MRI. Conclusions: Although the rate of associated fetal anomalies missed at neurosonography and detected only at fetal MRI in fetuses with isolated severe VM is lower than that previously reported, the findings from this study support the practice of MRI assessment in every fetus with a prenatal diagnosis of severe VM.