Introduction and Aims: fMRI studies were successfully introduced into the armamentarium of neuroradiological MRI examinations in the past year at the Department of Neurosurgery and Neurointervention, Semmelweis University, Budapest, Hungary. Our goal is to present the rationales and initial qualitative results of our fMRI studies.

Methods: 18 patients underwent BOLD fMRI. NordicActiva was used for paradigm presentations and CE-marked NordicBrainEx for postprocessing. fMRI was performed in 17/18 patients to evaluate language functions including one patient with additional motor function assessment, while one patient had only motor function examination. Language paradigms included sentence completion, synonym generation, picture naming and passive story listening. Motor paradigms were finger tapping or tongue moving. Paradigms were explained in detail to the patients days before the fMRI, so that they could practice at home the different tasks to achieve optimal results.

Results: fMRI were performed due to the following MRI diagnoses: cavernoma, focal cortical dysplasia, infiltrating glioma/glioneuronal tumor, metastasis, cystic lesion and old ischemic stroke. Results could not be evaluated only in one case of a 7 yo child due to lack of cooperation. Language lateralisation could be obviously determined with the Broca area demonstrating much more prominent activity on the dominant side. For the Wernicke area, most patients showed bilateral but asymmetrical activity associated with the dominant hemisphere. Finger tapping resulted in robust signal in the precentral gyrus hand area, while tongue moving nicely showed activity in the lateral aspect of the precentral gyrus, as expected. BOLD activation map was routinely fused with 3D anatomical T1-weighted images, or in one cavernoma case with 3D SPACE to better visualise the distance between the hemosiderin ring and the activation.

Conclusion: Our current fMRI setting with the applied paradigms provides valuable and robust results demonstrating the Broca, Wernicke and primary motor areas in relation to the intracranial abnormalities. This information is indispensable for neurosurgeons to safely perform lesion resection with the preservation of language and motor function.

Funding: The authors have no conflicts of interest to declare.