Under which Condition can fMRI Replace the Intracarotid Amobarbital Procedure (IAP) for Presurgical Language Lateralization?

Introduction: There is a large body of evidence showing that functional magnetic resonance imaging (fMRI) is able to lateralize cortical language representations. Across activation protocols, many studies show good congruence of fMRI-based language lateralization with the gold standard, IAP. However, in up to 25% of patients, fMRI and IAP are discordant. This can be due to a variety of factors. Hence, we developed a simple algorithm that identifies individuals with one strongly dominant hemisphere in whom fMRI can actually replace IAP for language lateralization. Patients and Methods: Forty-five patients with ph…