The Arcuate Fasciculus and Language Development in a Cohort of Pediatric Patients with Malformations of Cortical Development

AJNR Am J Neuroradiol. 2016 Jan;37(1):169-75. doi: 10.3174/ajnr.A4461. Epub 2015 Sep 17.


Background and purpose: Patients with epilepsy and malformations of cortical development have a high prevalence of language deficits. The purpose of this study was to investigate whether the status of the arcuate fasciculus at diffusion tractography could provide a clinically meaningful marker of language function in patients with cortical malformations.

Materials and methods: Thirty-seven patients 3-18 years of age who had DTI performed at 3T and language evaluation by a pediatric neurologist were retrospectively identified. Twenty-two age-matched children without any neurologic, language, or MR imaging abnormalities who had identical DTI performed for an indication of headache were selected as a control cohort. The arcuate fasciculi were constructed and segmented by deterministic tractography for all subjects.

Results: Twenty-one patients had intact language; 11 had mild-to-moderate and 5, profound language impairment. All patients with normal language and all control subjects had an identifiable left arcuate. The left arcuate was absent in 11 patients; all 11 were language-impaired. Failure to identify the left arcuate was strongly associated with some degree of language impairment (P < .001). Sensitivity, specificity, and positive predictive value for language dysfunction were 65%, 100%, and 100%, respectively. The absence of the arcuate bilaterally was associated with complete failure to develop oral language (P < .015).

Conclusions: Failure to identify the left arcuate fasciculus at diffusion tractography was a highly specific marker of language dysfunction in a cohort of pediatric patients with malformations of cortical development. Failure to identify the arcuate fasciculus on either side was associated with failure to develop oral language.

MeSH terms

  • Adolescent
  • Arcuate Nucleus of Hypothalamus / abnormalities*
  • Arcuate Nucleus of Hypothalamus / pathology*
  • Brain Neoplasms / complications
  • Child
  • Child, Preschool
  • Cohort Studies
  • Diffusion Tensor Imaging*
  • Dominance, Cerebral / physiology
  • Epilepsy / diagnosis*
  • Epilepsy / pathology*
  • Female
  • Humans
  • Language Development Disorders / diagnosis*
  • Language Development Disorders / pathology*
  • Male
  • Malformations of Cortical Development / diagnosis*
  • Malformations of Cortical Development / pathology*
  • Retrospective Studies