Evaluating the arcuate fasciculus with combined diffusion-weighted MRI tractography and electrocorticography.

The conventional model of language-related brain structure describing the arcuate fasciculus as a key white matter tract providing a direct connection between Wernicke's region and Broca's area has been called into question. Specifically, the inferior precentral gyrus, possessing both primary motor (Brodmann Area [BA] 4) and premotor cortex (BA 6), has been identified as a potential alternative termination. The authors initially localized cortical sites involved in language using measurement of event-related gamma-activity on electrocorticography (ECoG). The authors then determined whether language-related sites of the temporal lobe were connected, via white matter structures, to the inferior frontal gyrus more tightly than to the precentral gyrus. The authors found that language-related sites of the temporal lobe were far more likely to be directly connected to the inferior precentral gyrus through the arcuate fasciculus. Furthermore, tractography was a significant predictor of frontal language-related ECoG findings. Analysis of an interaction between anatomy and tractography in this model revealed tractrography to have the highest predictive value for language-related ECoG findings of the precentral gyrus. This study failed to support the conventional model of language-related brain structure. More feasible models should include the inferior precentral gyrus as a termination of the arcuate fasciculus. The exact functional significance of direct connectivity between temporal language-related sites and the precentral gyrus requires further study.