Changes in regional cerebral blood flow in the right cortex homologous to left language areas are directly affected by left hemispheric damage in aphasic stroke patients: evaluation by Tc-ECD SPECT and novel analytic software

Background: The objective of this study was to clarify the influence of regional cerebral blood flow (rCBF) changes in language-relevant areas of the dominant hemisphere on rCBF in each region in the non-dominant hemisphere in post-stroke aphasic patients. Methods: The study subjects were 27 aphasic patients who suffered their first symptomatic stroke in the left hemisphere. In each subject, we measured rCBF by means of 99mTc-ethylcysteinate dimmer single photon emission computed tomography (SPECT). The SPECT images were analyzed by the statistical imaging analysis programs easy Z-score Imaging System (eZIS) and voxel-based stereotactic extraction estimation (vbSEE). Segmented into Brodmann Area (BA) levels, Regions of Interest (ROIs) were set in language-relevant areas bilaterally, and changes in the relative rCBF as average negative and positive Z-values were computed fully automatically. To assess the relationship between rCBF changes of each ROIs in the left and right hemispheres, the Spearman ranked correlation analysis and stepwise multiple regression analysis were applied. Results: Globally, a negative and asymmetric influence of rCBF changes in the language-relevant areas of the dominant hemisphere on the right hemisphere was found. The rCBF decrease in left BA22 significantly influenced the rCBF increase in right BA39, BA40, BA44 and BA45. Conclusions: The results suggested that the chronic increase in rCBF in the right language-relevant areas is due at least in part to reduction in the trancallosal inhibitory activity of the language-dominant left hemisphere caused by the stroke lesion itself and that these relationships are not always symmetric.