Analysis of lesions in patients with unilateral tactile agnosia using cytoarchitectonic probabilistic maps

We propose a novel methodical approach to lesion analyses involving high-resolution MR images in combination with probabilistic cytoarchitectonic maps. 3D-MR images of the whole brain and the manually segmented lesion mask are spatially normalized to the reference brain of a stereotaxic probabilistic cytoarchitectonic atlas using a multiscale registration algorithm based on an elastic model. The procedure is demonstrated in three patients suffering from aperceptive tactile agnosia of the right hand due to chronic infarction of the left parietal cortex. Patient 1 presents a lesion in areas of the postcentral sulcus, Patient 3 in areas of the superior parietal lobule and adjacent intraparietal sulcus, and Patient 2 lesions in both regions. On the basis of neurobehavioral data, we conjectured degradation of sequential elementary sensory information processing within the postcentral gyrus, impeding texture recognition in Patients 1 and 2, and disturbed kinaesthetic information processing in the posterior parietal lobe, causing degraded shape recognition in the patients 2 and 3. The involvement of Brodmann areas 4a, 4p, 3a, 3b, 1, 2, and areas IP1 and IP2 of the intraparietal sulcus was assessed in terms of the voxel overlap between the spatially transformed lesion masks and the 50%-isocontours of the cytoarchitectonic maps. The disruption of the critical cytoarchitectonic areas and the impaired subfunctions, texture and shape recognition, relate as conjectured above. We conclude that the proposed method represents a promising approach to hypothesis-driven lesion analyses, yielding lesion-function correlates based on a cytoarchitectonic model. Finally, the lesion-function correlates are validated by functional imaging reference data.