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The number of TMS-induced speech disruptions and the volume of activation during functional MRI tasks were localized to Brodmann areas for each modality in 40 patients with epilepsy or brain tumor. We examined the concordance between TMS- and functional MRI\u2013derived language maps by deriving statistical performance metrics for TMS including sensitivity, specificity, accuracy, and diagnostic odds ratio. Brodmann areas 6, 44, and 9 in the frontal lobe and 22 and 40 in the temporal lobe were the most commonly identified language areas by both modalities. Overall accuracy of TMS compared to functional MRI in localizing language cortex was 71%, with a diagnostic odds ratio of 1.27 and higher sensitivity when identifying left hemisphere regions. TMS was more accurate in determining the dominant hemisphere for language with a diagnostic odds ratio of 6. This study is the first to examine the accuracy of the whole brain language map derived by TMS in the largest cohort examined to date. While this comparison against functional MRI confirmed that TMS reliably localizes cortical areas that are not essential for speech function, it demonstrated only slight concordance between TMS- and functional MRI\u2013derived language areas. That the localization of specific language cortices by TMS demonstrated low accuracy reveals a potential need to use concordant tasks between the modalities and other avenues for further optimization of TMS parameters.<\/jats:p>","DOI":"10.1177\/0883073820901415","type":"journal-article","created":{"date-parts":[[2020,3,3]],"date-time":"2020-03-03T04:17:10Z","timestamp":1583209030000},"page":"363-379","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":13,"title":["Concordance Between Transcranial Magnetic Stimulation and Functional Magnetic Resonance Imaging (MRI) Derived Localization of Language in a Clinical Cohort"],"prefix":"10.1177","volume":"35","author":[{"given":"Katherine","family":"Schiller","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Neurology, University of Tennessee Health Science Center, Memphis, TN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asim F.","family":"Choudhri","sequence":"additional","affiliation":[{"name":"Le Bonheur Children\u2019s Hospital, Le Bonheur Neuroscience Institute, Memphis, TN, USA"},{"name":"Department of Radiology, University of Tennessee Health Science Center, Memphis, TN, USA"},{"name":"Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamekia","family":"Jones","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Neurology, University of Tennessee Health Science Center, Memphis, TN, USA"},{"name":"Children\u2019s Foundation Research Institute, Le Bonheur Children\u2019s Hospital, Memphis, TN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christen","family":"Holder","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Neurology, University of Tennessee Health Science Center, Memphis, TN, USA"},{"name":"Le Bonheur Children\u2019s Hospital, Le Bonheur Neuroscience Institute, Memphis, TN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James W.","family":"Wheless","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Neurology, University of Tennessee Health Science Center, Memphis, TN, USA"},{"name":"Le Bonheur Children\u2019s Hospital, Le Bonheur Neuroscience Institute, Memphis, TN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0116-5785","authenticated-orcid":false,"given":"Shalini","family":"Narayana","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Neurology, University of Tennessee Health Science Center, Memphis, TN, USA"},{"name":"Le Bonheur Children\u2019s Hospital, Le Bonheur Neuroscience Institute, Memphis, TN, USA"},{"name":"Department of Neurobiology and Anatomy, University of Tennessee Health Science Center, Memphis, TN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2020,3,3]]},"reference":[{"key":"bibr1-0883073820901415","doi-asserted-by":"publisher","DOI":"10.1111\/epi.12544"},{"key":"bibr2-0883073820901415","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2016-311183"},{"key":"bibr3-0883073820901415","doi-asserted-by":"publisher","DOI":"10.1177\/0883073814553274"},{"key":"bibr4-0883073820901415","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000004650"},{"key":"bibr5-0883073820901415","doi-asserted-by":"publisher","DOI":"10.1016\/S0959-4388(00)00081-7"},{"key":"bibr6-0883073820901415","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroimage.2014.09.002"},{"key":"bibr7-0883073820901415","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinph.2013.08.015"},{"key":"bibr8-0883073820901415","doi-asserted-by":"publisher","DOI":"10.1007\/s11682-018-9921-1"},{"key":"bibr9-0883073820901415","unstructured":"Rezaie R, Schiller K, Embury L, Boop FA, Wheless JW. 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