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Functional MRI and electrical stimulation mapping for language localization: A comparative meta-analysis.

Timothy Holloway1, James L Leach2, Jeffrey R Tenney3

  • 1Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.

Clinical Neurology and Neurosurgery
|September 1, 2022
PubMed
Summary
This summary is machine-generated.

Functional magnetic resonance imaging (fMRI) shows moderate accuracy for pre-surgical language mapping compared to electrical stimulation mapping (ESM). However, due to heterogeneity and confidence intervals near the line of no effect, fMRI alone is not yet sufficient for guiding neurosurgical decisions.

Keywords:
Brain tumorsDrug-resistant epilepsyFunctional brain mappingLanguage mappingNeurosurgery

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Area of Science:

  • Neuroimaging
  • Neurosurgery
  • Diagnostic accuracy

Background:

  • Pre-surgical language mapping is crucial for neurosurgical planning.
  • Functional magnetic resonance imaging (fMRI) and electrical stimulation mapping (ESM) are key techniques for this purpose.
  • Evaluating the comparative diagnostic validity of fMRI and ESM is essential for optimizing patient outcomes.

Approach:

  • A systematic review and meta-analysis were conducted to assess diagnostic validity.
  • Nine studies comparing fMRI and ESM at the electrode level for language localization were analyzed.
  • Pooled estimates of diagnostic odds ratio (DOR), sensitivity, and specificity were calculated, with heterogeneity explored via meta-regression.

Key Points:

  • Pooled sensitivity for fMRI was 0.71 (95% CI 0.54–0.83) and specificity was 0.74 (95% CI 0.58–0.85), with a DOR of 7.0 (95% CI 3.5–13.8).
  • Significant heterogeneity was observed across studies, impacting the reliability of pooled estimates.
  • Higher sensitivity of fMRI was noted in studies employing higher maximal ESM currents.

Conclusions:

  • fMRI demonstrates moderate sensitivity and specificity for language localization when compared to ESM in well-designed studies.
  • However, confidence intervals close to the line of no effect and substantial unmeasured heterogeneity suggest caution.
  • Currently, fMRI should not be used as the sole modality for language localization in neurosurgical decision-making.