Note: This Copy Is for Your Personal, Non-commercial Use Only. to Order Presentation-ready Copies for Distribution to Your Colleagues or Clients, Contact Us at Www.rsna.org/rsnarights. Materials and Methods

PURPOSE To perform a systematic review and meta-analysis to quantitatively assess functional magnetic resonance (MR) imaging lateralization of language function in comparison with the Wada test. MATERIALS AND METHODS This study was determined to be exempt from review by the institutional review board. A systematic review and meta-analysis were performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A structured Medline search was conducted to identify all studies that compared functional MR imaging with the Wada test for determining hemispheric language dominance prior to brain surgery. Studies meeting predetermined inclusion criteria were selected independently by two radiologists who also assessed their quality using the Quality Assessment of Diagnostic Accuracy Studies tool. Language dominance was classified as typical (left hemispheric language dominance) or atypical (right hemispheric language dominance or bilateral language representation) for each patient. A meta-analysis was then performed by using a bivariate random-effects model to derive estimates of sensitivity and specificity, with Wada as the standard of reference. Subgroup analyses were also performed to compare the different functional MR imaging techniques utilized by the studies. RESULTS Twenty-three studies, comprising 442 patients, met inclusion criteria. The sensitivity and specificity of functional MR imaging for atypical language dominance (compared with the Wada test) were 83.5% (95% confidence interval: 80.2%, 86.7%) and 88.1% (95% confidence interval: 87.0%, 89.2%), respectively. CONCLUSION Functional MR imaging provides an excellent, noninvasive alternative for language lateralization and should be considered for the initial preoperative assessment of hemispheric language dominance. Further research may help determine which functional MR methods are most accurate for specific patient populations.

[1]  P. Bossuyt,et al.  BMC Medical Research Methodology , 2002 .

[2]  J. A. Frost,et al.  Determination of language dominance using functional MRI , 1996, Neurology.

[3]  S. Sato,et al.  Language dominance in partial epilepsy patients identified with an fMRI reading task , 2002, Neurology.

[4]  B. Abou-Khalil.  An Update on Determination of Language Dominance in Screening for Epilepsy Surgery: The Wada Test and Newer Noninvasive Alternatives , 2007, Epilepsia.

[5]  J. E Adcock,et al.  Quantitative fMRI assessment of the differences in lateralization of language-related brain activation in patients with temporal lobe epilepsy , 2003, NeuroImage.

[6]  Byron Bernal,et al.  Role of functional MR in determining language dominance in epilepsy and nonepilepsy populations: a Bayesian analysis. , 2007, Radiology.

[7]  R T Constable,et al.  Functional MRI of Language Processing: Dependence on Input Modality and Temporal Lobe Epilepsy , 2001, Epilepsia.

[8]  J. Hirsch,et al.  An Integrated Functional Magnetic Resonance Imaging Procedure for Preoperative Mapping of Cortical Areas Associated with Tactile, Motor, Language, and Visual Functions , 2000, Neurosurgery.

[9]  V. Haughton,et al.  Functional MR of frontal lobe activation: comparison with Wada language results. , 1998, AJNR. American journal of neuroradiology.

[10]  D. Le Bihan,et al.  Noninvasive assessment of language dominance in children and adolescents with functional MRI , 1997, Neurology.

[11]  G. Vingerhoets,et al.  MRI language dominance assessment in epilepsy patients at 1.0 T: region of interest analysis and comparison with intracarotid amytal testing , 2004, Neuroradiology.

[12]  G. Alarcón,et al.  Presurgical assessment of memory-related brain structures: the Wada test and functional neuroimaging , 2003, Seizure.

[13]  K. Radhakrishnan,et al.  Real-time functional MR imaging (fMRI) for presurgical evaluation of paediatric epilepsy , 2007, Pediatric Radiology.

[14]  Jerzy P. Szaflarski,et al.  Comprehensive presurgical functional MRI language evaluation in adult patients with epilepsy , 2008, Epilepsy & Behavior.

[15]  Michael P. Kaschak,et al.  Neuroimaging studies of language production and comprehension. , 2003, Annual review of psychology.

[16]  X. Gao,et al.  Determination of the dominant language hemisphere by functional MRI in patients with temporal lobe epilepsy. , 2001, Chinese medical journal.

[17]  Stephen M. Rao,et al.  Human Brain Language Areas Identified by Functional Magnetic Resonance Imaging , 1997, The Journal of Neuroscience.

[18]  J. Kassubek,et al.  Determination of hemisphere dominance for language: comparison of frontal and temporal fMRI activation with intracarotid amytal testing , 2002, Neuroradiology.

[19]  W. Scoville,et al.  LOSS OF RECENT MEMORY AFTER BILATERAL HIPPOCAMPAL LESIONS , 1957, Journal of neurology, neurosurgery, and psychiatry.

[20]  M. George,et al.  Comparison of functional magnetic resonance imaging for language localization and intracarotid speech amytal testing in presurgical evaluation for intractable epilepsy. Preliminary results. , 1997, Stereotactic and functional neurosurgery.

[21]  Johannes B Reitsma,et al.  Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews. , 2005, Journal of clinical epidemiology.

[22]  T. L. Davis,et al.  Language dominance determined by whole brain functional MRI in patients with brain lesions , 1999, Neurology.

[23]  A. Agresti,et al.  Approximate is Better than “Exact” for Interval Estimation of Binomial Proportions , 1998 .

[24]  O. Devinsky,et al.  Anterior temporal language areas in patients with early onset of temporal lobe epilepsy , 1993, Annals of neurology.

[25]  K Kuppusamy,et al.  Localization of language cortices by functional MR imaging compared with intracarotid amobarbital hemispheric sedation. , 1997, AJR. American journal of roentgenology.

[26]  D Le Bihan,et al.  Functional MR evaluation of temporal and frontal language dominance compared with the Wada test , 2000, Neurology.

[27]  P Kahane,et al.  Functional MRI assessment of the hemispheric predominance for language in epileptic patients using a simple rhyme detection task. , 2001, Epileptic disorders : international epilepsy journal with videotape.

[28]  G. J. M. Rutten,et al.  fMRI-Determined Language Lateralization in Patients with Unilateral or Mixed Language Dominance According to the Wada Test , 2002, NeuroImage.

[29]  Eugen Trinka,et al.  Language Lateralization in Temporal Lobe Epilepsy: A Comparison between fMRI and the Wada Test , 2006, Epilepsia.

[30]  F. Woermann,et al.  Language lateralization by Wada test and fMRI in 100 patients with epilepsy , 2003, Neurology.

[31]  Stefan Klöppel,et al.  Alternatives to the Wada test: a critical view of functional magnetic resonance imaging in preoperative use , 2005, Current opinion in neurology.

[32]  J. Binder,et al.  Use of preoperative functional MRI to predict verbal memory decline after temporal lobe epilepsy surgery , 2008, Epilepsia.

[33]  John S Duncan,et al.  Functional magnetic resonance imaging for assessment of language and memory in clinical practice: review , 2005, Current opinion in neurology.

[34]  S. Baxendale.  The Wada test , 2009, Current opinion in neurology.

[35]  B. Devaux,et al.  Functional MR Imaging in Assessment of Language Dominance in Epileptic Patients , 2003 .

[36]  M. Brázdil,et al.  fMRI evaluation of hemispheric language dominance using various methods of laterality index calculation , 2007, Experimental Brain Research.

[37]  D. Moher,et al.  Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement , 2009, BMJ.

[38]  J. Duncan,et al.  Evidence-based practice: a reevaluation of the intracarotid amobarbital procedure (Wada test). , 2008, Archives of neurology.

[39]  J. Schramm,et al.  Interhemispheric dissociation of expressive and receptive language functions in patients with complex-partial seizures: An amobarbital study , 1992, Brain and Language.

[40]  J. M. Watson,et al.  Evaluating functional MRI procedures for assessing hemispheric language dominance in neurosurgical patients , 2005, Neuroradiology.

[41]  S. Sato,et al.  fMRI language task panel improves determination of language dominance , 2004, Neurology.

[42]  Alan Connelly,et al.  A Direct Test for Lateralization of Language Activation using fMRI: Comparison with Invasive Assessments in Children with Epilepsy , 2002, NeuroImage.