Accuracy of Presurgical Functional MR Imaging for Language Mapping of Brain Tumors: A Systematic Review and Meta-Analysis

Abstract

Purpose To compare functional magnetic resonance (MR) imaging for language mapping (hereafter, language functional MR imaging) with direct cortical stimulation (DCS) in patients with brain tumors and to assess factors associated with its accuracy. Materials and Methods PubMed/MEDLINE and related databases were searched for research articles published between January 2000 and September 2016. Findings were pooled by using bivariate random-effects and hierarchic summary receiver operating characteristic curve models. Meta-regression and subgroup analyses were performed to evaluate whether publication year, functional MR imaging paradigm, magnetic field strength, statistical threshold, and analysis software affected classification accuracy. Results Ten articles with a total of 214 patients were included in the analysis. On a per-patient basis, the pooled sensitivity and specificity of functional MR imaging was 44% (95% confidence interval [CI]: 14%, 78%) and 80% (95% CI: 54%, 93%), respectively. On a per-tag basis (ie, each DCS stimulation site or "tag" was considered a separate data point across all patients), the pooled sensitivity and specificity were 67% (95% CI: 51%, 80%) and 55% (95% CI: 25%, 82%), respectively. The per-tag analysis showed significantly higher sensitivity for studies with shorter functional MR imaging session times (P = .03) and relaxed statistical threshold (P = .05). Significantly higher specificity was found when expressive language task (P = .02), longer functional MR imaging session times (P < .01), visual presentation of stimuli (P = .04), and stringent statistical threshold (P = .01) were used. Conclusion Results of this study showed moderate accuracy of language functional MR imaging when compared with intraoperative DCS, and the included studies displayed significant methodologic heterogeneity. RSNA, 2017 Online supplemental material is available for this article.

Accuracy analysis of fMRI and MEG activations determined by intraoperative mapping

“…Previous research has shown that language fMRI mapping, in particular, can vary significantly due to varied statistical thresholds, imaging times, and specific language task being performed. 23 Nevertheless, the present study does provide valuable information as how the distance used has a profound impact on the accuracy measures that surgeons may take into account even without assuming the uniformity of their data to that of the present study.…”

Presurgical resting‐state functional MRI language mapping with seed selection guided by regional homogeneity

“…FMRI based on the measurement of BOLD contrast is one of the most widely applied non‐invasive techniques to localize eloquent cortices for presurgical planning . By intermittently engaging patients in task and control conditions, task‐based FMRI has been shown to correlate well with intraoperative direct cortical stimulation . However, its practicality for presurgical language mapping is compromised when patients have inadequate compliance because of impaired cognitive, perceptual, and/or motor functions .…”

“…1,2 By intermittently engaging patients in task and control conditions, task-based FMRI has been shown to correlate well with intraoperative direct cortical stimulation. 3,4 However, its practicality for presurgical language mapping is compromised when patients have inadequate compliance because of impaired cognitive, perceptual, and/or motor functions. 5,6 Resting-state FMRI (rs-FMRI) has been considered as an adjunct to task-based FMRI for presurgical evaluations because it provides a means of functional mapping without task engagements by measuring the distant synchronization of low-frequency BOLD oscillations throughout the brain.…”

Best practices for MRI systematic reviews and meta‐analyses

“…Magnetic resonance imaging (MRI) is a powerful diagnostic tool and with a wide array of clinical, mainly diagnostic, applications . While MRI‐guided procedures (interventional MRI) began in the 1990s, image‐guided interventions are still dominated by ultrasound, fluoroscopy, and computed tomography (CT) .…”

“…Magnetic resonance imaging (MRI) is a powerful diagnostic tool and with a wide array of clinical, mainly diagnostic, applications. [2][3][4][5][6][7][8][9][10] While MRI-guided procedures (interventional MRI) began in the 1990s, image-guided interventions are still dominated by ultrasound, fluoroscopy, and computed tomography (CT). 11 There are several challenges to MR-guided interventions, such as longer acquisition times, increased cost of MRI-safe equipment, and the technical complexity of performing a procedure within a superconducting MRI system.…”