Metwali Hussam, Raemaekers Mathijs, Kniese Katja, Kardavani Babak, Fahlbusch Rudolf, Samii Amir
International Neuroscience Institute, Hannover, Germany; Leibniz Institute for Neurobiology, Magdeburg, Germany; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
World Neurosurg. 2019 May;125:183-190. doi: 10.1016/j.wneu.2019.01.194. Epub 2019 Feb 8.
Formal studies that validated functional magnetic resonance imaging (fMRI) against direct cortical stimulation (DCS) have shown inconsistencies.
We reviewed the reported data and performed a meta-analysis of studies that had validated fMRI using DCS and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We performed the meta-analysis of the studies that had met our inclusion criteria. The positive predictive values (PPVs), negative predictive values (NPVs), false omission rates (FORs), false discovery rates (FDRs), sensitivity, and specificity were calculated. We also identified the factors that could influence the fMRI findings.
Six studies of language activation and two of motor activation were eligible for the present meta-analysis. The PPV of fMRI for the detection of eloquent motor cortex was 59.5%, and the FDR was 40.5%. The NPV was 96% and the FOR was 3.9%. The sensitivity and specificity of fMRI for the detection of the eloquent motor cortex was 91% and 76%, respectively. For language activation, the PPV was 71.7%, the NPV was 80%, the FDR was 28.2%, and the FOR was 19.5%. The sensitivity and specificity was 80% and 71.5%, respectively. The factors that could have caused a mismatch or affected the reliability were analyzed.
The results from the present analysis of the available reported evidence suggest that fMRI itself (due to neurovascular uncoupling) or analysis of the findings have limitations regarding reliability when validated against DCS. From the existing studies, our results indicate that using fMRI alone for surgical planning could lead to undesirable outcomes.
通过直接皮质刺激（DCS）验证功能磁共振成像（fMRI）的正式研究结果并不一致。
我们回顾了已发表的数据，并根据系统评价和Meta分析的首选报告项目指南，对使用DCS验证fMRI的研究进行了Meta分析。我们对符合纳入标准的研究进行了Meta分析。计算了阳性预测值（PPV）、阴性预测值（NPV）、漏检率（FOR）、假发现率（FDR）、敏感性和特异性。我们还确定了可能影响fMRI结果的因素。
六项语言激活研究和两项运动激活研究符合本次Meta分析的条件。fMRI检测明确运动皮质的PPV为59.5%，FDR为40.5%。NPV为96%，FOR为3.9%。fMRI检测明确运动皮质的敏感性和特异性分别为91%和76%。对于语言激活，PPV为71.7%，NPV为80%，FDR为28.2%，FOR为19.5%。敏感性和特异性分别为80%和71.5%。分析了可能导致不匹配或影响可靠性的因素。
对现有已发表证据的本次分析结果表明，在与DCS验证时，fMRI本身（由于神经血管解耦）或结果分析在可靠性方面存在局限性。从现有研究来看，我们的结果表明，仅使用fMRI进行手术规划可能会导致不良后果。
