磁共振功能成像与 Wada 试验在颞叶癫痫患者记忆侧化中的一致性：荟萃分析和系统评价。

Concordance between fMRI and Wada test for memory lateralization in temporal lobe epilepsy: A meta-analysis and systematic review.

机构信息

Department of Neurology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.

Science Right Research Consulting, London, Ontario, Canada.

出版信息

Epilepsy Behav. 2020 Jun;107:107065. doi: 10.1016/j.yebeh.2020.107065. Epub 2020 Apr 7.

DOI:10.1016/j.yebeh.2020.107065

PMID:32276205

Abstract

OBJECTIVE

The Wada test (WT) is increasingly being replaced by functional magnetic resonance imaging (fMRI) to evaluate memory lateralization before temporal lobe epilepsy (TLE) surgery. We aimed to determine, via meta-analysis, agreement between the two tests and identify predictors of disagreement.

METHODS

We performed a systematic search for studies comparing WT and fMRI for memory lateralization with individual-patient data. If results were provided as laterality indexes instead of hemispheric lateralization, the cutoff point for memory lateralization was set to the usual ±2 for WT and ±0.20 for fMRI. We also evaluated results at our Epilepsy Center.

RESULTS

Seven published series plus our own were included, comprising 124 patients. Wada test was performed by recognizing objects in half of the studies, and scenes, drawings, and words in the rest. All used scenes or pictures encoding for fMRI. Wada test-fMRI agreement across the studies ranged from 21.1 to 100%, averaging 46.8% (95% confidence interval [CI]: 37.6-56.0%). When cases with bilateral memory in either test were excluded, agreement reached 78.7% (95% CI: 67.6-89.8%), and concordance with contralateral TLE foci 86.4% for the WT and 83.0% for fMRI. Higher agreement was associated with using multiple items during WT (p = 0.001) and higher disagreement with presence of a lesion on MRI (p = 0.024). Binary logistic regression confirmed use of multiple items on WT as the strongest predictor of agreement (odds ratio [OR]: 6.95, 95% CI: 1.84-26.22; p = 0.004) and a bilateral result on the WT or fMRI of disagreement (OR: 0.24, 95% CI: 0.07-0.89 and OR: 0.12, 95% CI: 0.03-0.45; p < 0.05).

CONCLUSION

Concordance between WT and fMRI for memory lateralization is low in patients with TLE and bilateral memoryl memory distribution or a structural etiology, and it improves with encoding of a varied set of items. Both tests can help to lateralize the TLE foci.

摘要

目的

在颞叶癫痫（TLE）手术前，越来越多的人采用功能磁共振成像（fMRI）替代瓦达测试（WT）来评估记忆侧化。本研究旨在通过荟萃分析确定这两种测试之间的一致性，并确定不一致的预测因素。

方法

我们系统性地检索了比较 WT 和 fMRI 用于记忆侧化的个体患者数据的研究。如果研究结果以侧化指数而不是半球侧化表示，则将 WT 的记忆侧化截断点设置为通常的±2，而 fMRI 的截断点设置为±0.20。我们还评估了我们癫痫中心的结果。

结果

共纳入了 7 项已发表的系列研究加我们自己的研究，共包括 124 例患者。有一半的研究通过识别物体来进行 WT，另一半则通过场景、绘图和单词进行。所有研究均使用场景或图片进行 fMRI 编码。研究中 WT-fMRI 的一致性范围为 21.1%至 100%，平均为 46.8%（95%置信区间[CI]：37.6-56.0%）。当排除两种测试中均存在双侧记忆的病例时，一致性达到 78.7%（95%CI：67.6-89.8%），与 WT 对侧 TLE 病灶的一致性为 86.4%，与 fMRI 的一致性为 83.0%。更高的一致性与 WT 中使用多种项目有关（p=0.001），而与 MRI 上存在病变有关（p=0.024）。二元逻辑回归证实，WT 中使用多种项目是一致性的最强预测因素（比值比[OR]：6.95，95%CI：1.84-26.22；p=0.004），WT 或 fMRI 双侧结果是不一致的预测因素（OR：0.24，95%CI：0.07-0.89 和 OR：0.12，95%CI：0.03-0.45；p<0.05）。