School of Medicine, University of Utah, Salt Lake City, Utah, USA.
Interdepartmental Program in Neuroscience, University of Utah, Salt Lake City, Utah, USA.
Interv Neuroradiol. 2023 Oct;29(5):599-604. doi: 10.1177/15910199221121384. Epub 2022 Aug 17.
For patients with drug-resistant epilepsy, surgery may be effective in controlling their disease. Surgical evaluation may involve localization of the language areas using functional magnetic resonance imaging (fMRI) or Wada testing. We evaluated the accuracy of task-based fMRI versus Wada-based language lateralization in a cohort of our epilepsy patients.
In a single-center, retrospective analysis, we identified patients with medically intractable epilepsy who participated in presurgical language mapping (n = 35) with fMRI and Wada testing. Demographic variables and imaging metrics were obtained. We calculated the laterality index (LI) from task-evoked fMRI activation maps across language areas during auditory and reading tasks to determine lateralization. Possible scores for LI range from -1 (strongly left-hemisphere dominant) to 1 (strongly right-hemisphere dominant). Concordance between fMRI and Wada was estimated using Cohen's Kappa coefficient. Association between the LI scores from the auditory and reading tasks was tested using Spearman's rank correlation coefficient.
The fMRI-based laterality indices were concordant with results from Wada testing in 91.4% of patients during the reading task ( = .55) and 96.9% of patients during the auditory task ( = .79). The mean LIs for the reading and auditory tasks were -0.52 ± 0.43 and -0.68 ± 0.42, respectively. The LI scores for the language and reading tasks were strongly correlated, r(30) = 0.57 ( = 0.001).
Our findings suggest that fMRI is generally an accurate, low-risk alternative to Wada testing for language lateralization. However, when fMRI indicates atypical language lateralization (e.g., bilateral dominance), patients may benefit from subsequent Wada testing or intraoperative language mapping.
对于耐药性癫痫患者，手术可能有助于控制疾病。手术评估可能涉及使用功能磁共振成像（fMRI）或 Wada 测试定位语言区。我们评估了基于任务的 fMRI 与基于 Wada 的语言侧化在我们的癫痫患者队列中的准确性。
在一项单中心回顾性分析中，我们确定了接受 fMRI 和 Wada 测试的药物难治性癫痫患者（n=35），这些患者参与了术前语言定位。获取了人口统计学变量和影像学指标。我们从听觉和阅读任务中语言区的任务诱发 fMRI 激活图中计算了侧化的侧化指数（LI）。LI 的可能得分范围从-1（强烈左半球优势）到 1（强烈右半球优势）。使用 Cohen's Kappa 系数估计 fMRI 和 Wada 之间的一致性。使用 Spearman 等级相关系数检验听觉和阅读任务的 LI 评分之间的相关性。
在阅读任务（ = .55）和听觉任务（ = .79）中，fMRI 侧化指数与 Wada 测试结果在 91.4%和 96.9%的患者中一致。阅读和听觉任务的平均 LI 分别为-0.52±0.43 和-0.68±0.42。语言和阅读任务的 LI 评分呈强相关，r(30)=0.57（ = 0.001）。
我们的发现表明，fMRI 通常是 Wada 测试的一种准确、低风险的语言侧化替代方法。然而，当 fMRI 提示不典型的语言侧化（例如双侧优势）时，患者可能受益于随后的 Wada 测试或术中语言定位。
