Boerwinkle Varina L, Nowlen Mary A, Vazquez Jesus E, Arhin Martin A, Reuther William R, Cediel Emilio G, McCarty Patrick J, Manjón Iliana, Jubran Jubran H, Guest Ashley C, Gillette Kirsten D, Nowlen Frances M, Pines Andrew R, Kazemi Meitra H, Qaqish Bahjat F
Division of Child Neurology, University of North Carolina, School of Medicine, Chapel Hill, NC, United States.
Department of Obstetrics and Gynecology, Banner University Medical Center, Phoenix, AZ, United States.
Front Neuroimaging. 2024 Dec 17;3:1481858. doi: 10.3389/fnimg.2024.1481858. eCollection 2024.
Resting-state functional MRI (rs-fMRI) may localize the seizure onset zone (SOZ) for epilepsy surgery, when compared to intracranial EEG and surgical outcomes, per a prior meta-analysis. Our goals were to further characterize this agreement, by broadening the queried rs-fMRI analysis subtypes, comparative modalities, and same-modality comparisons, hypothesizing SOZ-signal strength may overcome this heterogeneity.
PubMed, Embase, Scopus, Web of Science, and Google Scholar between April 2010 and April 2020 via PRISMA guidelines for SOZ-to-established-modalities were screened. Odd ratios measured agreement between SOZ and other modalities. Fixed- and random-effects analyses evaluated heterogeneity of odd ratios, with the former evaluating differences in agreement across modalities and same-modality studies.
In total, 9,550 of 14,384 were non-duplicative articles and 25 met inclusion criteria. Comparative modalities were EEG 7, surgical outcome 6, intracranial EEG 5, anatomical MRI 4, EEG-fMRI 2, and magnetoencephalography 1. Independent component analysis 9 and seed-based analysis 8 were top rs-fMRI methods. Study-level odds ratio heterogeneity in both the fixed- and random-effects analysis was significant ( < 0.001). Marked cross-modality and same-modality systematic differences in agreement between rs-fMRI and the comparator were present ( = 0.005 and = 0.002), respectively, with surgical outcomes having higher agreement than EEG ( = 0.002) and iEEG ( = 0.007). The estimated population mean sensitivity and specificity were 0.91 and 0.09, with predicted values across studies ranging from 0.44 to 0.96 and 0.02 to 0.67, respectively.
We evaluated centrality and heterogeneity in SOZ agreement between rs-fMRI and comparative modalities using a wider variety of rs-fMRI analyzing subtypes and comparative modalities, compared to prior. Strong evidence for between-study differences in the agreement odds ratio was shown by both the fixed- and the random-effects analyses, attributed to rs-fMRI analysis variability. Agreement with rs-fMRI differed by modality type, with surgical outcomes having higher agreement than EEG and iEEG. Overall, sensitivity was high, but specificity was low, which may be attributed in part to differences between other modalities.
根据先前的一项荟萃分析，与颅内脑电图和手术结果相比，静息态功能磁共振成像（rs-fMRI）可能会定位癫痫手术的癫痫发作起始区（SOZ）。我们的目标是通过扩大所查询的rs-fMRI分析亚型、比较方式以及同方式比较来进一步描述这种一致性，假设SOZ信号强度可能会克服这种异质性。
根据PRISMA指南，对2010年4月至2020年4月期间PubMed、Embase、Scopus、Web of Science和谷歌学术中关于SOZ与既定方式的研究进行筛选。比值比用于衡量SOZ与其他方式之间的一致性。固定效应和随机效应分析评估比值比的异质性，前者评估不同方式和同方式研究之间一致性的差异。
总共14384篇文章中有9550篇为非重复文章，25篇符合纳入标准。比较方式包括脑电图7篇、手术结果6篇、颅内脑电图5篇、解剖磁共振成像4篇、脑电图-功能磁共振成像2篇和脑磁图1篇。独立成分分析9篇和基于种子点的分析8篇是主要的rs-fMRI方法。固定效应和随机效应分析中研究水平的比值比异质性均具有显著性（<0.001）。rs-fMRI与比较方式之间在一致性方面存在明显的跨方式和同方式系统差异（分别为=0.005和=0.002），手术结果的一致性高于脑电图（=0.002）和颅内脑电图（=0.007）。估计总体平均敏感性和特异性分别为0.91和0.09，各研究的预测值范围分别为0.44至0.96和0.02至0.67。
与之前相比，我们使用了更广泛的rs-fMRI分析亚型和比较方式，评估了rs-fMRI与比较方式之间在SOZ一致性方面的中心性和异质性。固定效应和随机效应分析均显示了研究间一致性比值比差异的有力证据，这归因于rs-fMRI分析的变异性。与rs-fMRI的一致性因方式类型而异，手术结果的一致性高于脑电图和颅内脑电图。总体而言，敏感性较高，但特异性较低，这可能部分归因于其他方式之间的差异。
