title: Is functional MR imaging assessment of hemispheric language dominance as good as the Wada test?: a meta-analysis.
abstract: OBJECTIVE
  To perform a systematic review and meta-analysis to quantitatively assess functional magnetic resonance (MR) imaging lateralization of language function in comparison with the Wada test.
  
  
  METHODS
  This study was determined to be exempt from review by the institutional review board. A systematic review and meta-analysis were performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A structured Medline search was conducted to identify all studies that compared functional MR imaging with the Wada test for determining hemispheric language dominance prior to brain surgery. Studies meeting predetermined inclusion criteria were selected independently by two radiologists who also assessed their quality using the Quality Assessment of Diagnostic Accuracy Studies tool. Language dominance was classified as typical (left hemispheric language dominance) or atypical (right hemispheric language dominance or bilateral language representation) for each patient. A meta-analysis was then performed by using a bivariate random-effects model to derive estimates of sensitivity and specificity, with Wada as the standard of reference. Subgroup analyses were also performed to compare the different functional MR imaging techniques utilized by the studies.
  
  
  RESULTS
  Twenty-three studies, comprising 442 patients, met inclusion criteria. The sensitivity and specificity of functional MR imaging for atypical language dominance (compared with the Wada test) were 83.5% (95% confidence interval: 80.2%, 86.7%) and 88.1% (95% confidence interval: 87.0%, 89.2%), respectively.
  
  
  CONCLUSIONS
  Functional MR imaging provides an excellent, noninvasive alternative for language lateralization and should be considered for the initial preoperative assessment of hemispheric language dominance. Further research may help determine which functional MR methods are most accurate for specific patient populations.
authors.affiliation: Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, 1300 Morris Park Ave, Bronx, NY 10461, USA.
authors.forename: R Joshua
authors.initials: RJ
authors.lastname: Dym
authors.forename: Judah
authors.initials: J
authors.lastname: Burns
authors.forename: Katherine
authors.initials: K
authors.lastname: Freeman
authors.forename: Michael L
authors.initials: ML
authors.lastname: Lipton
mesh_terms: D000654:Amobarbital; D001931:Brain Mapping; D004292:Dominance, Cerebral; D004827:Epilepsy / Q000503:physiopathology* / Q000601:surgery; D018757:GABA Modulators; D006801:Humans; D007802:Language; D008279:Magnetic Resonance Imaging / Q000379:methods*; D012680:Sensitivity and Specificity
chemical_list: D018757:GABA Modulators; D000654:Amobarbital