SynthesisNeuroradiology2025
Is functional MRI a reliable surrogate for the Wada test for preoperative assessment of hemispheric language laterality in pediatric patients? A systematic review and meta-analysis.
Synthesis in Neuroradiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTask-based fMRI (tb-fMRI) has emerged as a promising imaging modality for determination of language lateralization in patients undergoing neurosurgery, largely replacing the invasive gold standard Wada test. However, its applicability in pediatric populations remains uncertain due to the unique characteristics of the developing pediatric brain. This meta-analysis and systematic review aim to synthesize existing data on the concordance rates of tb-fMRI and the intracarotid amobarbital test (IAT) in children undergoing neurosurgery.
methodsWe systematically searched PubMed, Embase, Cochrane and PsycINFO through 2025 for observational studies reporting concordance rates of tb-fMRI and IAT for language laterality assessment in children.
resultsFourteen studies were included in the systematic review, of which eight studies with 70 patients met the inclusion criteria in the meta-analysis. The pooled concordance rate between tb-fMRI/IAT was 81% (95% CI: 69% to 91%), with an overall sensitivity of 80% and specificity of 62%. The concordance was 86% (95% CI: 68% to 97%) for typical laterality and 85% (95% CI 68% to 96%) for atypical. There was no difference between groups for region-of-interest (ROI, p = 0.4943), paradigm (p = 0.3960) or interpretation method (p = 0.1501).
conclusionConcordance rates between tb-fMRI/IAT in pediatric patients show promising results. However, tb-fMRI demonstrates higher sensitivity in patients with typical left-lateralization, suggesting that confirmatory testing with Wada may still be warranted in cases without strong left-lateralization. These findings align with trends observed in the adult population, supporting the use of fMRI as a valuable tool in children.
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