Visualization of super-selective Wada with computed tomography perfusion: toward a novel option in preoperative functional mapping

@article{nakae2026visualization,
  title = {{Visualization of super-selective Wada with computed tomography perfusion: toward a novel option in preoperative functional mapping}},
  author = {Shunsuke Nakae and Motoharu Hayakawa and Masanobu Kumon and Noeru Kawase and Kenichiro Suyama and Eiji Fujiwara and Daijiro Kojima and Shigeo Ohba and Shogo Imamura and Yuriko Sato and Yoko Inamoto and Masaki Fukunaga and Yuichi Hirose},
  journal = {Frontiers in Neuroimaging},
  year = {2026},
  month = oct,
  doi = {10.3389/fnimg.2026.1876584},
  url = {https://doi.org/10.3389/fnimg.2026.1876584},
  note = {CC BY},
}

TY  - JOUR
TI  - Visualization of super-selective Wada with computed tomography perfusion: toward a novel option in preoperative functional mapping
AU  - Shunsuke Nakae
AU  - Motoharu Hayakawa
AU  - Masanobu Kumon
AU  - Noeru Kawase
AU  - Kenichiro Suyama
AU  - Eiji Fujiwara
AU  - Daijiro Kojima
AU  - Shigeo Ohba
AU  - Shogo Imamura
AU  - Yuriko Sato
AU  - Yoko Inamoto
AU  - Masaki Fukunaga
AU  - Yuichi Hirose
PY  - 2026
DA  - 2026/10/26
JO  - Frontiers in Neuroimaging
DO  - 10.3389/fnimg.2026.1876584
UR  - https://doi.org/10.3389/fnimg.2026.1876584
AB  - IntroductionThe Wada test has long been a well-established method for evaluating hemispheric dominance and functional localization; however, it has not been established as a visualizable functional imaging modality. Recently, the super-selective Wada test (ssWada) has emerged as a technique enabling more localized functional evaluation. By selectively catheterizing distal cerebral arterial branches, ssWada enables territory-based functional evaluation with higher spatial resolution than conventional approaches. In this study, we combined ssWada with computed tomography perfusion (CTP) to visualize pharmacologically inactivated brain regions preoperatively. These data were further fused with magnetic resonance imaging (MRI) and CT to propose a novel functional mapping approach delineating the relationship between perfusion-defined functional territories, lesions, and seizure onset zone (SOZ)-related stereoelectroencephalography (SEEG) contacts.MethodsPatients who underwent ssWada for preoperative evaluation of brain tumors or drug-resistant epilepsy at our institution were included. During ssWada, propofol was selectively injected via a microcatheter into the ICA and distal branches of the middle cerebral artery (MCA), as well as the anterior or posterior cerebral artery when necessary. Perfusion territories were simultaneously visualized using CTP. These datasets were subsequently fused with MRI and post-SEEG CT to evaluate the spatial relationship between perfusion-defined functional territories, lesions, and SOZ-related SEEG contacts.ResultsAmong the 23 patients, hemispheric dominance was left in 18 patients (78.3%), bilateral in 3 (13.0%), and right in 2 (8.7%). No complications were observed. In the MCA superior trunk territory, repetition, naming, and reading tasks showed positive rates of approximately 70%. In contrast, in the inferior trunk territory, repetition and reading demonstrated high positive rates (93.8%), whereas naming positivity was lower (56.3%). Fusion with MRI and post-SEEG CT enabled spatial visualization of lesions and SOZ-related SEEG contacts within perfusion-defined functional territories, facilitating individualized functional-anatomical assessment for surgical planning.DiscussionssWada combined with CTP enables territory-based visualization of pharmacologically inactivated brain regions and provides a novel preoperative functional mapping approach with high spatial resolution. Fusion with MRI and post-SEEG CT further facilitates individualized functional-anatomical assessment of lesions and SOZ-related networks. These findings support the clinical utility of ssWada-CTP fusion imaging as a novel strategy for individualized preoperative functional brain mapping.
SN  - 2813-1193
ER  -