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Purpose Thepurposeofthestudyistoevaluatetheroleofmagneticresonancespectroscopyinlateralizationdiagnosisfor epilepsyandexplorepotentialpre-operativeway. Methods Acomputer-assistedsearchwasperformedintheCochraneLibrary(16),PubMed(1064),Embase(1477),CBM(423),CNKI(171),andWangfang(189)dataforarticlesinvolvinglateralizationofepilepsywithMRS.Twoinvestigatorsscreenedstudiesin strictaccordancewiththeinciusionandexclusioncriteria,andextracteddataindependently.QUADASwasappliedtoassessthe includedarticlesqualities. Results Thecomputersearchinitiallyfound3340articles,aftereliminating237duplicates,thetitlesandabstractswerescreened. Ofthese,506articleswereexcluded.Afterreadingthefulltexts,weexcluded22articles.finally,22articlesfulfilledalltheinclusion criteriaandformedthestudypopulation.Amongtheincludedarticles,21articleswereretrospective,and1wasprospective.The referencestandardwas"surgical"and/or"histopathological"and/or"cytological"findingsalonein12articles,andboth "histopathological"findingsand"clinical"and/or"imagingfollow-up"intheother10articles.Onlateralizationdiagnosisfor epilepsy,thepooledsensitivityofMRSwas0.814[95%CI:0.773-0.849],thepooledspecificityofMRSwas0.984[95%CI:0.937-0.996],thepooledPositiveLikelihoodRatioofMRSwas51.900[95%CI:12.578,214.160],thepooledNegativeLikelihoodRatioof MRSwas0.189[95%CI:0.154,0.232],thepooledDiagnosticScoreofMRSwas5.616[95%CI:4.179,7.052],thepooleddiagnostic oddsratioofMRSwas274.706[95%CI:65.328,1155.151]. Conclusions MRSisapowerfulimagingtechniquesforlateralizationdiagnosisofepilepsy.AnditmaybeacceptabletouseMRS asalateralizationdiagnosistool.