功能磁共振联合Wada实验在难治性癫痫术前语言评中应用

Application of fMRI in combination with Wada test in preoperative assessment of speech function in medically refractory epilepsy

目的根据有效任务组的功能磁共振(functional Magnetic resonance,fMRI),结果与Wada语言区的定侧的一致性,探讨任务组在语言评估的推广。方法收集2018年12月13—2020年1月3日期间于广省三九脑科医院癫痫中心可能需要进行术前语言功能评估的90例难治性癫痫患者。使用了两种较为简单的fMRI任务,完成fMRI检查,其中25例患者完成Wada实验检查。采用Block实验设计,ABBA方式呈现,使用Analysis of Functional NeuroImages(AFNI)软件处理fMRI数据,偏侧化指数计算,多重回归分析。结果25例患者中10例(40%)右侧半球为语言优势半球、1例(4%)为双侧语言优势半球、14例(56%)为左侧语言优势半球。通过对fMRI偏侧化指数计算,其中句子任务总共有15个有效数据,与Wada实验结果的一致性为80%(12/15),图片命名任务中fMRI结果与Wada实验的一致性为75%(18/24),句子和图片任务共同判断语言优势半球结果与Wada实验的一致性为93.3%(14/15)。结论相较于单一任务的结果,综合多个功fMRI任务的结果,在激活范围和语言优势半球的判断中,都更加稳定。fMRI与Wada语言区定侧准确率93.3%,fMRI任务定侧有效并具有推广价值。

Objective To investigate the task group’s effectiveness in language evaluation based on the task group's functional Magnetic resonance(fMRI)results’agreement with the fixation side of the Wada language area.Methods We collected 90 patients with intractable epilepsy of 90 patients from December 13,2018 to January 3,2020 from the Epilepsy Center of Guangdong 999 Brain Hospital.We used two simple fMRI tasks.Among them,25 patients completed the Wada experimental examination,and 8 patients completed the electrode implantation and subsequent preoperative language area mapping.Adopt block experimental design,ABBA style presentation,and use AFNI software to process fMRI data,lateralization index calculation,and multiple regression analysis.Results fMRI results from 90 patients showed that the results from both the sentence-completion task and the image-naming task were more stable than those from either task.The results were then compared with the results of the“gold standard”Wada test in 25 patients with fMRI-located language dominance in the hemisphere.The results showed that the accuracy of the single task was between 70%and 80%,but the accuracy of the combined results of the two tasks was 93.3%.Conclusions Compared with the results of a single task,the results of multiple fMRI tasks are more stable in the judgment of activation range and language dominance hemisphere.fMRI and Wada language area siding accuracy 93.3%,fMRI task siding valid and replicable.