功能磁共振与术中直接皮层电刺激定位初级运动区的对照研究

The correlation between functional magnetic resonance imaging and direct electrocortical stimulation in motor cortex tumor surgery:a comparative study

目的:评价在病理条件下运用血氧饱和水平检测(BOLD)技术的功能磁共振成像(fMRI)结合功能神经导航定位皮质运动区的可靠性。方法:选取14例邻近初级运动区的病变,所有患者均按受BOLD-fMRI检查,检查中患者完成对指任务以定位初级运动区,根据其结果重建出运动区后将其融合进导航计划中。术中应用直接皮层电刺激来定位初级运动区,与BOLD-fMRI定位的初级运动区进行对照。结果:在13例(92.9%)患者中BOLD-fMRI结合神经导航定位皮质运动区与术中直接皮层电刺激相吻合。有1例(7.1%)患者皮层电刺激未在BOLD-fMRI激活区范围内引出肌电位变化。结论:BOLD-fMRI定位初级运动区的可靠性较高,在某些情况(如肿瘤浸润或瘤周水肿较严重)下,需结合术中皮层电刺激来确定功能区的位置。

Objective：To determine the reliablty of blood oxygen level dependent （BOLD）-functional magnetic resonance imaging （fMRI）in locating the primary motor cortex （PMC）under pathological conditions caused by the proximity of a brain tumor.Methods：Fourteen patients with brain tumor adjacent to the PMC were includ- ed in the study.BOLD-fMRI was performed preoperatively in each patient using a finger-tapping task.The im- age of PMC was then delineated and merged into the navigation plan.During the operation,direct eleetrocorti- cal stimulation （DES）was routinely performed to locate the PMC.The fMRI and DES consistency was analyzed and evaluated.Results： In 13 cases （92.9%）, the PMC, depicted with DES, correlated well with BOLD fMRl.In 1 patient（7.1%）,the PMC,depicted with DES,localized outside the BOLD signal cluster.Conclusion：BOLD-fMRI has acceptable validity to locate PMC,eomparing with DES.DES is necessary to located PMC under some con- ditions like severe edema and tumor infiltration adjacent to PMC.