摘要
目的探讨功能性磁共振成像(fMRI)对手术前、后颅内病变累及运动中枢及其程度的诊断价值。方法选择45例经手术、病理证实的颅内占位性病变患者作为功能组,另20例颅内占位性病变手术患者为对照组;采用1.5T超导型MR成像仪,对功能组手术前、后行常规MRI及fMRI,对照组仅行常规MRI。结果45例功能组被检者均在脑fMRI中表现出局部的脑功能活动激活区,其中有22例运动皮层中枢的位置有不同程度移位,有23例运动皮层中枢未见明显移位改变;但手指运动功能区的分布并不会随病变类型而发生改变。病灶距功能区的距离与术前肌力呈正相关(r=0.553,P<0.001);与术后肌力无相关性(r=0.059,P>0.05);距离与肌力差呈负相关(r=-0.570,P<0.001)。术后有19例fMRI显示功能支配区较术前有不同程度增大;45例中无一例术后肌力降低,而对照组有5例(5/20)术后肌力降低。对照组手术前后肌力差平均值为(-0.05±0.69)级,功能组手术前后肌力差为(0.31±0.47)级,两者比较差异有统计学意义(t=2.473,P=0.016)。结论平均血氧水平依赖fMRI能清楚显示手运动皮层功能区,fMRI在术前提供了病变是否侵犯手运动皮质功能区的信息,为术中最大限度地保留功能区、避免和减少手术后并发症提供了客观依据;术前功能成像的应用对手术方案的制定及术后患者的功能恢复评估起指导作用。
Objective To investigate clinical usefulness of intracranial lesions in pre- and postoperation by functional MRI with blood oxygen level dependent（BOLD） technique. Methods Common MRI and Motor hand area functional MRI examinations were performed in 45 patients （fMRI group ） with intracranial lesions adjacent to the motor cortex before and after operation. As contrast group, 20 patients with occupying position lesions were made a routine MRI examination without fMRI before surgery. A 1.5 T signa super conducting system was employment （GE company , America）. Results The focal transactivation domain of cerebration was seen on fMRI in all cases of fMRI group. The cortical motor hand area shown displacement in 22 cases with abnormal size and shape and found not displacement in 23 cases. The distribution of transactivation domain was not changed in different disease . There was positive correlation between the distance from lesions to the domains and myodynamia in preoperation （r = 0. 553, P 〈 0. 001 ） , but none in past-operation （ r = 0. 059, P 〉 0. 05 ）. Our data indicated that there was negative correlation between the distance and the difference of myodynamia （ r = - 0. 570, P 〈 0.1301 ） . After operation, the size of cortical motor hand domain increased in 19 cases with different degree compared to preoperation, no myodynamia decrease was found after operation. In the contrast group, myodynamia decreased in 25% of cases. The average values of differences in myodynamia pre- and postoperatively in fMRI group and control group were relatively 0. 31±0. 47 and -0. 05±0. 069, there were significant difference between the two average values（t =2. 473 ,P =0. 016）. Conclusion BOLD fMRI could display the domain of hand motor cortex clearly and provide the information about whether the lesions involved with this domain in preoperation, which became the objective proofs for saving the domain utmost, reducing and avoiding postoperative complication. The application of fMRI in pre-operation plays an guidance role in making surgery plans and the evaluation of brain functional recovery in post-operation.
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2006年第2期165-170,共6页
Chinese Journal of Radiology
基金
广西省自然科学基金资助项目(桂科基:0144013)
关键词
运动皮质
磁共振成像
脑肿瘤
神经外科手术
Motor cortex
Magnetic resonance imaging
Brain neoplasms
Neurosurgical procedures
