摘要
目的利用经皮层电刺激的方法验证血氧水平依赖（BOLD）激活信号的准确性，并探讨语言BOLD技术在神经外科导航中的应用价值。方法选取脑肿瘤患者8例，术前行BOLD—fMRI。然后清醒麻醉状态下唤醒患者，进行经皮层电刺激过程，在神经导航的指导下与BOLD信号进行点对点对照。将皮层电刺激阳性点与BOLD激活区位置比较，分别计算刺激阳性点位于BOLD激活区（真阳性）、非激活区（假阴性）的个数及刺激阴性点位于BOLD激活区（假阳性）、非激活区（真阴性）的个数，观察BOLD的敏感度和特异度。用两种不同的方法分别统计：即刺激阳性点位于BOLD激活区上和刺激阳性点距离BOLD激活区1cm范围内。避开语言区1．0cm外进行病灶切除，保留阳性点0．5—1．0cm以内的皮质。结果8例患者仅6例顺利完成任务。6例患者中，星形胶质细胞瘤Ⅱ级3例、Ⅲ级2例，胶母细胞瘤1例。共刺激48个点，其中阳性点11个。以刺激点位于BOLD激活区为标准，结果显示BOLD敏感度72．7％（8／11），特异度81．8％（30／37）；以距离BOLD激活区小于1cm为标准，BOLD敏感度82．0％（9／11），特异度75．6％（28／37）。术后随访，患者均未出现失语表现。结论语言BOLD激活区敏感度及特异度较高。但客观上因语言脑区个体变异较大，此项技术真正应用到临床有待于样本量增加和经验总结。
Objective To verify the accuracy of blood oxygenation level dependent （BOLD）-based activation using eleetrocortical stimulation mapping （ESM） and explore the value of language fMRI in the navigating operation of neurosurgery. Methods In 8 cases with brain tumors, BOLD-fMRI examinations were done before the operations. Under the state of awake anesthesia,the patients were aroused and ESM was conducted. Point-to-point comparison between the BOLD signal activations and the ESM was carried oul under the surveillance of the neuro-navigation technology. In order to observe the sensibility and specificity of BOLD activations, the location of BOLD activations and the point of ESM was compared to calculate the stimulating positive points inside the regions of BOLD signals（ real positive）, outside BOLD regions（ pseudo- negative） , the stimulating negative points inside the regions of BOLD signals（pseudo-positive） , and outside BOLD region（real negative）. Two kinds of criteria for assessment were used. One was that the positive stimulating points were located in BOLD regions, and the other was that the positive stimulating points were located within 1 cm around the range of BOLD regions. Removal of the lesions were conducted with the tissue 1 era around the language region preserved, and the cortex inside 0. 5--1.0 cm distance from the positive points were retained. Results Of the 8 cases, only 6 finished the tasks. Among them, 3 cases were with astroeytoma of grade 2,2 were with astrocytoma of grade 3, and one with glioblastoma. The total number of stimulating points was 48, among which the positive points were 11. When the first criteria was applied, the sensitivity was 72. 7% （8/11）, and the specificity was 81.8% （30/37）. When the second criteria was applied, the sensitivity was 82. 0% （9/11）, and the specificity was 75.6% （28/37）. Follow-up after operation showed no aphasia occurred. Conclusions BOLD-fMRI had a high sensitivity and specificity in displaying the language regions. B
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2011年第7期628-631,共4页
Chinese Journal of Radiology
关键词
磁共振成像
经皮神经电刺激
神经导航
麻醉
Magnetic resonance imaging
Transcutaneous electric nerve stimulation
Neuronavigation
Anesthesia
