摘要
无运动障碍的功能区胶质瘤患者,其手术风险较高,结合手运动任务态功能磁共振(fMRI)及运动网络功能连接能否更准确的评估手术风险需要进一步探索.本研究收集24例运动功能区胶质瘤且无明显肢体运动功能障碍的患者,非运动功能区胶质瘤患者8例,术前进行fMRI手运动任务态及静息态检查,术后3个月对患者进行随访.计算初级运动皮质(M1)激活的偏侧化指数(lateralization indices,LI).选取运动网络感兴趣区域(ROI),计算双侧M1与各ROI间功能连接系数(FC).运用受试者工作特性曲线(receiver operating characteristic curve,ROC)评估M1激活的LI对术后偏瘫的预测效能.同非运动功能区胶质瘤患者相比,运动功能区胶质瘤患者M1激活LI显著升高(P=0.001).同术后未偏瘫功能区胶质瘤患者相比,术后偏瘫患者M1激活LI值显著升高(P=0.011).ROC曲线下面积(AUC)=0.867,临界点LI=0.31,LI≥0.31对术后偏瘫预测灵敏性为87.5%,特异性为87.5%.以M1激活LI≥0.31将病人分为手术高风险组及低风险组,手术高风险组患者双侧M1与运动网络多个ROI间FC出现显著改变.本研究中功能区胶质瘤患者虽无肢体运动功能障碍,但肿瘤对功能区皮层激活及运动网络FC已有不同程度的破坏;结合任务态及静息态fMRI可以更好地评估手术风险并了解机体功能受损及代偿机制.
The risk of post-operative paralysis is high in patients with eloquent area gliomas and without apparent limb motor dysfunction preoperatively.This study aims to evaluate the risk of postoperative paralysis via task-based and resting state fMRI.24 patients with eloquent area gliomas who had no obvious limb dysfunction and 8 patients with non-eloquent area gliomas were admitted.All patients underwent task-based and resting state fMRI.Lateralization index(LI) of Ml activation was calculated.The regions-of-interest(ROIs) within motor network were selected.Functional connectivity(FC) between bilateral M1 and other ROIs were calculated.Occurrences of postoperative paralysis were recorded three months after operations.Receiver operating characteristic(ROC) analysis was performed to determine the optimum LI thresholds for prediction of paralysis.Compared with non-eloquent gliomas group,LI of M1 increased significantly(P=0.001) in eloquent gliomas group.Compared with patients without paralysis,LI of M1 in patients with paralysis increased significantly(P=0.011).ROC analysis showed the area under the curve(AUC) was 0.867.The best cut-off value for LI in the prediction of postoperative paralysis is 0.31 with sensitivity of 87.5%,specificity of 87.5%.Patients were then divided into groups of high and low risk of operation by LI≥ 0.31.In patients with high-risk of operation,the tumors caused more damages to FC than in patients with low-risk of operation.Task-based and resting state fMRI can be combined together to better evaluate the risk of surgery and to clarify the mechanism of functional damage and its compensation.
作者
于嵩林
于洮
左真涛
王静
徐宗胜
杨凯元
任晓辉
赵元立
林松
YU Song-Lin;YU Tao;ZUO Zhen-Tao;WANG Jing;XU Zong-Sheng;YANG Kai-Yuan;REN Xiao-Hui;ZHAO Yuan-Li;LIN Song(Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;State Key Laboralory of Brain and Cognitire Science,Instiute of Biophysics,Chinese Academy of Sciences,Beijing 100101,China;Sino-Danish College,University of Chinese Academy of Sciences,Beijing 100101,China;Department of Neurosurgery,Peking University International Hospital,Bejing 102206,China)
出处
《生物化学与生物物理进展》
SCIE
CAS
CSCD
北大核心
2020年第9期982-988,共7页
Progress In Biochemistry and Biophysics
基金
科技部重点研发计划“变革性技术关键科学问题”专项(2019YFA0707103)
国家自然科学基金(81701140,31730039,81771309,81571632,81401381,81741001)
中科院战略先导(XDB32010300)
国家重大科研装备研制项目(ZDYZ2015-2)资助~~。
