CAJ | 학술논문

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1 cm范围内.避开语言区1.0 cm外进行病灶切除,保留阳性点0.5～1.0 cm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1 cm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.
목적 이용경피층전자격적방법험증혈양수평의뢰(BOLD)격활신호적준학성,병탐토어언BOLD기술재신경외과도항중적응용개치.방법 선취뇌종류환자8례,술전행BOLD-fMRI.연후청성마취상태하환성환자,진행경피층전자격과정,재신경도항적지도하여BOLD신호진행점대점대조.장피층전자격양성점여BOLD격활구위치비교,분별계산자격양성점위우BOLD격활구(진양성)、비격활구(가음성)적개수급자격음성점위우BOLD격활구(가양성)、비격활구(진음성)적개수,관찰BOLD적민감도화특이도.용량충불동적방법분별통계:즉자격양성점위우BOLD격활구상화자격양성점거리BOLD격활구1 cm범위내.피개어언구1.0 cm외진행병조절제,보류양성점0.5～1.0 cm이내적피질.결과 8례환자부6례순리완성임무.6례환자중,성형효질세포류Ⅱ급3례、Ⅲ급2례,효모세포류1례.공자격48개점,기중양성점11개.이자격점위우BOLD격활구위표준,결과현시BOLD민감도72.7%(8/11),특이도81.8%(30/37);이거리BOLD격활구소우1 cm위표준,BOLD민감도82.0%(9/11),특이도75.6%(28/37).술후수방,환자균미출현실어표현.결론 어언BOLD격활구민감도급특이도교고.단객관상인어언뇌구개체변이교대,차항기술진정응용도림상유대우양본량증가화경험총결.
Objective To verify the accuracy of blood oxygenation level dependent (BOLD)-based activation using electrocortical 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 out 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 cm 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 astrocytoma 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. But due to the great variation of brain language area among the people, we need more studies of large sample to obtain enough experience before it can be used clinically.