CAJ | 학술논문

目的观察视路疾病患者视网膜拓扑投射的分布及脑功能性磁共振成像(fMRI)与视野检查结果的关系.方法 3例经病理检查确诊为垂体瘤和颅咽管瘤的鞍区占位患者(患者组)6只眼以及年龄24～30岁的3名健康志愿者纳入研究.患者组6只眼最佳矫正视力无光感～1.0;健康志愿者矫正视力1.0,除近视外无其他眼疾.受检者均无fMRI检查禁忌.常规行最佳矫正视力、直接和(或)间接检眼镜眼底检查,Octopus101电脑全自动视野计32程序策略趋势导向检查法行中心静态视野检查.fMRI检查采用GE signa VH/I 3.0T扫描机.视觉刺激占据12°视角,采用对比度接近100%的黑白棋盘格,背景为棋盘格的平均亮度,包括周期性扩张或收缩的环形刺激和顺时针或逆时针旋转的楔形刺激两种模式.功能图像采用梯度回波的平面同波序列的血氧水平依赖扫描序列,垂直于距状裂冠状位扫描,三维采集方式的扰相梯度回波序列矢状位采集高分辨率解剖结构数据.数据分析采用AFNI软件,并且应用Freesurfer进行皮层的分割、膨胀处理.结果 6只患眼中,视野颢侧缺损3只眼,颞上方缺损2只眼,不能完成检查1只眼.环形刺激的功能图像显示,枕叶视觉皮层产生了时相对应的激活图像,枕叶后极沿距状裂向前迁移对应黄斑中心区向周边视野的迁移.楔形刺激的功能图像显示,初级视觉皮层的极角拓扑投射的空间序列与视野相反.距状裂下方的视皮层主要对应对侧上方视野,距状裂上方主要对应对侧下方视野.刺激患眼不能诱导出与相应视野缺损相关的初级视觉皮层的激活,存在相应视觉皮层反应的减少.结论 fMRI检查结果与常规视野计检查的结果有很好的对应关系,可以反映视路疾病患者的视野缺损对应的皮层反应.
목적 관찰시로질병환자시망막탁복투사적분포급뇌공능성자공진성상(fMRI)여시야검사결과적관계.방법 3례경병리검사학진위수체류화로인관류적안구점위환자(환자조)6지안이급년령24～30세적3명건강지원자납입연구.환자조6지안최가교정시력무광감～1.0;건강지원자교정시력1.0,제근시외무기타안질.수검자균무fMRI검사금기.상규행최가교정시력、직접화(혹)간접검안경안저검사,Octopus101전뇌전자동시야계32정서책략추세도향검사법행중심정태시야검사.fMRI검사채용GE signa VH/I 3.0T소묘궤.시각자격점거12°시각,채용대비도접근100%적흑백기반격,배경위기반격적평균량도,포괄주기성확장혹수축적배형자격화순시침혹역시침선전적설형자격량충모식.공능도상채용제도회파적평면동파서렬적혈양수평의뢰소묘서렬,수직우거상렬관상위소묘,삼유채집방식적우상제도회파서렬시상위채집고분변솔해부결구수거.수거분석채용AFNI연건,병차응용Freesurfer진행피층적분할、팽창처리.결과 6지환안중,시야호측결손3지안,섭상방결손2지안,불능완성검사1지안.배형자격적공능도상현시,침협시각피층산생료시상대응적격활도상,침협후겁연거상렬향전천이대응황반중심구향주변시야적천이.설형자격적공능도상현시,초급시각피층적겁각탁복투사적공간서렬여시야상반.거상렬하방적시피층주요대응대측상방시야,거상렬상방주요대응대측하방시야.자격환안불능유도출여상응시야결손상관적초급시각피층적격활,존재상응시각피층반응적감소.결론 fMRI검사결과여상규시야계검사적결과유흔호적대응관계,가이반영시로질병환자적시야결손대응적피층반응.
Objective To observe the results of function MRI and perimetry in patients with visual pathway diseases. Methods Three patients (6 eyes) with pituitary adenoma and craniopharyngioma diagnosed via pathological examination and three healthy volunteers aged from 24 to 30 were collected. The best corrected visual acuity was non-light perception-1. 0 in the 6 sick eyes and 1. 0 in the healthy eyes;all the involved individuals had no other ocular diseases except myopia and without any contraindications of MRI. Common tests including the best visual acuity, fundus test by direct or indirect ophthalmoscope, center static visual field tested by Octopus 101 perimeter, program 32, tendency oriented perimetry were performed. The visual stimulation subtended a field of view of about 12 degrees,consisted of high contrast and drifting checkerboards. MRI parameters: GE signa VH/i 3. 0T scanner. Functional data: GRE-EPI sequence, 20 slices lying perpendicular to the calcarine sulcus. Anatomical data was obtained using 3DSPGR sequence to acquire high resolution. The cortical surface was unfolded and then cut and inflated. Functional data was presented to the inflated surface and subsequently analyzed by AFNI software. Results In six eyes, three had temporal defects, two had upper temporal visual field defects, and the other one did not finish the visual field test. The retinotopic representations of health adults were obtained by using the phase-encoded visual stimulation. The Eccentricity coordinate maps showed that foveal representations lay in the occipital poles and the representations appeared further anterior as eccentricity increased. The polar angle coordinate maps showed that early retinotopically organized areas had a representation of visual field. The visual cortex beneath the calcarine sulcus matched with the upper visual field of the opposite side and which upon the calcarine sulcus matched with the under visual field of the opposite side. Less or no visual cortex response was revealed in the patients' function MRI or the response in injury side was vanished. The visual cortex response related with the visual field defects could not be induced in function MRI. Conclusion There is a good correlation between function MRI data and the results of perimetric evaluation. The function MRI can show the visual cortex response correlated with the visual field defects of the patients with visual pathway diseases.