CAJ | 학술논문

目的探讨人工耳蜗植入术前应用功能性磁共振(functional magnetic resonance imaging,fMRI)评价植入者听皮层功能的临床价值.方法 21例拟行人工耳蜗植入的重度、极重度感音神经性聋患儿(17例内耳结构正常,3例为大前庭水管综合征,1例为耳蜗神经发育不良)和7例听力正常儿童在镇静状态下行fMRI检查.受检者接受四种随机频率(500、1 000、2 000、4000 Hz)声刺激,采用组块式设计,每个组块的听觉刺激持续16 s,刺激间隔16 s,每类刺激重复2次,总扫描时间为4 min 28 s.患儿人工耳蜗植入后定期进行听力学随访,评估其听觉言语功能.结果 28例受检者在单耳及双耳接受声刺激后fMRI上出现大脑听皮层激活,表现为单纯颞横回激活、单纯丘脑激活以及颞横回和丘脑均激活.接受单耳刺激时,21例患儿中6例表现对侧优势,5例同侧优势,10例双侧均衡;7例听力正常儿童,3例对侧优势,2例同侧优势,2例双侧均衡.耳蜗植入患儿术前听皮层的激活强度与听力正常儿童无明显区别,差异无统计学意义(P＞0.05).21例人工耳蜗植入患儿术后听觉言语康复效果良好,大前庭水管综合征患儿与内耳结构正常患儿在听觉言语康复水平上未见明显差别.耳蜗神经发育不良患儿术前左耳给予声刺激后双侧颞横回激活,左耳植入耳蜗后开机对声音有反应,术后10个月行为测听平均阈值为55 dBHL.结论 fMRI是一种可行的听皮层功能评价方法,结合ABR和影像学检查,能够在人工耳蜗植入前较完整地评估整个听觉系统的功能.
목적 탐토인공이와식입술전응용공능성자공진(functional magnetic resonance imaging,fMRI)평개식입자은피층공능적림상개치.방법 21례의행인공이와식입적중도、겁중도감음신경성롱환인(17례내이결구정상,3례위대전정수관종합정,1례위이와신경발육불량)화7례은력정상인동재진정상태하행fMRI검사.수검자접수사충수궤빈솔(500、1 000、2 000、4000 Hz)성자격,채용조괴식설계,매개조괴적은각자격지속16 s,자격간격16 s,매류자격중복2차,총소묘시간위4 min 28 s.환인인공이와식입후정기진행은역학수방,평고기은각언어공능.결과 28례수검자재단이급쌍이접수성자격후fMRI상출현대뇌은피층격활,표현위단순섭횡회격활、단순구뇌격활이급섭횡회화구뇌균격활.접수단이자격시,21례환인중6례표현대측우세,5례동측우세,10례쌍측균형;7례은력정상인동,3례대측우세,2례동측우세,2례쌍측균형.이와식입환인술전은피층적격활강도여은력정상인동무명현구별,차이무통계학의의(P＞0.05).21례인공이와식입환인술후은각언어강복효과량호,대전정수관종합정환인여내이결구정상환인재은각언어강복수평상미견명현차별.이와신경발육불량환인술전좌이급여성자격후쌍측섭횡회격활,좌이식입이와후개궤대성음유반응,술후10개월행위측은평균역치위55 dBHL.결론 fMRI시일충가행적은피층공능평개방법,결합ABR화영상학검사,능구재인공이와식입전교완정지평고정개은각계통적공능.
Objective To investigate the functional evaluation of auditory cortex by functional magnetic resonance imaging (fMRI) before cochlear implantation (CI).Methods Twenty-one children with severe to profound sensorineural hearing loss(SNHL)(7 cases with normal inner ear structure,3 cases with large vestibular aqueduct syndrome,1 case with cochlear nerve hypoplasia) and 7 children with normal hearing were examined by fMRI under sedation.The subjects received acoustic stimuli at four random frequencies (500,1 000,2 000,4 000 Hz) during fMRI examination.Tones were interleaved with silence in a block-periodic fMRI design with 16-second on-off intervals.Each stimulus repeated twice and the total acquisition time was 4 minutes and 28 seconds.Results Activation was identified in the auditory cortex of the 28 subjects in response to monaural and binaural acoustic stimulation,which was shown in the transverse temporal gyrus (Heschl gyrus),the thalamus and both.Of the 21 patients with SNHL,contralateral dominance was shown in six cases,ipsilateral dominance in five cases and bilateral equilibrium in 10 cases when one ear was exposed to the stimuli.Of the seven children with normal hearing,contralateral dominance was shown in three cases,ipsilateral dominance in two cases and bilateral equilibrium in two cases.No significant difference of the activation intensity in auditory cortex was shown between children with SNHL and normal hearing(P ＞ 0.05).Good hearing recovery was obtained in the 21 patients after CI.No significant difference in the level of hearing and speech rehabilitation was shown between children with LVAS and with normal inner ear structure.Listening behavior response threshold was 55 dBHL in the case with cochlear nerve hypoplasia 10 months after CI.Conclusions fMRI would be a feasible means of evaluating the function of the auditory cortex,which can be used for assessing the function of the entire auditory system prior to CI combined with ABR and imaging.