CAJ | 학술논문

目的评价在血氧水平依赖性功能磁共振(BOLD-fMRI)精确引导下的大脑白质纤维束示踪技术(DTT)结合术中导航、B超对涉及手运动传导束附近占位性病变手术的应用价值.方法 20例位于手运动传导束附近的占位性病变患者,术前进行常规3DT1轴位全脑容积图、fMRI及DTI扫描.图像处理过程中,采用双感兴趣区示踪纤维束,将fMRI激活区作为纤维束示踪的起始感兴趣区,将大脑脚作为目标感兴趣区,在fMRI引导下对受病变影响的手运动传导束进行精确的纤维束示踪,结合神经导航进行术前、术中定位,并利用B超对病变切除过程进行指导,在最大范围切除病变的同时保护运动传导束.结果 16例镜下全切除,4例大部分切除.20例术后复查fMRI及DTT并且进行精确示踪后可见手运动传导束保护完好.结论在fMRI引导下的DTT技术可以显著提高受病变影响的手运动传导束显像的准确性,可视化的显示纤维束走行及与肿瘤的关系,有利于优化术前个体化手术方案,术中合理应用导航、B超,可降低术后致残率,提高术后患者生存质量.
목적 평개재혈양수평의뢰성공능자공진(BOLD-fMRI)정학인도하적대뇌백질섬유속시종기술(DTT)결합술중도항、B초대섭급수운동전도속부근점위성병변수술적응용개치.방법 20례위우수운동전도속부근적점위성병변환자,술전진행상규3DT1축위전뇌용적도、fMRI급DTI소묘.도상처리과정중,채용쌍감흥취구시종섬유속,장fMRI격활구작위섬유속시종적기시감흥취구,장대뇌각작위목표감흥취구,재fMRI인도하대수병변영향적수운동전도속진행정학적섬유속시종,결합신경도항진행술전、술중정위,병이용B초대병변절제과정진행지도,재최대범위절제병변적동시보호운동전도속.결과 16례경하전절제,4례대부분절제.20례술후복사fMRI급DTT병차진행정학시종후가견수운동전도속보호완호.결론 재fMRI인도하적DTT기술가이현저제고수병변영향적수운동전도속현상적준학성,가시화적현시섬유속주행급여종류적관계,유리우우화술전개체화수술방안,술중합리응용도항、B초,가강저술후치잔솔,제고술후환자생존질량.
Objective To evaluate the value of incorporating fMRI into DTT in the operational assessment of lesions involving the motor hand representation tracts in patients.Methods 20 patients with lesions involving the motor hand representation tracts underwent 3D T1-weighted imaging for anatomical reference,a gradient echo planar imaging sequence for fMRI,and a spin echo-echo planar imaging sequence for DTI.We used two regions of interest (ROI) to define 3D connectivity maps within the whole brain,from seed points selected in the white matter adjacent to the location of the maximum of fMRI activation,and the target region of interest (ROI) was placed in the cerebral peduncle.During surgery,the border of the tumor was identified using neuronavigation and intraoperative ultrasonography for protecting deep white matter and enhancing the accuracy of resection.Results Total lesion resection was achieved in 16 patients,and subtotal resection in 4 cases.In 20 patients,we successfully tracked the motor hand representation tracts by choosing seed and target regions of interest on the path of the fibers.Moreover,no obvious harmful effects to the motor areas and adjacent fibers were observed in all patients.Condusions fMRI-driven DTT can provide the ability to evaluate the spatial relationship between the motor tracts and tumor borders.Not only has the new technology provided a maximum benefit in surgical treatment and improved preoperative planning,it also enhanced the accuracy of postsurgical outcomes.