多语言任务功能磁共振指导国人语言区动静脉畸形切除手术

目的 观察针对中国人主要汉语语言区的多语言任务功能磁共振（functional MRI，fMRI）指导语言 区动静脉畸形（arteriovenous malformations，AVM）切除手术对术后语言功能的保护作用。 方法 前瞻性纳入首都医科大学附属北京天坛医院神经外科2017年12月-2019年12月收治的语言区 AVM患者31例，术前行多语言任务（包括同义字判断、单字朗读、听力理解）fMRI扫描。使用SPM12软件 明确各个任务的激活区并分析病变与激活区关系（包括二者之间的距离以及是否存在激活区右侧半 球重塑），借助Brainlab导航系统指导手术，术前、术后一周采用西方失语症语言量表（western aphasia battery，WAB）评估患者语言功能。 结果 所有患者均得到有效语言区定位。同义字判断任务主要激活左侧半球额中回（24/31， 77.4%），其中1例（3.2%）患者出现语言区右侧半球优势；单字朗读任务主要激活左侧半球额下回后 部（23/31，74.2%），7例（22.6%）患者出现语言区右侧半球优势；听力理解任务主要激活左侧半球颞 上回后部（30/31，96.8%），6例（19.4%）患者出现语言区右侧半球优势。病变距离语言区平均距离为 5.5±3.4 mm。术后WAB量表评分（38.51±2.84分）较术前（39.32±0.64分）无下降（P =0.135），仅2例 （6.4%）患者术后出现语言功能障碍。 结论 术前采用针对国人主要汉语语言区的多任务fMRI行语言功能定位可有效保护语言功能。     

丙泊酚Wada试验对语言功能的定侧价值及其与fMRI的初步比较

目的探讨丙泊酚Wada试验对语言功能的定侧价值,并与功能MRI（fMRI）相比较。方法在2010年1月至2012年3月对18例患者进行了丙泊酚Wada试验,对其中有进行语言功能评估且fMRI语言激活资料完整的4例难治性癫痫患者的临床资料进行回顾性分析。结果4例患者丙泊酚Wada试验语言功能评估均提示右侧半球为语言优势。fMRI检查提示1例为右侧半球,余3例双侧半球均有语言兴奋区激活表现。埋藏电极慢性电刺激与术中皮层电刺激的结果与Wada试验相符。手术病例术后均未出现语言功能受损表现。结论丙泊酚Wada试验对语言优势半球的确定具有较高的准确性,在存在半球病变时fMRI对语言评估易出现定侧偏差。     

功能区胶质瘤手术前后语言功能皮质的变化（附8例分析）

目的探讨功能区胶质瘤手术前后语言功能皮质的改变。方法对8例胶质瘤累及功能区的病人,在切除术前和术后3-6个月内进行听觉方式呈现的汉语词汇语义判断任务的血氧水平依赖功能性磁共振（BOLD～fMRI,3．0T）扫描,采用AFNI软件进行脑功能区活动图像分析,获得语言皮质的激活体素,计算出术前和术后的半球激活指数（HAI）并行统计学分析。结果术后3个月,病人左侧大脑半球瘤腔周围的激活明显增加。量化激活体素结果表明：术前HAI为0．96±0．22,术后1．10±0．21,两者差异有统计学意义（P〈0．001）。结论手术部分切除或大部切除脑胶质瘤3个月后,左侧大脑半球的语言皮质激活体素较术前有不同程度升高。这说明语言功能皮质具有一定的可塑性。     

fMRI功能导航下切除汉语运动性语言区附近病变

目的探讨功能磁共振(functional magnetic resonance imaging,fMRI)导航在汉语运动性语言区附近病变手术中的应用价值。方法对43例大脑皮层运动性语言区附近病变患者,通过组块设计的汉语朗读任务,利用血氧水平依赖性功能磁共振成像(BOLD-fMRI)获得运动性语言区激活,利用磁共振弥散张量成像技术(diffusion tensori maging,DTI)获得白质纤维束走行,将结构影像、fMRI功能影像与DTI的各项异性系数(FA)图像同时传入导航系统,术中定位fMRI确定的语言区,在唤醒状态利用皮层电刺激技术进行语言区验证,避开运动性语言区在显微镜下切除病变。结果本组患者29例术前语言功能正常,14例有不同程度语言功能障碍。38例获得了有效的fM-RI语言区激活,进行了36例核心激活脑区与皮层电刺激比较:25例为重叠关系,11例为邻近关系。手术全切除17例,次全切除14例,大部份切除12例。术后语言功能8例较术前好转,31例无变化,4例出现短暂性运动性失语。结论汉语朗读任务所获得的fMRI运动性语言区激活具有良好的敏感性与准确性;fMRI导航手术可以提高汉语运动性语言区附近病变切除程度,减少术后运动性失语的发生。     

特发性高颅压患者脑血流自动调节研究

目的 分析特发性颅内压增高（idiopathic intracranial hypertension，IIH）患者脑血流自动调节机能。
方法 连续入组2018年12月-2019年3月在首都医科大学附属北京天坛医院就诊的IIH患者，并选取年
龄匹配的健康志愿者作为对照组。应用传递函数的算法分析TCD显示的大脑中动脉血流速度及动脉
血压的自然波动以评估脑血流自动调节机能。
结果 入组IIH组10例，对照组13例。所有入组者均完成了双侧大脑半球的脑血流自动调节检测，共
检测了20个高颅压半球及26个正常对照半球。与对照组相比，IIH组大脑中动脉脑血流增益显著降
低[（0.64±0.35）%/% vs（0.37%±0.20）%/%，P =0.004]；相位也显著降低（58.80±20.86°vs
39.16±23.79°，P =0.005），差异有统计学意义。IIH组每秒钟脑血流速度的恢复率较对照更低，但差
异尚未达到统计学意义（[ 26.34±43.29）%/s vs（38.81±20.16）%/s，P=0.240]。
结论 IIH患者脑血流自动调节机能显著受损。     

运动性失语患者不同疗效的功能MRI研究

目的探讨运动性失语患者不同疗效的脑区激活特点。方法选取处于同一基线水平的运动性失语患者,均进行1个月常规失语症康复训练。根据评价结果分为疗效较好组和疗效较差组,与正常人分别进行图片命名任务的fMRI检查,分析各组激活脑区的差异:结果正常人组双侧岛叶(BA13)、左侧Broca区及其右侧镜像区(BA45)等区域有明显激活,激活区域以左侧半球为多,有明显左侧偏侧性;疗效较差组整体激活较正常人组明显下降,右侧大脑脑区有过多激活,左右间差距较正常人组缩小;疗效较好组则激活区域左侧偏侧性明显,左右间差距较疗效较差组增大,无右侧大脑脑区过多激活。结论语言功能有明显左侧偏侧性,运动性失语症患者语言功能恢复与左侧半球未受损的功能相关。     

症状性大脑中动脉狭窄血管内支架成形术治疗的临床研究

目的 探讨血管内支架成形术在症状性大脑中动脉血管狭窄治疗中的应用,评价其安全性及治疗
效果。
方法 回顾性分析2008年5月-2015年2月在沧州市人民医院神经内科行血管内支架成形术治疗的症
状性大脑中动脉狭窄患者,观察血管内支架置入成功率、手术并发症、支架术前后血管狭窄率并随访
血管内支架成形术的治疗效果。
结果 入组98例患者,均成功置入支架,术前患者平均狭窄率为（83.8±7.9）%,术后患者残余狭窄
率为（21.9±4.2）%,术后3 d发生亚急性血栓1例（1.0%）,再狭窄发生率12.9%（10/77）,随访1年疗
效终点事件（术后30 d内发生缺血性卒中、出血性卒中及手术相关性死亡;30 d后发生病变血管责任区
域内的缺血性卒中）累计发生率为14.3%（14/98）。
结论 血管内支架成形术治疗症状性大脑中动脉狭窄具有良好的安全性,手术成功率高,1年再狭窄
率低。     

正常国人汉语语言Broca区的fMRI刺激模式筛选

目的 为临床应用筛选出能够在fMRI上稳定激活Broca区的汉语语言任务刺激模式.方法 选用正常右利手国人10名,采用组块设计,应用西门子SONATA 1.5T MRI分别在不同的汉语语言任务下进行脑功能成像,汉语语言任务分四组默读组、朗读组、图片命名组、文字阅读组.图像资料经FADA与AFNI软件后处理获得脑区激活图.结果 默读组仅见少量小脑区激活,未见Broca区激活;朗读组有9例可见Broca区激活,时间-信号强度动态曲线稳定;图片命名组有7例、文字阅读组有8例可见Broca区激活,但同时伴有强烈的视皮层激活.结论 汉语朗读任务可以作为临床fMRI中激活Broca区的语言任务刺激模式.     

微血管减压术对桥小脑角区颅神经疾病合并高血压患者术后血压的影响

目的 探讨微血管减压术（MVD）对桥小脑角区颅神经疾病合并高血压患者术后血压的影响。方法 2010年11月至2013年12月收治桥小脑角区颅神经疾病患者合并高血压患者92例（颅神经疾病位于左侧59例、右侧33例;三叉神经痛14例、面肌痉挛28例、舌咽神经痛50例）,应用乙状窦后入路微血管减压术治疗。结果 92例患者中,术后高血压缓解59例（左侧减压手术53例,右侧减压手术6例）,其中脱离高血压用药34例,均为左侧减压手术患者;术后高血压无明显变化33例。总有效率为64.13%（59/92）,其中左侧减压手术有效率为89.83%（53/59）,右侧减压手术有效率为18.18%（6/33）;左侧减压手术治愈率为57.63%（34/59）。左侧颅神经疾病患者术后血压较术前明显降低（P<0.05）,而右侧颅神经疾病患者术后血压无明显变化（>P>0.05）。结论 对左侧桥小脑角区颅神经疾病患者合并高血压患者,微血管减压术具有一定的降血压效果。     

弓状束纤维示踪与功能磁共振成像定位额叶语言皮质的比较研究

目的 联合弓状束纤维示踪技术和任务态fMRI,评价弓状束终末投影定位额叶语言皮质的临床可行性.方法 采用任务态fMRI定位语言皮质激活区,并纤维示踪定位弓状束终末端;将两者皮质投影在导航系统融合,比较两者吻合度.结果 弓状束终末投影区域与任务态fMRI语言皮质激活区高度吻合.弓状束投影区主要位于左侧中央前回腹侧部(87.5％)及左侧额下回(75.0％).弓状束终末投影平均半径(R1)=(12.4±5.3)mm;fMRl语言任务激活区平均半径(R2)=(10.9±4.6) mm;两者中心距离(D)=(10.6±6.9)mm.结论 弓状束纤维示踪不仅可用于定位和保护皮质下语言通路,还可用于额叶语言皮质定位,并与fMRI的定位结果吻合.     

Functional MR evaluation of temporal and frontal language dominance compared with the Wada test

OBJECTIVE: To evaluate the reliability of temporal and frontal functional MRI (fMRI) activation for the assessment of language dominance, as compared with the Wada test. PATIENTS AND METHODS: Ten patients with temporal lobe epilepsy were studied using blood oxygen level dependent fMRI and echoplanar imaging (1.5-T). Three tasks were used: semantic verbal fluency, covert sentence repetition, and story listening. Data were analyzed using pixel by pixel autocorrelation and cross-correlation. fMRI laterality indices were defined for several regions of interest as the ratio (L - R)/(L + R), L being the number of activated voxels in the left hemisphere and R in the right hemisphere. Wada laterality indices were defined as the difference in the percentages of errors in language tests between left and right carotid injections. RESULTS: Semantic verbal fluency: The asymmetry of frontal activation was correlated with Wada laterality indices. The strongest correlation was observed in the precentral/middle frontal gyrus/inferior frontal sulcus area. Story listening: The asymmetry of frontal, but not temporal, activation was correlated with Wada laterality indices. Covert sentence repetition: No correlation was observed. CONCLUSIONS: There was a good congruence between hemispheric dominance for language as assessed with the Wada test and fMRI laterality indices in the frontal but not in the temporal lobes. The story listening and the covert sentence repetition tasks increased the sensitivity of detection of posterior language sites that may be useful for brain lesion surgery.     

Variability of fMRI activation during a phonological and semantic language task in healthy subjects

Assessing inter-individual variability of functional activations is of practical importance in the use of functional magnetic resonance imaging (fMRI) in a clinical context. In this fMRI study we addressed this issue in 30 right-handed, healthy subjects using rhyme detection (phonologic) and semantic categorization tasks. Significant activations, found mainly in the left hemisphere, concerned the inferior frontal gyrus, the superior/middle temporal gyri, the prefrontal cortex, the inferior parietal lobe, the superior parietal lobule/superior occipital gyrus, the pre-central gyrus, and the supplementary motor area. Intensity/spatial analysis comparing activations in both tasks revealed an increased involvement of frontal regions in the semantic task and of temporo-parietal regions in the phonologic task. The frequency of activation analyzed in nine regional subdivisions revealed a high inter-subject variability but showed that the most frequently activated regions were the inferior frontal gyrus and the prefrontal cortex. Laterality indices, strongly lateralizing in both tasks, were slightly higher in the semantic (0.76 +/- 0.19) than the phonologic task (0.66 +/- 0.27). Frontal dominance indices (a measure of frontal vs. posterior left hemisphere dominance) indicated more robust frontal activations in the semantic than the phonologic task. Our study allowed the characterization of the most frequently involved foci in two language tasks and showed that the combination of these tasks constitutes a suitable tool for determining language lateralization and for mapping major language areas.     

Is dichotic word listening a valid predictor of cerebral language dominance?

Abstract

Although the pattern of ear asymmetry derived from dichotically presented verbal stimuli is used to predict cerebral language dominance, the reliability of this procedure for individual patients has not been adequately established. To determine the accuracy with which verbal dichotic stimuli can predict cerebral language dominance, dichotic word listening performances of 106 patients whose language dominance had been determined by Wada (intracarotid amobarbital) testing were examined. On a group level, ear advantages were in the expected direction, however, no statistically significant differences between left, bilateral, and right language dominance patients were obtained. Predicting side of language dominance was even more ineffective in the individual patient regardless of ear asymmetry criterion. Results suggest that the dichotic word listening task employed in this study is not a valid predictor of cerebral language dominance in adults. Thus, caution should be exercised when inferring language lateralization based solely upon dichotic word listening performance.     

卒中后失语患者非语言认知功能损害特点的临床研究

目的 探讨卒中后失语患者非语言认知功能损害的特点，并分析卒中后失语患者语言障碍与非语言 性认知功能损害之间的关系。 方法 选择2017年5月-2018年6月就诊的卒中患者共32例，经西方失语症成套测验（western aphasia battery，WAB）评估语言功能，分为失语组和无失语组，其中失语组15例，无失语组17例。洛文斯顿成 套测验中文版（Loewenstein occupational therapy cognitive assessment，LOTCA）第2版评估患者非语言认 知功能。对失语组与非失语组的LOTCA各分项分值及总分分别进行非参数检验；对WAB中各分项得 分及失语商与LOTCA各认知分项得分及总分进行偏相关分析，并行多元逐步回归分析。 结果 失语组的LOTCA总分低于无失语组，差异有统计学意义[85.0（69.0～92.0）分 vs 99.0 （86.0～102.5）分，P <0.05]；失语患者LOTCA总分与WAB各分项及失语商呈正相关（r =0.587～0.883， 均P <0.05），WAB分项中的各分项与LOTCA中各分项之间呈正相关（r =0.521～0.843，均P <0.05）；多 元逐步回归分析显示，影响患者失语商的主要因素为LOTCA总分（β=0.707，P =0.003）。 结论 卒中后失语患者存在非语言认知功能障碍，失语程度越重其非语言认知功能受损程度越重。     

Visual half-field experiments are a good measure of cerebral language dominance if used properly: evidence from fMRI

Traditional neuropsychology employs visual half-field (VHF) experiments to assess cerebral language dominance. This approach is based on the assumption that left cerebral dominance for language leads to faster and more accurate recognition of words in the right visual half-field (RVF) than in the left visual half-field (LVF) during tachistoscopic presentation. Information in the RVF is directly projected to the left hemisphere, whereas information presented in the LVF needs interhemispheric transfer to reach the left half of the brain. This interpretation of the RVF superiority for word recognition lacks direct evidence however, and a multitude of studies have lead to contradictory findings. To investigate this matter further we try to establish the ideal parameters for VHF experiments to measure language dominance, and subsequently compare laterality indices (LIs) obtained from RT patterns in bilateral VHF tasks to those LIs acquired in the same individuals during a mental word generation task in the fMRI scanner. Our results reveal a direct link between VHF advantages and individual language lateralization. Differences in behavioral performance between left-hemisphere dominant and right-hemisphere dominant individuals suggest that carefully designed VHF tests can be used as a reliable predictor of cerebral language dominance.     

Cognitive processing in Chinese literate and illiterate subjects: an fMRI study

Functional magnetic resonance imaging (fMRI) and positron emission tomography (PET) were used to map brain activation during language tasks. While previous studies have compared performance between alphabetic literate and illiterate subjects, there have been no such data in Chinese-speaking individuals. In this study, we used fMRI to examine the effects of education on neural activation associated with silent word recognition and silent picture-naming tasks in 24 healthy right-handed Chinese subjects (12 illiterates and 12 literates). There were 30 single Chinese characters in the silent word recognition task and 30 meaningful road-signs in the silent picture-naming task. When we compared literate and illiterate subjects, we observed education-related differences in activation patterns in the left inferior/middle frontal gyrus and both sides of the superior temporal gyrus for the silent word recognition task and in the bilateral inferior/middle frontal gyrus and left limbic cingulated gyrus for the silent picture-naming task. These results indicate that the patterns of neural activation associated with language tasks are strongly influenced by education. Education appears to have enhanced cognitive processing efficiency in language tasks.     

Right hemispheric language dominance in a right-handed male with a right frontal tumor shown by functional transcranial Doppler sonography

BACKGROUND: A 38-year-old, right-handed man with late-onset right frontal epilepsy due to a ganglioglioma and atypical right hemispheric language dominance is described. METHODS: Language dominance was investigated with functional transcranial Doppler sonography (fTCD), and language localization with functional magnetic resonance imaging (fMRI). RESULTS: During a word generation task, fTCD showed atypical right hemispheric language dominance, which was confirmed by fMRI using a semantic word comparison and a word stem completion task. This information helped to guide the resective procedure, which left the patient seizure-free and did not induce new deficits. CONCLUSION: Functional TCD appears to be a useful and reliable screening tool for determining hemispheric language dominance, even in patients with atypical language representation. Functional MRI may be used to confirm fTCD results and further localize eloquent cortex.     

Anatomical and functional distribution of functional MRI language mapping

ObjectiveThe aim of the present study was to compare localization of the language cortex using electrical cortical stimulation (ECS) and functional magnetic resonance imaging (fMRI) to establish the relevance of fMRI language mapping.MethodsLanguage mapping with fMRI and functional ECS mapping were retrospectively compared in ten patients with refractory epilepsy who underwent fMRI language mapping and functional ECS mapping between June 2012 and April 2019. A shiritori task, a popular Japanese word chain game, was used for fMRI language mapping.ResultsBOLD signal activation was observed in the left inferior frontal gyrus (including the pars opecularis and the pars triangularis), and superior temporal gyrus, which is a language-related area, as well as in the left superior and middle frontal gyri, the intraparietal sulcus, and fusiform gyrus. These results were compared with ECS to elucidate the functional role of the activated areas during fMRI language tasks. These activated areas included language areas, negative motor areas, supplementary motor areas (SMAs), and non-functional areas.ConclusionThe activated areas of fMRI language mapping include language-related areas, the negative motor area, and SMAs. These findings suggest the involvement of language and higher order motor networks in verbal expression.     

Language lateralization from task‐based and resting state functional MRI in patients with epilepsy

We compared resting state (RS) functional connectivity and task‐based fMRI to lateralize language dominance in 30 epilepsy patients (mean age = 33; SD = 11; 12 female), a measure used for presurgical planning. Language laterality index (LI) was calculated from task fMRI in frontal, temporal, and frontal + temporal regional masks using LI bootstrap method from SPM12. RS language LI was assessed using two novel methods of calculating RS language LI from bilateral Broca's area seed based connectivity maps across regional masks and multiple thresholds (p < .05, p < .01, p < .001, top 10% connections). We compared LI from task and RS fMRI continuous values and dominance classifications. We found significant positive correlations between task LI and RS LI when functional connectivity thresholds were set to the top 10% of connections. Concordance of dominance classifications ranged from 20% to 30% for the intrahemispheric resting state LI method and 50% to 63% for the resting state LI intra‐ minus interhemispheric difference method. Approximately 40% of patients left dominant on task showed RS bilateral dominance. There was no difference in LI concordance between patients with right‐sided and left‐sided resections. Early seizure onset (<6 years old) was not associated with atypical language dominance during task‐based or RS fMRI. While a relationship between task LI and RS LI exists in patients with epilepsy, language dominance is less lateralized on RS than task fMRI. Concordance of language dominance classifications between task and resting state fMRI depends on brain regions surveyed and RS LI calculation method.