BOLD技术与皮质电刺激定位语言功能区的比较

目的:将语言BOLD与术中皮质电刺激作点对点比较,评价其对语言功能区定位的准确性.材料和方法:12例左侧大脑半球近语言功能区手术病例术前采用词语联想任务进行BOLD扫描,融合在导航序列上进行神经导航手术.在局麻下进行术中皮质电刺激,与导航影像对应,采用完全吻合或相邻1cm以内两种不同的标准来比较BOLD激活区与电刺激阳性区的关系.结果:12例病人共刺激了145个点,其中阳性点27个.与ESM比较,以完全重叠为标准,BOLD敏感性48.1%,特异性83.1%;以相距小于1cm为标准,BOLD敏感性88.9%,特异性75%.良性或低级别肿瘤(9例)BOLD敏感性(95.2%)特异性(80.4%)均高于高级别恶性肿瘤(3例)(敏感性66.7%,特异性68.6%).结论:词语联想任务的BOLD-fMRI与ESM结果有较好的吻合,显示出一定的临床应用价值.

BOLD-fMRI in Preoperative Assessment of Language Areas: Correlation with Direct Cortical Stimulation

The aim of this study was to analyze the usefulness of preoperative language functional mag-netic resonance imaging(fMRI),by correlating fMRI data with intraoperative cortical stimulation results for patients with brain tumors.Materials and Methods:Word generation task was used for12right-handed patients with lesions in the left hemisphere.The fMRI data were registered in a frameless stereotactic neuronavigational device and correlated with direct brain mapping results.We used a sta-tistical model with the fMRI information as a predictor,spatially correlating each intraoperatively mapped cortical site with fMRI data integrated in the neuronavigational system(site-by-site correla-tion).Two matching criteria(overlapping and adjacent within1cm)were used to adjust the relationship between area actived by language task in BOLD-fMRI and site inducing language interruption in intra-operative cortical simulation.Results:A total of145cortical sites were tested among the12patients.Poor sensitivity of the fMRI technique was observed by using strict criteria(overlapping within two methods)in total areas(48.1%).while loosening the criteria to adjacent within1cm,the sensitivity was increased to88.9%,though the specificity was slightly decreased(83.1%to75%).The sensitivity and specificity of the fMRI technique was good in benign or low grade tumor(95.2%and80.4%,respective-ly.BOLD-fMRI was less reliable in localizing language area in malignant tumors(with sensitivity of66.7%and specificity of68.6%respectively).Conclusion:Good correlation between word-generation BOLD and ESM was obtained by using the criteria to adjacent within1cm.Preoperative language BOLD-fMRI may useful in identification language area in patients underwent neurosurgery,especially in those with benign and low grade tumor.