功能磁共振成像和弥散张量成像融合指导立体定向脑运动皮层区小病灶切除

目的 探讨血氧水平依赖效应的功能核磁共振成像(BOLD-fMRI)和弥散张量成像(DTI)融合技术指导立体定向下脑运动皮层区小病灶切除的方法.方法 15例额叶后部-中央前回病灶患者,病变直径1.5～3 cm,采用增强核磁共振成像(MRI)、BOLD-fMRI、DTI和计算机结合完成图像融合,直观显示病灶、运动皮层和皮质脊髓束结构,明确它们之间的相邻关系,设计手术入路和立体定向下病灶切除的策略.结果 15例患者的融合影像显示运动皮层区和皮质脊髓束位于病灶的后外侧,均受压、变形和移位,其中4例肿瘤边缘与上述重要神经组织结构紧密接触.病变镜下全切12例,次全切除3例(胶质瘤).病理学诊断为脑膜瘤6例,星形细胞瘤Ⅱ级者3例,星形细胞瘤Ⅲ级者2例,脑脓肿2例,海绵状血管瘤2例.术后无并发症发生.结论 BOLD-fMRI和DTI影像融合后可优势互补,能安全、准确、有效的指导立体定向运动皮层区小病灶的切除,避免了运动皮层区和皮质脊髓束损伤,提高了患者的生存质量.

Stereotactic resection of small intracerebral lesions in motor cortex using blood oxygen level depended functional magnetic resonance imaging and diffusion tensor imaging fusion guidance

Objective To explore the effect of stereotactic resection of small intracerebral lesionslocated in the motor cortex using blood oxygen level depended functional magnetic resonance imaging(BOLD-fMRI) and diffusion tensor imaging (DTI) fusion guidance. Methods Fifteen patients with lesionsin posterior frontal lobe to anterior central gyms, 1.5 - 3 cm in diameter, underwent combined three-dimensional (3D) enhancement MRI with BOLD-fMRI, and DTI. Computer procedure was used to performthe images fusion to show directly the lesions, motor cortex, and corticospinal tract, and to confirm theirposition relationship and design the operative approach so as to guide the stereotactic resection of the smallintracerebral lesions. Results The images fusion demonstrated that the motor cortex and corticospinal tractwere located in the lateral-posterior side of the lesions, and were both compressed, deformated anddisplaced. Total removal of the lesions under microscope was achieved in 12 cases, and subtotal removal in 3cases. Histological examination showed 3 cases of meningeoma, 3 cases of astrocytoma of grade Ⅱ , 2 casesof astrocytoma of grade Ⅲ, 2 cases of abscess, and 2 cases of cavernous angioma. No complication wasfound postoperatively. Conclusion Mutual complementarity can be achieved by combining 3D-enhancementMRI,BOLD-fMRI, and DTI. Stereotactic resection of the small intracerebral lesions is safe, accurate andeffective under the images fusion guidance.