功能磁共振成像在神经外科应用的初步经验

背景与目的：位于脑中央沟附近的肿瘤在外科手术中易造成运动功能损伤。本研究拟运用功能磁共振成像（functional magnetic resonance imaging,fMRI）的方法术前确定手运动功能皮层的位置及其与肿瘤的关系。探索fMRI在神经外科的应用价值。方法：31例位于中央沟附近的脑肿瘤患者接受常规和功能磁共振检查,其中转移瘤10例,胶质瘤11例,脑膜瘤6例,动静脉畸形2例,蛛网膜囊肿2例。功能成像方法采用在手静止和开合运动中,行快速梯度平面回波连续成像,以平行胼胝体前后联合的连线为基线,连续16层,层厚为4mm,层距为零,共获得1280幅功能原始图像,并经处理获得统计学Z-score图。结果：除2例患者头运动较明显外。其余患者都显示了手运动功能皮层活化兴奋区。并测得了功能皮层区与肿瘤的最短距离。功能皮层活化区表现出3种不同类型,包括：病灶内或边缘散在的活化小斑点;功能皮层活化区受挤压、移位;功能皮层活化区形态,位置正常。此外,在其他区域亦出现了不同例数的活化现象。结论：fMRI能帮助确定中央沟附近的脑肿瘤与手运动功能区位置的关系,从而为外科手术提供参考。

Preliminary application of functional magnetic resonance imaging to neurosurgery

BACKGROUND & OBJECTIVE: Motor functional deficit may be caused by surgery resection of brain tumors around the central sulcus. This study was to evaluate the application of functional magnetic resonance imaging (fMRI) to neurosurgery through identifying motor hand functional cortex and depicting the relationship between the cortex and tumor with fMRI before surgery. METHODS: Routine MRI and fMRI were performed on 31 patients with brain tumor around the cetral sulcus. Of the 31 cases of brain tumor, 10 were metastases, 11 were gliomas, 6 were meningiomas, 2 were arterial-venal malformation (AVM), and 2 were arachnoid cysts. fMRI was performed using FFE-EPI sequence. Sixteen continuent slices with 4 mm thickness and 0 gap parallel to bicommissural line were scanned during the rest, and actions of opening and closing of hand were imaged. A total of 1 280 functional original pictures and statistical Z-score maps were obtained. RESULTS: The activation areas of motor hand functional cortex were showed in all patients except 2 whose heads moved obviously during the scanning. The minimal distance between the functional cortex and tumor was measured. There were 3 types of activation of motor hand functimal cortex, including activation spots in or near the tumor, deformation and shift of cortex activation area, normal shape and location of cortex activation area. Other activation areas in different places of brain in individual patients were also appeared. CONCLUSION: fMRI may help to identify the relationship between the brain tumors near central sulcus and the location of motor hand functional cortex, therefore, provide reference for neurosurgery.