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首页> 外文期刊>Neurosurgery >Language functional magnetic resonance imaging in preoperative assessment of language areas: correlation with direct cortical stimulation.
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Language functional magnetic resonance imaging in preoperative assessment of language areas: correlation with direct cortical stimulation.

机译：术前语言区域评估中的语言功能磁共振成像：与直接皮层刺激的相关性。

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OBJECTIVE: The aim of this study was to analyze the usefulness of preoperative language functional magnetic resonance imaging (fMRI), by correlating fMRI data with intraoperative cortical stimulation results for patients with brain tumors. METHODS: Naming and verb generation tasks were used, separately or in combination, for 14 right-handed patients with tumors in the left hemisphere. fMRI data obtained were analyzed with SPM software, with two standard analysis thresholds (P < 0.005 and then P < 0.05). The fMRI data were then registered in a frameless stereotactic neuronavigational device and correlated with direct brain mapping results. We used a statistical 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 correlation). Eight patients were also studied with language fMRI postoperatively, with the same acquisition protocol. RESULTS: We observed high variability in signal extents and locations among patients with both tasks. The activated areas were located mainly in the left hemisphere in the middle and inferior frontal gyri (F2 and F3), the superior and middle temporal gyri (T1 and T2), and the supramarginal and angular gyri. A total of 426 cortical sites were tested for each task among the 14 patients. In frontal and temporoparietal areas, poor sensitivity of the fMRI technique was observed for the naming and verb generation tasks (22 and 36%, respectively) with P < 0.005 as the analysis threshold. Although not perfect, the specificity of the fMRI technique was good in all conditions (97% for the naming task and 98% for the verb generation task). Better correlation (sensitivity, 59%; specificity, 97%) was achieved by combining the two fMRI tasks. Variation of the analysis threshold to P < 0.05 increased the sensitivity to 66% while decreasing the specificity to 91%. Postoperative fMRI data (for the cortical brain areas studied intraoperatively) were in accordance with brain mapping results for six of eight patients. Complete agreement between pre- and postoperative fMRI studies and direct brain mapping results was observed for only three of eight patients. CONCLUSION: With the paradigms and analysis thresholds used in this study, language fMRI data obtained with naming or verb generation tasks, before and after surgery, were imperfectly correlated with intraoperative brain mapping results. A better correlation could be obtained by combining the fMRI tasks. The overall results of this study demonstrated that language fMRI could not be used to make critical surgical decisions in the absence of direct brain mapping. Other acquisition protocols are required for evaluation of the potential role of language fMRI in the accurate detection of essential cortical language areas.
机译：目的：本研究旨在通过将fMRI数据与脑肿瘤患者术中皮层刺激结果相关联，分析术前语言功能磁共振成像（fMRI）的有用性。方法：命名和动词生成任务分别或组合用于14名左半球肿瘤的惯用右手患者。使用SPM软件分析获得的fMRI数据，并使用两个标准分析阈值（P <0.005，然后P <0.05）。然后将fMRI数据记录在无框立体定向神经导航设备中，并与直接的大脑定位结果相关联。我们使用功能磁共振成像信息作为预测变量的统计模型，将每个术中映射的皮层位与神经导航系统中集成的功能磁共振成像数据进行空间关联（逐点关联）。八名患者在术后接受了相同功能的语言功能磁共振成像研究。结果：我们观察到这两个任务的患者的信号范围和位置的高度变化。激活的区域主要位于额中回和下回（F2和F3），颞上和中回回（T1和T2）以及上腹和角上回的左半球。在14位患者中，总共426个皮质位点针对每个任务进行了测试。在额叶和颞顶区域，对于命名和动词生成任务（分别为22％和36％），以f <0.005作为分析阈值，观察到fMRI技术的敏感性较差。尽管并不完美，但fMRI技术的特异性在所有条件下都很好（命名任务为97％，动词生成任务为98％）。通过将两个功能磁共振成像任务结合在一起，可以实现更好的相关性（敏感性为59％;特异性为97％）。将分析阈值更改为P <0.05可将灵敏度提高到66％，而将特异性降低到91％。术后fMRI数据（用于术中研究的皮质大脑区域）与八名患者中六名患者的脑成像结果一致。八名患者中只有三名在术前和术后fMRI研究与直接脑成像结果之间完全一致。结论：利用本研究的范例和分析阈值，在手术前后通过命名或动词生成任务获得的语言功能磁共振成像数据与术中脑成像结果不完全相关。通过组合fMRI任务可以获得更好的相关性。这项研究的总体结果表明，在没有直接脑成像的情况下，fMRI语言不能用于做出关键的手术决策。需要其他采集协议来评估语言功能磁共振成像在准确检测基本皮层语言区域中的潜在作用。

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