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目的研究功能磁共振成像(fMRI)定位脑运动功能区和弥散张量纤维束示踪成像(diffusion tensor tractography,DTT)显示锥体束与肿瘤位置关系在脑胶质瘤行直接皮质电刺激手术的指导作用。方法对28例邻近或累及脑运动功能区的患者,术前在常规成像基础上,分别行双手握拳刺激策略的血氧水平依赖性功能磁共振成像(BOLD-fMRI)和弥散张量成像(DTI),经工作站提供的 BOLD-fMRI 和 DTI 图像分析软件包获得脑运动功能区的激活图像、二维的部分各向异性伪彩图(fractional anisotropy,FA Color)和三维的白质纤维束示踪图。提供脑肿瘤与脑运动皮质区和运动传导束即锥体束的位置关系信息,制定手术方案。所有患者均行术中皮质直接电刺激定位运动区。术前、术后均行 Karnofsky 生活状态(KPS)评分,判断患者的状态。结果 28例患者的 fMRI 和 DTI 获得良好的脑双手握拳运动功能区激活图像和锥体束纤维束走形图像,显示初级运动皮质区、运动前皮质区、辅助运动皮质区等手运动相关的脑功能区和运动传导束——锥体束与肿瘤的位置关系。在术前脑功能磁共振图像指导下,直接皮质电刺激快捷、准确定位初级运动皮质区,发现两者具有良好的一致性。术后患者 KPS 评分结果较术前提高。结论术前 BOLD-fMRI 和 DTY 可于活体、无创地描绘脑运动功能区和锥体束与肿瘤的功能解剖位置关系,优化手术方案,在唤醒麻醉下指导直接皮质电刺激定位运动区的手术,实现最大程度保护患者重要的功能,并最大程度地切除肿瘤。
Objective To study the relationship between pyramidal tract and tumor location by diffusion magnetic resonance imaging (fMRI) in brain motor function zone and diffusion tensor tractography (DTT). In direct glioma with cortical electrical stimulation Guidance. Methods Totally 28 patients with functional areas adjacent to or involved with brain motion were treated with BOLD-fMRI and DTI (digital subtraction angiography) ), BOLD-fMRI and DTI image analysis software packages provided by the workstation were used to obtain activation images of brain motor function area, two-dimensional fractional anisotropy (FA Color) and three-dimensional white matter fiber bundle tracer . Provide information about the location of the brain tumor in relation to the cortical area of the motor cortex and the trabeculectomy that is the pyramidal tract, and develop the surgical protocol. All patients underwent intraoperative cortical direct stimulation of locomotion area. Preoperative and postoperative Karnofsky life status (KPS) score, to determine the status of patients. Results FMRI and DTI of 28 patients achieved good brain flicker motor function area activation images and pyramidal tract bundles shape images showing the movement related brain in the primary motor cortex, pre-motor cortex, cortex of assist motor Functional area and motion-guided beam - The relationship between pyramidal tract and tumor. Under the guidance of preoperative brain functional magnetic resonance imaging, direct cortical electrical stimulation quickly and accurately locates the primary motor cortex and found a good consistency between the two. Postoperative KPS score results improved compared with preoperative. Conclusions BOLD-fMRI and DTY can be used to describe the functional anatomy of brain motor function area, pyramidal tract and tumor in vivo and noninvasively, optimize the surgical plan, guide the operation of direct cortical electrical stimulation in locating motor area under awakening anesthesia, To achieve the maximum protection of patients with important functions, and to maximize the removal of the tumor.