【摘要】 目的术前联合应用血氧水平依赖功能磁共振成像与扩散张量成像技术,评估位于大脑中央沟附近运动区,包括初级运动皮层区、前运动区及辅助运动区脑肿瘤与上述脑功能区及皮质脊髓束的关系,评价其在术前评估中的作用。方法对30例邻近运动区肿瘤的患者术前分别行BOLD-f MRI与DTI检查,所得到的图像分别经SPM 8软件和工作站(ADW4.4)提供的分析软件包获得脑运动功能区的激活图像和三维白质纤维束示踪图,观察并分析肿瘤与运动区及皮质脊髓束的关系。结果 1)运动区激活图像对激活区的数目、位置和分布范围显示良好,M1区受累者90%(27/30),其中63%(17/27)的患者M1区位于瘤周水肿区内,并且发生了不同程度、不同方向的移位;37%(10/27)的患者无水肿区,但M1区紧邻肿瘤。13%(4/30)患者出现双侧PMA区激活,30%(9/30)患者出现SMA区激活。2)白质纤维束示踪图显示了皮质脊髓束的受累情况,表现为单纯受压、移位者67%(20/30),发生浸润、破坏者33%(10/30),其中单纯破坏者30%(3/10),不仅纤维束中断、破环,残留部分纤维束轻度受压、移位者为70%(7/10)。16例脑膜瘤患侧皮质脊髓束表现为受压、移位,14例星形细胞瘤患者中,仅有29%(4/14)也表现为单纯受压、移位,其余71%(10/14)表现为不同程度的浸润、破坏。结论术前联合应用BOLD-f MRI与DTI能够直观的观察到运动区附近的脑肿瘤与运动区及皮质脊髓束的关系,对手术计划的制定及手术入路的选择具有指导意义。更多还原

【Abstract】 Objective To explore the relationship between the brain tumor near the motor cortex of the brain( including the primary motor cortex area( M1),premotor area( PMA) and supplementary motor area( SMA)and the areas and corticospinal tract using blood oxygen level dependent-functional magnetic resonance imaging( BOLD-f MRI) combined with diffusion tensor imaging( DTI) technology. Methods BOLD-f MRI and DTI scans were performed in 30 cases with adjacent motor cortex tumors before surgery. The activation images of the motor area and three dimensional white matter fiber tract images were analyzed by SPM 8 software and software package provided by workstations( ADW4. 4). The relationship between the tumor and the M1,PMA,SMA area and corticospinal tract were observed and investigated. Results 1) The activation maps which had been processed illustrated the numbers,location of the activated motor area,M1 areas in 90%( 27 /30) patients were involved. M1 areas in 63%( 17 /27) patients were in edema areas adjacent to the tumor,and displacement towards different directions was founded. Edema areas in 37%( 10 /27) patients could not be founded,but the M1 areas were adjacent to the tumor. Both sides of PMA areas could be founded in 13%( 4 /30) patients,and SMA areas could be founded in 30%( 9 /30) patients. 2) DTT figures showed the involvement of the corticospinal tract by the tumor. The displacement of white matter fiber tract was observed in 67%( 20 /30) cases,disruption and interruption in 33%( 10 /30) cases. Only interruption was found in 30%( 3 /10) cases,and displacement and interruption were found at the same time in other 70%( 7 /10) cases. Corticospinal tract showed displacement in 16 cases with meningioma,but showed disruption and interruption in 14 cases with astrocytoma. 29%( 4 /14) cases were found displacement and other 71%( 10 /14) cases were found disruption and interruption in the cases with astrocytoma. Conclusion By using BOLD-f MRI conbined with DTI before surgery,we could visually find the relationship between the tumor and motor cortex and corticospinal tract,so that we can make the surgical planning more exactly.更多还原