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目的 探讨联合应用fMRI及扩散张量纤维束成像对左侧语言相关脑区肿瘤的应用价值.方法 选取15例左侧语言相关脑区肿瘤患者行fMRI及DTI.其中3例患者失语,余患者语言功能轻度受损或正常.功能MR扫描采用视觉呈现、组块设计模式,以及语义相关判断任务.fMRI图像后处理采用个体化分析,在功能激活图与解剖图叠加的图像上测量获得的Broca区和中央前回"手结节"区边缘距离肿瘤边缘最短距离,并计算语言功能偏侧化指数(LI),DTI图像后处理应用Volume-one软件进行纤维束追踪成像,观察额叶白质纤维束,主要是弓状束与肿瘤的位置关系.术前与神经外科医师共同根据脑功能激活图和白质纤维束图显示的肿瘤与功能区和纤维束解剖关系制定手术方案,术后1年进行影像和语言功能随访.结果 语义相关判断任务很好地激活了前、后语言区和中央前回"手结节"运动区.12例患者患侧均可见Broca区、Wernicke区和其他语言处理相关脑区神经网络的激活,并测量Broca区和中央前回"手结节"区距离肿瘤的最短距离,另3例患者因头动明显,数据处理失败.8例患者为左侧语言优势半球,3例患者为右侧语言优势半球,1例患者为双侧语言优势.14例患者纤维柬重建后,3例患者左侧弓状束受浸润破坏,6例受压变形移位,5例完全正常.1例患者DTI图像头动伪影明显,图像处理失败.fMRI和扩散张量纤维束成像成功地帮助神经外科制定个体化手术计划.术后1年随访,1例患者死于并发症,其余患者没有发现肿瘤复发.术前语言功能受损的3例患者,因弓状柬受浸润破坏语言表达能力轻度改善,其余患者语言表达能力明显改善或正常.结论 fMRI及扩散张量纤维束成像联合应用能够更好地观察肿瘤、语言功能区及相关白质纤维束的解剖关系,辅助术前个体化手术方案的制定,最大程度地切除肿瘤,降低了术后语言功能障碍的比例.

Objective To evaluate the application of combination of BOLD-fMRI and diffusion tensor tractography (DTT) in pre-operative evaluation of cerebral tumors located at the left language related areas.Methods A non-vocal button pressing semantic judging paradigm was developed and validated in 10 right-handed volunteers at 3 T.After validation, this protocol combined with DTI were applied to 15 patients with left cerebral tumor prior to surgical resection, and 3 of them had aphasia fMRI data analysis was on subject-specific basis by one-sampled t-test.The distance from the tumor to Broca area and pre-central "hand-knot" area were measured separately.Functional language laterality index (LI) was calculated by taking out Broca area and Wernicke area.Three dimensional architecture of frontal lobe white matter fibers, especially arcuate fasciculus, were visualized using diffusion tensor tractography on Volume-one software.The images demonstrating relationship among tumor, language activation areas and white matter fibers were reviewed by neurosurgeons as part of pre-operative planning.One year after the operation, patients were followed up with MRI and language function test Results The non-vocal semantic judging paradigm successfully detect Broca area, Wernicke area and pre-central "hand-knot" area In 12 of 15 patients, the relationship of Broca area and pre-central motor area to the left brain tumor in language related areas was identified, which make the pre-operative neurosurgical plan applicable to minimize the disruption of language and motor.8 patients had the left language dominant hemisphere, 3 patients with the right language dominant hemisphere and 1 patient with bilateral dominance.The other 3 patients' fMRI data were corrupted by patients' motion.Diffusion tensor images were corrupted by motion in 1 patient but demonstrated the impact of tumor on left arcuate fasciculus in 14 patients.Diffusion tensor tractography showed disruption of left arcuate fasciculus in 3 patients, deviation/deformation in 6 cases and unaffected by tumor in the remaining 5 cases.Pre-operative review of language activation maps and diffusion tensor tractography of arcuate fasciculus influenced the surgical approach in all 12 patients.Post-operatively, one patient died accidentally, the remaining 14 patients showed no tumor recurrence after one year follow-up.No patient showed deterioration of language function, though 3 patients who had aphasia pre-operation improved slightly.Conclusion The combination of fMRI and diffusion tensor tractography is helpful for identifying the relationship of brain tumors with language cortex and white matter fibers, which is important for sparing language function during individually surgical plan.