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神经外科术前计划中语言通路的构建方法研究

Reconstruction method of language pathways in the preoperative planning of brain tumor surgery

摘要:

目的 探讨一种新的语言通路纤维追踪方法在语言区脑肿瘤术前计划中应用的可行性.方法 2013年12月至2014年6月采用3.0 T MRI对18名健康志愿者和13例语言区脑肿瘤患者进行颅脑弥散张量成像序列的扫描,采用双感兴趣区方法利用Syngo工作站的Neuro 3D的任务模块重建人脑语言通路联络纤维的三维结构.首先通过健康志愿者探索该语言通路纤维追踪重建方法的可行性,进而在语言区脑肿瘤中评价该方法的应用价值,并分析肿瘤与联络纤维的解剖关系.结果 通过选择恰当的感兴趣区,弥散张量纤维束成像在18名健康志愿者中均可清楚地显示语言处理的背侧通路(上纵束/弓状束,包括直接通路和间接通路)和腹侧通路(钩束、中纵束、下纵束和下额-枕束)联络纤维的三维结构.在肿瘤患者中,肿瘤与相邻联络纤维的解剖关系分为两种:肿瘤推移邻近纤维,包括6例上纵束/弓状束,4例中纵束,3例钩束,3例下纵束,2例下额-枕束;肿瘤浸润、破坏邻近纤维,包括10例下额-枕束,8例钩束,5例中纵束,4例下纵束,3例上纵束/弓状束.结论 基于弥散张量成像的纤维追踪技术可以快速、实时可视化人脑语言通路的各种联络纤维,在语言区脑肿瘤术前计划中具有可行性.

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abstracts:

Objective To propose a clinically practical and simple fiber tracking method for language pathways,and to explore its feasibility in preoperative planning for brain tumors adjacent to the language cortex.Methods Diffusion tensor imaging was examined in 18 healthy subjects and 13 patients with brain tumors adjacent to the language cortex between December 2013 and June 2014.The associated fibers of language pathways were reconstructed using a commercial software (Syngo workstation).Firstly,the feasibility of fiber tracking method for language pathways in healthy subjects were studied,and then its application was assessed in patients with brain tumors.The anatomic relationship between tumors and the associated fibers was analyzed.Results By selecting appropriate regions of interest,the associated fibers in the dorsal pathways (superior longitudinal fasciculus/arcuate fasciculus,including both direct and indirect pathways) and ventral pathways (uncinate fasciculus,middle longitudinal fasciculus,inferior longitudinal fasciculus and inferiorfronto-occipital fasciculus) were reconstructed in all 18 healthy subjects.In patients with brain tumors,the relationship between the tumors and adjacent associated fibers were divided into two types:adjacent associated fibers could be displaced or separated,and involved the superior longitudinal fasciculus/arcuate fasciculus (n =6),middle longitudinal fasciculus (n =4),uncinate fasciculus (n =3),inferior longitudinal fasciculus (n =3) and inferiorfronto-occipital fasciculus (n =2);alternatively,the adjacent associated fibers were infiltrated or destroyed,and involved the inferiorfronto-occipital fasciculus (n =10),uncinate fasciculus (n =8),middle longitudinal fasciculus (n =5),inferior longitudinal fasciculus (n =4) and superior longitudinal fasciculus/arcuate fasciculus (n =3).Conclusions The associated fibers of language pathways could be visualized rapidly and in real-time by fiber tracking technology based on diffusion tensor imaging.This is feasible for preoperative planning regarding brain tumors adjacent to the language cortex.

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作者: 阎静 [1] 路俊锋 [2] 程敬亮 [1] 吴劲松 [2] 章捷 [2] 王朝艳 [1] 聂云飞 [3] 庞贝贝 [3] 刘献志 [4]
第一作者: 阎静
期刊: 《中华外科杂志》2015年53卷5期 362-367页 MEDLINEISTICPKUCSCD
栏目名称: 论著
DOI: 10.3760/cma.j.issn.0529-5815.2015.05.010
发布时间: 2015-05-28
基金项目:
国家自然科学基金面上项目 河南省医学科技攻关计划项目 上海市卫生系统优秀人才培养计划项目 国家十二五科技支撑计划项目
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