屏气功能磁共振评价神经胶质瘤患者脑血管反应性的研究
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摘要
目的利用屏气功能磁共振成像(BH-f MRI)评价神经胶质瘤患者的脑血管反应能力(CVR),帮助神经外科医师脑肿瘤术前规划。方法对8名神经胶质瘤患者(男性5名,女性3名;年龄18~53岁,平均33.4岁)进行静息态和屏气任务的f MRI研究。采用SPM8软件对f MRI数据进行预处理(P<0.05,FDR校正),采用AFNI软件计算肿瘤异常信号区域和对侧镜像正常脑组织BOLD信号变化百分比(PSC),方差分析两者ROI的信号变化差异,对照分析静息态f MRI定位的脑功能像和BH-f MRI CVR像。结果独立成分分析(ICA)不仅能够全面揭示运动功能区的位置,而且能够很好地显示肿瘤组织周边的不同功能系统。BH-f MRI CVR像显示神经胶质瘤异常信号区域较对侧镜像正常脑组织的BOLD信号明显下降(P<0.05),并与静息态f MRI的BOLD信号阴性区存在交集。结论静息态f MRI的ICA对肿瘤组织周边的功能系统把握较为全面、准确。BH-f MRI是一种可靠的、简便易行的CVR评价方法,可以提示神经血管耦合障碍(NVU)现象,发现f MRI功能定位的假阴性区,为脑肿瘤外科手术计划的制定和术后风险的判断提供重要参考。
Objective To evaluate the cerebrovascular reactivity of patients with glioma by breath-hold f MRI and plan the safest surgical trajectory. Methods Eight patients with glioma( five male and three female; ages 18 to 53 years old,average 33. 4 years) were performed the f MRI with resting-state and breath holding task. SPM8 was applied in data processing( P < 0. 05,FDR correction),AFNI was used to calculate the percentage of signal change of BOLD in the tumor regional and contralateral normal brain tissue. The difference of the signal change in two ROI was analyzed. The resting-state f MRI( R-f MRI) mapping and BH f MRI CVR mapping was compared. Results Independent component analysis( ICA) was not only able to reveal the location of the motor function area,but also can display the different functional systems around the tumor tissue. Relative to the mirror side normal brain parenchyma,BH BOLD signal around glioma was significantly decreased( P < 0. 05),and there was the intersection of the negative region of BOLD signal in R-f MRI. Conclusion ICA of R-f MRI was more comprehensive and accurate in the function system of tumor tissue. BH-f MRI was a convenient and reliable method for CVR assessing to suggest the phenomenon of NVU,and to find false negative areas of f MRI function mapping. It could provide important reference for the formulation of brain tumor surgical plan and the judgment of risk after operation.
Objective To evaluate the cerebrovascular reactivity of patients with glioma by breath-hold f MRI and plan the safest surgical trajectory. Methods Eight patients with glioma( five male and three female; ages 18 to 53 years old,average 33. 4 years) were performed the f MRI with resting-state and breath holding task. SPM8 was applied in data processing( P < 0. 05,FDR correction),AFNI was used to calculate the percentage of signal change of BOLD in the tumor regional and contralateral normal brain tissue. The difference of the signal change in two ROI was analyzed. The resting-state f MRI( R-f MRI) mapping and BH f MRI CVR mapping was compared. Results Independent component analysis( ICA) was not only able to reveal the location of the motor function area,but also can display the different functional systems around the tumor tissue. Relative to the mirror side normal brain parenchyma,BH BOLD signal around glioma was significantly decreased( P < 0. 05),and there was the intersection of the negative region of BOLD signal in R-f MRI. Conclusion ICA of R-f MRI was more comprehensive and accurate in the function system of tumor tissue. BH-f MRI was a convenient and reliable method for CVR assessing to suggest the phenomenon of NVU,and to find false negative areas of f MRI function mapping. It could provide important reference for the formulation of brain tumor surgical plan and the judgment of risk after operation.
引文
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[14]ZHANG Quan,ZHANG Yunting.Status of application of breath holding in functional MRI of brain[J].Chinese Journal of Medical Imaging Technology,2012,28(6):1230-1233.
[15]张迪,张寒,戚乐,等.屏气功能磁共振评价脑血管反应性的研究进展[J].实用医学杂志,2014,30(7):1011-1013.
[2]Krieg SM,Shiban E,Buchmann N,et al.Utility of presurgical navigated transcranial magnetic brain stimulation for the resection of tumors in eloquent motor areas[J].Journal of Neurosurgery,2012,116(5):994-1001.
[3]Pillai JJ,Zaca D.Clinical utility of cerebrovascular reactivity mapping in patients with low grade gliomas[J].World J Clin Oncol,2011,2(12):397-403.
[4]Zaca D,Hua J,Pillai JJ.Cerebrovascular reactivity mapping for brain tumor presurgical planning[J].World J Clin Oncol,2011,2(7):289-298.
[5]Wengenroth M,Blatow M,Guenther J,et al.Diagnostic benefits of presurgical f MRI in patients with brain tumours in the primary sensorimotor cortex[J].Eur Radiol,2011,21(7):1517-1525.
[6]Abou-Elseoud A,Starck T,Remes J,et al.The effect of model order selection in group PICA[J].Human Brain Mapping,2010,31(8):1207-1216.
[7]Birn RM,Smith MA,Jones TB,et al.The respiration response function:the temporal dynamics of f MRI signal fluctuations related to changes in respiration[J].Neuroimage,2008,40(2):644-654.
[8]Zhang H,Zuo XN,Ma SY,et al.Subject order-independent group ICA(SOI-GICA)for functional MRI data analysis[J].Neuro Image,2010,51(4),1414-1424.
[9]高原雪,王露萍,戚乐,等.BOLD-f MRI在脑肿瘤外科手术中的应用及发展[J].实用医学杂志,2014,30(13):2026-2027.
[10]陈思攀,王晓明.血氧水平依赖功能磁共振成像在脑肿瘤诊治中的应用[J].磁共振成像,2012,3(1):69-73.
[11]牛晨,张明,林盘,等.静息态与任务态功能MRI在脑肿瘤患者术前运动皮层定位的研究[J].磁共振成像,2012,3(3):168-173.
[12]王引言,伊慧明,赵澎,等.静息态独立成分分析在累及运动区脑肿瘤患者术前评价中的应用[J].中华脑科疾病与康复杂志(电子版),2011,1(1):22-27.
[13]刘浩,林青,徐文坚,等.血氧水平依赖功能磁共振评价脑肿瘤恶性程度与脑皮层功能区距离和激活体积的相关性[J].中国医学影像学杂志,2012,20(2):97-99,102.
[14]ZHANG Quan,ZHANG Yunting.Status of application of breath holding in functional MRI of brain[J].Chinese Journal of Medical Imaging Technology,2012,28(6):1230-1233.
[15]张迪,张寒,戚乐,等.屏气功能磁共振评价脑血管反应性的研究进展[J].实用医学杂志,2014,30(7):1011-1013.