低场强术中磁共振BOLD导航在脑功能区胶质瘤术中的应用  

Integrating preoperative BOLD and low - field intraoperative MRI in neuronavigation surgery of brain glioma involving motor cortex

作　　者：姚成军[1] 吴劲松[1] 毛颖[1] 李士其[1] 庄冬晓[1] 朱凤平[1] 周良辅[1] 

机构地区：[1]复旦大学附属华山医院神经外科,上海市神经外科临床医学中心,上海 200040

出　　处：《中华神经外科杂志》2010年第4期299-302,共4页Chinese Journal of Neurosurgery

基　　金：基金项目：卫生部临床学科重点项目（2007-2009年度）;国家自然科学基金资助（30600639）

摘　　要：目的探讨低场强术中磁共振（iMRI）融合术前采集血液氧饱和水平检测功能成像（BOLD）功能导航的可行性和应用价值。方法48例脑皮层功能区的胶质瘤患者随机分组，试验组用术前高场强的BOLD影像与术中iMRI解剖影像融合，对照组将高场强的BOLD与术前高场强MRI解剖影像融合，分别导航手术。两组均采用术中电生理来验证BOLD功能区定位的准确性并随访。结果试验组BOLD敏感性73．3％，特异性83．3％；对照组BOLD敏感性75．5％，特异性81．2％，差异无统计学意义。试验组肿瘤全切率为85．1％，对照组77．8％，差异有统计学意义（P=n012）；试验组术后功能改善或保持率为80．8％，对照组83．3％，差异无统计学意义。结论低场强iMRI与术前BOLD功能导航手术可实时提供病灶与功能区可视化解剖信息，有助于提高肿瘤切除率，降低术后致残率。Objective To assess the feasibility and clinical application for integration of preoperative BOLD and low - field iMRI in glioma surgery involving motor cortex. Methods 48 patients with glioma involving the motor cortex were randomly divided into trial or control group. In the trail group, the preoperative BOLD was merged into the image from low -field iMRI for neuronavigation. In the control group, the preoperative BOLD was merged into preoperative high- field MRI for neuronavigation. The IOM were performed to evaluate the effectiveness of BOLD. The motor function of extremities was examined before and after operation. Results In the trail group, the sensitivity of BOLD was 73.3% and specificity was 83.3% while it was 75.5% and 81.2% in the control group respectively. The lesions were completely resected in 85. 1% of the trial group, and 77.8% of the control group （ P 〈0.05）. 80. 8% of the patients in trial group did not suffer surgery - induced paralysis, while the rate in the control group was 83.3% （ P 〉 0. 05 ）. Conclusions The integration of BOLD and iMRI is feasible to raise the total removal rate and decrease the rate of aggravation of motor function in glioma surgery involving motor cortex.

关 键 词：术中磁共振成像 血液氧饱和水平检测成像 神经导航 神经胶质瘤 电生理监护 

分 类 号：R739.41[医药卫生—肿瘤]