磁共振弥散张量成像与术中皮层下电刺激定位锥体束的初步对照研究  

Diffusion tensor imaging correlates with subcortical stimulation for intraoperative pyramidal tract mapping： a preliminary study

作　　者：朱凤平[1] 吴劲松[1] 姚成军[1] 郎黎琴[1] 许耿[1] 张军[2] 孙申[2] 毛颖[1] 周良辅[1] 

机构地区：[1]复旦大学附属华山医院神经外科、复旦大学上海医学院神经外科学系、上海市神经外科临床医学中心,上海200040 [2]复旦大学附属华山医院神经外科、复旦大学上海医学院神经外科学系、上海市神经外科临床医学中心麻醉科,上海200040

出　　处：《中华神经外科杂志》2010年第9期789-793,共5页Chinese Journal of Neurosurgery

基　　金：卫生部临床学科重点项目（2007-2009年度）;上海市科委“启明星”科技人才培养计划（07QA14008）

摘　　要：目的 采用术中皮层下刺激定位技术（ISM）,验证磁共振弥散张量成像（DTI）显示锥体束的精确性和可靠性.方法 前瞻性研究11例运动皮层和（或）皮层下邻近锥体束的脑肿瘤.采用基于DTI锥体束成像的功能神经导航,引导手术切除肿瘤.术中以ISM记录靶肌群的复合肌肉动作电位,比较DTI锥体束成像与ISM的符合率,验证DTI锥体束成像的灵敏度和特异性.结果 DTI锥体束成像与ISM定位锥体束的符合率为86%,敏感度为100%,特异度为79%.16个ISM（＋）位点距离锥体束的截距平均为（3.8±1.5）mm.结论 DTI可显示锥体束结构,可用于运动区肿瘤的术前计划并引导手术操作,有条件者应联合应用ISM.Objective To evaluate the reliability of diffusion tensor imaging（DTI）-based pyramidal tract（PT）mapping, and to compare with intraoperative subcortical mapping（ISM）. Method A prospective study comprised 11 subjects with various intracerebral neoplasms located within or adjacent to PTs was conducted. The PTs were illustrated by the DTI FA maps, and merged with the anatomical structure. During the procedure,DTI- based functional neuronavigation was used for presurgical planning and intraoperative surgical guidance ,whereas ,ISM was regarded as ＂Gold Standard＂ for motor function monitoring. The white matter beneath the resection cavity was electrically stimulated near the PT shown on the functional neuronavigation. Motor response was recorded by compound muscle action potential（cMAP）. The distance between PT and the stimulation site was measured. Both techniques of DTI and ISM were compared to assess the accordance for PT mapping.Results ISM verified a high accordance rate with DTI PT mapping in 86% of all subjects（19/22）. The cMAP was consistently elicited in 16 stimulation sites. The mean intercept between the positive subcortical stimulation sites and the imaged PTs on DTI was（3.8 ± 1.5）mm. The sensitivity of DTI PT mapping was 100% ,whereas,the specificity was 79%. Conclusions DTI is valuable in delineating PT and visualizing the complicated spatial relationship between the neoplasm and PT. It can be used to identify the descending motor pathways within white matter for presurgical planning, as well as surgical guidance. If possible ,combined usage of DTI -based functional neuronavigation and ISM is recommended for maximal safe resection of tumor in motor area.

关 键 词：脑肿瘤 锥体束 弥散张量成像 术中监护 电刺激 

分 类 号：R445.2[医药卫生—影像医学与核医学]