Anatomic Location of Tumor Predicts the Accuracy of Motor Function Localization in Diffuse Lower-Grade Gliomas Involving the Hand Knob Area
Anatomic Location of Tumor Predicts the Accuracy of Motor Function Localization in Diffuse Lower-Grade Gliomas Involving the Hand Knob Area
复制标题
肿瘤的解剖位置可预测涉及手旋钮区域的弥漫性低级别胶质瘤的运动功能定位的准确性
DOI：
10.3174/ajnr.a5342
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发表时间：
2017-10-01
影响因子：
3.5
通讯作者：
Jiang, T.
中科院分区：
文献类型：
--
作者：
Fang, S.;Liang, J.;Jiang, T.
背景和目的：术前血氧水平依赖性功能磁共振成像的准确性仍存在争议。本研究评估了弥漫性低级别胶质瘤中肿瘤的解剖位置与基于 fMRI 的运动功能图谱准确性之间的关联。 材料和方法：35 名涉及运动区的低级别胶质瘤患者接受了术前血氧水平依赖性 fMRI 扫描（包括抓握任务），并接受了术中直接皮质刺激。根据血氧水平依赖性功能磁共振成像和直接皮质刺激结果一致的程度，将患者分为重叠组和非重叠组。定量测量肿瘤位置，包括肿瘤到手旋钮的最短距离以及与正常对侧半球相比，病灶半球手旋钮中点相对于中线的偏差距离。结果：肿瘤到手旋钮的最短距离4mm被确定为区分重叠组和非重叠组的接收者操作特征曲线的最佳值（敏感性，84.6％；特异性， 77.8%）。从肿瘤到手旋钮的最短距离为 4 毫米，这与基于功能磁共振成像的手部运动皮层定位不准确有关。与非重叠组相比，重叠组中肿瘤到手旋钮的最短距离较大 (P = .002)，且病灶半球手旋钮中点的偏差距离更小 (P = .003)。 结论：本研究表明，肿瘤到手旋钮的最短距离和病灶半球手旋钮中点的偏差距离可以预测血液的准确性氧水平依赖性功能磁共振成像结果。从肿瘤到手柄的最短距离较小，病变半球手柄中点的偏差距离较大，与血氧水平依赖性 fMRI 运动皮层定位的准确性较低有关。当肿瘤到手旋钮的最短距离为 4 mm 时，应谨慎使用术前 fMRI 数据进行手术规划，特别是对于中央沟前方的低级别胶质瘤。
BACKGROUND AND PURPOSE: The accuracy of preoperative blood oxygen level-dependent fMRI remains controversial. This study assessed the association between the anatomic location of a tumor and the accuracy of fMRI-based motor function mapping in diffuse lower-grade gliomas.MATERIALS AND METHODS: Thirty-five patients with lower-grade gliomas involving motor areas underwent preoperative blood oxygen level-dependent fMRI scans with grasping tasks and received intraoperative direct cortical stimulation. Patients were classified into an overlapping group and a nonoverlapping group, depending on the extent to which blood oxygen level-dependent fMRI and direct cortical stimulation results concurred. Tumor location was quantitatively measured, including the shortest distance from the tumor to the hand knob and the deviation distance of the midpoint of the hand knob in the lesion hemisphere relative to the midline compared with the normal contralateral hemisphere.RESULTS: A 4-mm shortest distance from the tumor to the hand knob value was identified as optimal for differentiating the overlapping and nonoverlapping group with the receiver operating characteristic curve (sensitivity, 84.6%; specificity, 77.8%). The shortest distances from the tumor to the hand knob of 4 mm were associated with inaccurate fMRI-based localizations of the hand motor cortex. The shortest distances from the tumor to the hand knob were larger (P = .002), and the deviation distances for the midpoint of the hand knob in the lesion hemisphere were smaller (P = .003) in the overlapping group than in the nonoverlapping group.CONCLUSIONS: This study suggests that the shortest distance from the tumor to the hand knob and the deviation distance for the midpoint of the hand knob on the lesion hemisphere are predictive of the accuracy of blood oxygen level-dependent fMRI results. Smaller shortest distances from the tumor to the hand knob and larger deviation distances for the midpoint of hand knob on the lesion hemisphere are associated with less accuracy of motor cortex localization with blood oxygen level-dependent fMRI. Preoperative fMRI data for surgical planning should be used cautiously when the shortest distance from the tumor to the hand knob is 4 mm, especially for lower-grade gliomas anterior to the central sulcus.