Accuracy of Diffusion Tensor Magnetic Resonance Imaging-Based Tractography for Surgery of Gliomas Near the Pyramidal Tract: A Significant Correlation Between Subcortical Electrical Stimulation and Postoperative Tractography
Accuracy of Diffusion Tensor Magnetic Resonance Imaging-Based Tractography for Surgery of Gliomas Near the Pyramidal Tract: A Significant Correlation Between Subcortical Electrical Stimulation and Postoperative Tractography
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DOI：
10.1227/neu.0b013e31823020e6
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发表时间：
2012-02-01
期刊：
影响因子：
4.8
通讯作者：
Ohnishi, Takanori
中科院分区：
文献类型：
--
作者：
Ohue, Shiro;Kohno, Shohei;Ohnishi, Takanori
背景：基于扩散张量(DT)成像的纤维追踪是一种非侵入性的磁共振技术，可以描绘脑白质纤维的走行。目的：评价这种基于扩散张量成像的纤维追踪技术在锥体束(PT)附近胶质瘤手术中的准确性和有效性。所有患者均在术前和术后3天内生成基于DT成像的PT纤维轨迹。在行动中使用了履带摄影综合导航系统。在切除过程中还监测皮质和皮质下运动诱发电位(MEP)，以最大限度地保护运动功能。通过寻找刺激点和改变刺激强度来检测皮层下MEP的阈值强度。结果：所有受试者均成功地完成了基于DT成像的PT的气管造影术，显示了肿瘤与PT之间的关系。使用综合导航系统和术中MEPS，所有患者术后的运动功能均得以保留。皮层下MEP的阈值强度与术后DT图像上切除边缘至PT的距离有显著相关性。结论：基于DT成像的纤维追踪是一种可靠、准确的皮质下PTS标测方法。纤维追踪和术中MEP有助于保留PT附近神经胶质瘤患者的运动功能。
BACKGROUND: Diffusion tensor (DT) imaging-based fiber tracking is a noninvasive magnetic resonance technique that can delineate the course of white matter fibers.OBJECTIVE: To evaluate the accuracy and usefulness of this DT imaging-based fiber tracking for surgery in patients with gliomas near the pyramidal tract (PT).METHODS: Subjects comprised 32 patients with gliomas near the PT. DT imaging-based fiber tracks of the PT were generated before and within 3 days after surgery in all patients. A tractography-integrated navigation system was used during the operation. Cortical and subcortical motor-evoked potentials (MEPs) were also monitored during resection to maximize the preservation of motor function. The threshold intensity for subcortical MEPs was examined by searching the stimulus points and changing the stimulus intensity. Minimum distance between the resection border and the illustrated PT was measured on postoperative tractography.RESULTS: In all subjects, DT imaging-based tractography of the PT was successfully performed, preoperatively demonstrating the relationship between tumors and the PT. With the use of the tractography-integrated navigation system and intraoperative MEPs, motor function was preserved postoperatively in all patients. A significant correlation was seen between threshold intensity for subcortical MEPs and the distance between the resection border and PT on postoperative DT imaging.CONCLUSION: DT imaging-based fiber tracking is a reliable and accurate method for mapping the course of subcortical PTs. Fiber tracking and intraoperative MEPs were useful for preserving motor function in patients with gliomas near the PT.