Tumor location and reduction in functional MRI estimates of language laterality.
Tumor location and reduction in functional MRI estimates of language laterality.
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DOI：
10.3171/2020.9.jns202036
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发表时间：
2021-12-01
影响因子：
4.1
通讯作者：
Bookheimer SY
中科院分区：
文献类型：
--
作者：
Połczyńska MM;Beck L;Kuhn T;Benjamin CF;Ly TK;Japardi K;Cavanagh L;Bookheimer SY
位于语言皮层附近的脑肿瘤可能会扭曲基于功能磁共振成像（fMRI）的语言优势估计。这种扭曲的性质，以及这是否是许多混杂因素的伪影，仍然未知。作者基于独立于混杂因素的偏侧性估计假设肿瘤偏倚，并且该效应对于邻近Broca区的肿瘤最大。为了回答这个问题，作者回顾了超过1113例术前接受fMRI的患者，以匹配11个已知混杂因素（肿瘤位置、大小、类型和分级;癫痫发作史;既往神经外科手术;失语症的存在和严重程度;患者年龄、性别和利手）的样本。样本包括30例左半球肿瘤患者（前半球15例，后半球15例）和30例右半球肿瘤患者（前半球15例，后半球15例），因此共计60例患者（25例女性; 18例左撇子和4例左右手;平均年龄47 [SD 14.1]岁）。重要的是，作者不仅匹配了左半球和右半球肿瘤的患者，还匹配了前半球和后半球肿瘤的患者。使用全脑和感兴趣区域（ROI）方法（布罗卡区和韦尼克区）计算标准fMRI偏侧指数（LI）。左脑靠近布罗卡区的肿瘤降低了LI，与已知的混杂因素无关。在全脑水平，这似乎反映了与右前肿瘤患者相比，左前肿瘤患者的LI值降低。ROI分析重复了这些发现。与右前肿瘤患者（平均LI 0.70）相比，左前肿瘤患者（平均LI 0.28）的布罗卡区LI显著降低（p = 0.02）。Wernicke面积为基础的LI的变化没有不同的肿瘤半球的功能。因此，在左前肿瘤患者中，使用左后ROI评估语言偏侧性至关重要。在所有剩余的肿瘤组（左后半球肿瘤和右半球肿瘤）中，来自前语言ROI的语言偏侧性是语言优势的最可靠的测量。肿瘤靠近布罗卡区的患者显示出更多的双侧功能磁共振语言图，与已知的混杂因素无关。作者警告说，这种语言偏侧性的减少表明左额下回肿瘤切除后对语言功能没有或几乎没有风险。他们的结果解决了如何解释功能磁共振成像数据的神经外科目的，沿着的理论问题，对侧功能补偿和去抑制。
Brain tumors located close to the language cortex may distort functional MRI (fMRI)–based estimates of language dominance. The nature of this distortion, and whether this is an artifact of numerous confounders, remains unknown. The authors hypothesized tumor bias based on laterality estimates independent of confounders and that the effects are the greatest for tumors proximal to Broca’s area. To answer this question, the authors reviewed more than 1113 patients who underwent preoperative fMRI to match samples on 11 known confounders (tumor location, size, type, and grade; seizure history; prior neurosurgery; aphasia presence and severity; and patient age, sex, and handedness). The samples included 30 patients with left hemisphere tumors (15 anterior and 15 posterior) and 30 with right hemisphere tumors (15 anterior and 15 posterior), thus totaling 60 patients (25 women; 18 left-handed and 4 ambidextrous; mean age 47 [SD 14.1] years). Importantly, the authors matched not only patients with left and right hemisphere tumors but also those with anterior and posterior tumors. Standard fMRI laterality indices (LIs) were calculated using whole-brain and region of interest (ROI) approaches (Broca’s and Wernicke’s areas). Tumors close to Broca’s area in the left hemisphere decreased LIs independently of known confounders. At the whole-brain level, this appeared to reflect a decrease in LI values in patients with left anterior tumors compared with patients with right anterior tumors. ROI analysis replicated these findings. Broca’s area LIs were significantly lower (p = 0.02) in patients with left anterior tumors (mean LI 0.28) when compared with patients with right anterior tumors (mean LI 0.70). Changes in Wernicke’s area–based LIs did not differ as a function of the tumor hemisphere. Therefore, in patients with left anterior tumors, it is essential to assess language laterality using left posterior ROIs. In all remaining tumor groups (left posterior tumors and right hemisphere tumors), language laterality derived from the anterior language ROI was the most robust measure of language dominance. Patients with tumors close to Broca’s area showed more bilateral fMRI language maps independent of known confounders. The authors caution against the assumption that this reduced language laterality suggests no or little risk to language function following tumor resection in the left inferior frontal gyrus. Their results address how to interpret fMRI data for neurosurgical purposes, along with theoretical questions of contralesional functional compensation and disinhibition.