Clinical utility of functional magnetic resonance imaging for brain mapping in epilepsy surgery
Clinical utility of functional magnetic resonance imaging for brain mapping in epilepsy surgery
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DOI：
10.1016/j.eplepsyres.2009.12.001
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发表时间：
2010-03-01
影响因子：
2.2
通讯作者：
Klein, Gad
中科院分区：
文献类型：
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作者：
Mehta, Ashesh D.;Klein, Gad
功能磁共振成像（fMRI）通常用于定位大脑功能，但其在临床环境中的效用仍不清楚。硬膜下电极植入提供了将血氧水平依赖性（BOLD）反应的空间关系与接受分期癫痫手术的患者的术外电刺激标测（ESM）定义的区域相关联的机会。 4 名受试者接受了术前功能磁共振成像，使用与 ESM 类似的范例来描述语言和运动功能。将术前 MRI 与术后 CT 和 MRI 扫描进行配准，以评估 BOLD 响应与用于 ESM 的电极接触位置之间的空间关系，同时考虑脑转移。 fMRI 可以准确预测运动皮层的位置，灵敏度和阴性预测值 (NPV) 为 1.0。特异性为 0.96，阳性预测 (PPV) 值为 0.8。在所有 4 名受试者中，语言功能磁共振成像的偏侧指数在预测 WADA 测试测量的偏侧化方面是准确的。虽然发生 ESM 引起的语言缺陷的区域的 T 分数显着高于没有 ESM 引起的语言缺陷的区域的 T 分数（p < .05，学生 t 检验），但在一系列阈值标准上，敏感性、特异性和预测值都很差。通过排除额骨和颞骨基部 1 cm 以内的部位以及 ESM 显示面部运动功能的部位，提高了敏感性和特异性。尽管如此，敏感性和特异性分别为 0.47 和 0.76（T 评分 2.5，p < 0.01 校正 FDR），PPV 和 NPV 分别为 0.40 和 0.77。预测 ESM 定义的语言位点 1 厘米以内区域的灵敏度较高，为 0.82，NPV 为 0.94。结果表明，功能磁共振成像在临床上对于语言偏侧化和运动皮层定位很有用。功能磁共振成像对语言的定位不太准确，但它可能有助于估计远离额骨和颞骨基部的 ESM 引起的缺陷区域。 (C) 2010 Elsevier B.V. 保留所有权利。
Functional magnetic resonance imaging (fMRI) is commonly used to localize brain function, but its utility in the clinical setting remains unclear. Subdural electrode implantation provides opportunities to correlate the spatial relationship of the blood oxygen level-dependent (BOLD) response to areas defined by extraoperative electrical stimulation mapping (ESM) in patients undergoing staged epilepsy surgery. 4 subjects underwent pre-operative fMRI using the analogous paradigms to those used for ESM to delineate language and motor function. Coregistration of the pre-operative MRI to a post-operative CT and MRI scan was performed in order to assess the spatial relationship between the BOLD response and the location of electrode contacts used for ESM while accounting for brain shift. fMRI was accurate in predicting the location of motor cortex with sensitivity and negative predictive value (NPV) of 1.0. Specificity was .96 with a positive predictive (PPV) value of .8. In all 4 subjects, a laterality index of the fMRI for language was accurate in predicting lateralization measured by Wada testing. While T-scores over regions where ESM-induced language deficits occurred were significantly higher (p < .05, Student's t-test) than those over regions where there was no ESM-induced deficit, sensitivity, specificity and predictive values were poor over a range of threshold criteria. Sensitivity and specificity were improved by excluding sites within 1 cm of the base of the frontal and temporal bone and sites where ESM showed motor function of face. Despite this, sensitivity and specificity were .47 and .76, respectively (T score 2.5, p < .01 corrected FDR) with PPV and NPV of .40 and .77, respectively. Sensitivity for predicting areas within 1 cm of ESM-defined language sites was higher at .82 with an NPV of .94. The results indicate that fMRI is clinically useful for lateralizing language and the localizing motor cortex. fMRI localizes language less accurately, but it may be useful in estimating the region of ESM-induced deficit in areas away from the base of the frontal and temporal bone. (C) 2010 Elsevier B.V. All rights reserved.