Naturalistic Neuroimaging for Presurgical Language Mapping

摘要 保留语言功能对生活质量至关重要。对于接近假定语言的脑瘤患者 皮质，神经外科医生可以使用功能磁共振成像(FMRI)术前语言映射来 评估和减轻手术引起的永久性语言障碍的风险。临床面临的关键障碍 术前功能磁共振成像的部署是：1)常规功能磁共振成像的有效性取决于患者的能力 执行精确计时的语音和语义任务。但高达50%的被分配到功能磁共振成像的患者 语言或其他认知缺陷会影响任务绩效，并可能使映射无效。2)专业知识 在许多临床环境中，在执行语言任务方面是不够的。为了应对这些挑战，我们建议 一项测试电影功能磁共振成像的单组临床试验(受试者在被扫描的同时观看简短的电影剪辑) 作为神经外科患者语言映射的一种新的诊断干预措施。我们的主要假设是 相对于基于任务和静止状态的FMRI，观看电影可以提供全面的语言映射 神经外科患者的数量更多，特别是那些有语言障碍的患者。与传统的 FMRI语言映射任务中，看电影预测会更完全地参与神经网络 支持现实生活中的语言。在功能磁共振扫描中，看电影还可以提高受试者的依从性。我们的 初步结果显示，扫描仪内头部运动减少，接受者的标测灵敏度更高 语言区域，以及总体上更高的语言映射特异性，与传统任务fMRI相比，在 脑肿瘤患者术前语言测绘(n=34)。在这个项目中，目标1将在 80例卒中失语症患者和40例健康对照的理解和表达 作为语言障碍的一种功能，是由看电影引起的，而不是传统范式。我们预测 在看电影方面，失语症患者的语言表现可以与之媲美，而且在大多数患者中表现更佳 相对于其他范式。目标2将评估神经学健康受试者(n=40)的电影质量 FMRI语言映射作为电影剪辑的函数，并且相对于传统范例，使用以下索引 语言本地化敏感度和特异度，半球偏侧化，以及接近语言白色- 物质轨迹。我们预测，对于诱导最敏感和最特异的同步fMRI激活的片段， 与其他范式相比，电影功能磁共振成像能产生更好的语言映射质量指标。同样，《目标3》也将 评价额叶或颞顶胶质瘤神经外科患者(n=80)的电影功能磁共振成像 基线语言功能，对照金标准的术中皮质刺激语言 映射，并与术后语言结果相关。我们预测，电影功能磁共振成像将产生更好的 在很大比例的患者中，特别是那些有语言缺陷的患者中，语言映射。学习材料将 公开发布，包括针对某些语言缺陷的最佳电影剪辑和功能磁共振分析例程。

Summary Preserved language function is essential to quality of life. For patients with a brain tumor near putative language cortex, neurosurgeons may use functional magnetic resonance imaging (fMRI) presurgical language mapping to assess and mitigate the risks of surgery-induced permanent language deficits. Critical barriers to clinical deployment of presurgical fMRI are that 1) The validity of conventional fMRI is contingent on the patient’s ability to perform precisely timed phonological and semantic tasks. But up to 50% of patients assigned to fMRI have language or other cognitive deficits that affect task performance and may invalidate the mapping. 2) Expertise in administering language tasks is insufficient in many clinical settings. To tackle these challenges, we propose a single-group clinical trial to test movie fMRI (in which subjects watch short movie clips while being scanned) as a novel diagnostic intervention for language mapping in neurosurgical patients. Our primary hypothesis is that movie-watching relative to task-based and resting-state fMRI can provide comprehensive language mapping in a greater number of neurosurgical patients, especially those with language deficits. Compared to conventional fMRI language mapping tasks, movie-watching is predicted to engage more completely the neural networks supporting language in real life. Movie-watching also improves subject compliance in fMRI scanning. Our preliminary results demonstrate reduced in-scanner head motion, higher mapping sensitivity in receptive language areas, and overall higher language mapping specificity, of movie versus conventional task fMRI, in brain tumor patients undergoing presurgical language mapping (n=34). In this project, Aim 1 will evaluate in individuals with stroke-induced aphasia (n=80) and healthy controls (n=40), the comprehension and expression elicited by movie-watching versus conventional paradigms, as a function of language impairment. We predict that language performance will be comparable, and in most individuals with aphasia superior, for movie-watching relative to the other paradigms. Aim 2 will assess in neurologically-healthy subjects (n=40), the quality of movie fMRI language mapping as a function of movie clip, and relative to conventional paradigms, using indices of language localization sensitivity and specificity, hemispheric lateralization, and proximity to language white- matter tracts. We predict that for clips inducing the most sensitive and specific synchronized fMRI activation, movie-fMRI will produce better language mapping quality indices than the other paradigms. Aim 3 will similarly evaluate movie-fMRI in neurosurgical patients with frontal or temporoparietal gliomas (n=80), as a function of baseline language function, against the gold standard intra-operative electrocortical stimulation language mapping, and relative to post-operative language outcome. We predict that movie-fMRI will produce better language mapping in a large proportion of patients, especially those with language deficits. Study materials will be publicly released, including optimal movie clips for certain language deficits and fMRI analysis routines.