Plasticity in language cortex and white matter tracts after resection of dominant inferior parietal lobule arteriovenous malformations: a combined fMRI and DTI study
Plasticity in language cortex and white matter tracts after resection of dominant inferior parietal lobule arteriovenous malformations: a combined fMRI and DTI study
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显性顶下小叶动静脉畸形切除后语言皮层和白质束的可塑性：功能磁共振成像和 DTI 联合研究
DOI：
10.3171/2019.12.jns191987
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发表时间：
2021-03-01
影响因子：
4.1
通讯作者：
Zhao, Jizong
中科院分区：
文献类型：
--
作者：
Jiao, Yuming;Lin, Fuxin;Zhao, Jizong
目的：优势顶叶下叶（IPL）包括皮层和皮层下结构，为语言加工服务。术后短期失语症的发生率很高，语言重组的潜力也很好。作者的目标是研究位于IPL的脑动静脉畸形（BAVM）患者的语言皮层和语言相关纤维的可塑性。方法2016年9月至2018年5月前瞻性招募了6例接受IPL BAVM显微手术治疗的患者。术前1周及术后6个月分别行血氧水平依赖性功能磁共振成像（BOLD-fMRI）和弥散张量成像（DTI）检查。追踪脑损伤相关的白色功能纤维束及其对侧同源纤维束。使用西方失语症成套测验评估语言功能。作者确定了每个单独的纤维束的纤维总数和平均各向异性分数（FA）指数。此外，他们还计算了病变半球和对侧半球激活的语言皮层体素之间的偏侧指数（LI），并将这些指数与术前和术后的fMR和DT图像进行了比较。结果6例IPL BAVMs患者术后均出现短期语言障碍，5例（83.3%）在术后6个月完全恢复。5例（83.3%）患者在Broca区和Wernicke区都有BOLD信号激活的右侧同源重组。在病变半球的弓状束（AF）中观察到的纤维多于对侧半球（1905 vs 254纤维，p = 0.035）。术后6个月，在右半球AF中观察到纤维数量显著增加（术前249根纤维vs术后485根纤维，p = 0.026）。术后左侧额枕下束（IFOF）中的神经纤维明显更多（术前874根纤维vs术后1186根，p = 0.010）。观察到Wernicke区的右半球优势在统计学上显著增加。整体功能LI显示右侧大脑半球Wernicke区（LI
OBJECTIVE The dominant inferior parietal lobe (IPL) contains cortical and subcortical structures that serve language processing. A high incidence of postoperative short-term aphasia and good potential for language reorganization have been observed. The authors' goal was to study the plasticity of the language cortex and language-related fibers in pa- tients with brain arteriovenous malformations (BAVMs) located in the IPL.METHODS A total of 6 patients who underwent microsurgical treatment of an IPL BAVM were prospectively recruited between September 2016 and May 2018. Blood oxygen level-dependent functional MRI (BOLD-fMRI) and diffusion ten -sor imaging (DTI) were performed within 1 week before and 6 months after microsurgery. Language-related white matter (WM) eloquent fiber tracts and their contralateral homologous fiber tracts were tracked. The Western Aphasia Battery was administered to assess language function. The authors determined the total number of fibers and mean fractional anisotropy (FA) indices for each individual tract. In addition, they calculated the laterality index (LI) between the activated language cortex voxels in the lesional and contralesional hemispheres and compared these indices between the preop-erative and postoperative fMR and DT images.RESULTS Of the 6 patients with IPL BAVMs, all experienced postoperative short-term language deficits, and 5 (83.3%) recovered completely at 6 months after surgery. Five patients (83.3%) had right homologous reorganization of BOLD signal activations in both Broca's and Wernicke's areas. More fibers were observed in the arcuate fasciculus (AF) in the lesional hemisphere than in the contralesional hemisphere (1905 vs 254 fibers, p = 0.035). Six months after sur- gery, a significantly increased number of fibers was seen in the right hemispheric AF (249 fibers preoperatively vs 485 postoperatively, p = 0.026). There were significantly more nerve fibers in the postoperative left inferior frontooccipital fasciculus (IFOF) (874 fibers preoperatively vs 1186 postoperatively, p = 0.010). A statistically significant increase in right hemispheric dominance of Wernicke's area was observed. The overall functional LI showed functional lateralization of Wernicke's area in the right hemisphere (LI