Naturalistic Neuroimaging for Presurgical Language Mapping

总结 保持语言功能对生活质量至关重要。对于那些在语言能力附近有脑瘤的病人 皮质，神经外科医生可以使用功能性磁共振成像（fMRI）术前语言映射， 评估和减轻手术引起的永久性语言缺陷的风险。临床的关键障碍 术前fMRI的部署是：1）常规fMRI的有效性取决于患者的能力 来完成精确的语音和语义任务。但在接受功能磁共振成像的患者中， 语言或其他认知缺陷，影响任务表现，并可能使映射无效。2)专门知识 在许多临床环境中，管理语言任务是不够的。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（受试者在扫描时观看短片） 作为神经外科患者语言映射的新型诊断干预。我们的主要假设是 相对于基于任务和静息状态的功能磁共振成像，看电影可以提供全面的语言映射， 更多的神经外科患者，特别是那些有语言缺陷的患者。相比于常规 在fMRI语言映射任务中，观看电影被预测会更完全地参与神经网络 支持真实的生活中的语言。看电影也能提高受试者在功能磁共振成像扫描中的依从性。我们 初步结果表明，减少扫描仪头部运动，更高的映射灵敏度，在接受 语言区，以及整体更高的语言映射特异性，电影与传统的任务功能磁共振成像，在 接受术前语言映射的脑肿瘤患者（n=34）。在这个项目中，目标1将评估 80例脑卒中失语症患者和40例健康对照者， 由看电影与传统范式引起的，作为语言障碍的函数。我们预测 对于大多数患有失语症的人来说，看电影的语言表现是相当的，而且是上级的 相对于其他范式。目标2将评估神经健康受试者（n=40）的电影质量 功能磁共振成像语言映射作为电影剪辑的功能，相对于传统的范例，使用指数 语言定位的敏感性和特异性，半球偏侧化，接近语言白色- 物质束我们预测，对于诱导最敏感和最特异的同步fMRI激活的剪辑， 电影功能磁共振成像将产生更好的语言映射质量指数比其他范例。Aim 3将类似地 评价额叶或颞顶胶质瘤神经外科患者（n=80）的movie-fMRI， 基线语言功能，对照金标准术中皮层电刺激语言 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会产生更好的 语言映射在很大一部分患者中，特别是那些有语言缺陷的患者。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成像分析程序。

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.