PDF(Pubmed)
Abstract：
Diffusion tensor imaging (DTI)-tractography and functional magnetic resonance imaging (fMRI) have dynamically entered the presurgical evaluation context of brain surgery during the past decades, providing novel perspectives in surgical planning and lesion access approaches. However, their application in the presurgical setting requires significant time and effort and increased costs, thereby raising questions regarding efficiency and best use. In this work, we set out to evaluate DTI-tractography and combined fMRI/DTI-tractography during intra-operative neuronavigation in resective brain surgery using lesion-related preoperative neurological deficit (PND) outcomes as metrics. We retrospectively reviewed medical records of 252 consecutive patients admitted for brain surgery. Standard anatomical neuroimaging protocols were performed in 127 patients, 69 patients had additional DTI-tractography, and 56 had combined DTI-tractography/fMRI. fMRI procedures involved language, motor, somatic sensory, sensorimotor and visual mapping. DTI-tractography involved fiber tracking of the motor, sensory, language and visual pathways. At 1 month postoperatively, DTI-tractography patients were more likely to present either improvement or preservation of PNDs (p = 0.004 and p = 0.007, respectively). At 6 months, combined DTI-tractography/fMRI patients were more likely to experience complete PND resolution (p < 0.001). Low-grade lesion patients (N = 102) with combined DTI-tractography/fMRI were more likely to experience complete resolution of PNDs at 1 and 6 months (p = 0.001 and p < 0.001, respectively). High-grade lesion patients (N = 140) with combined DTI-tractography/fMRI were more likely to have PNDs resolved at 6 months (p = 0.005). Patients with motor symptoms (N = 80) were more likely to experience complete remission of PNDs at 6 months with DTI-tractography or combined DTI-tractography/fMRI (p = 0.008 and p = 0.004, respectively), without significant difference between the two imaging protocols (p = 1). Patients with sensory symptoms (N = 44) were more likely to experience complete PND remission at 6 months with combined DTI-tractography/fMRI (p = 0.004). The intraoperative neuroimaging modality did not have a significant effect in patients with preoperative seizures (N = 47). Lack of PND worsening was observed at 6 month follow-up in patients with combined DTI-tractography/fMRI. Our results strongly support the combined use of DTI-tractography and fMRI in patients undergoing resective brain surgery for improving their postoperative clinical profile.
摘要：
在过去的几十年中，扩散张量成像（DTI）-纤维束成像和功能磁共振成像（fMRI）已经动态地进入了脑外科的术前评估背景。为手术计划和病变入路提供新的视角。然而,它们在术前设置中的应用需要大量的时间和精力，并增加了成本，从而提出了关于效率和最佳使用的问题。在这项工作中,我们开始使用与病变相关的术前神经功能缺损(PND)结局作为衡量标准,评估切除性颅脑手术术中神经导航期间的DTI-纤维束成像和fMRI/DTI-纤维束成像联合.我们回顾性回顾了252例连续接受脑部手术的患者的病历。127例患者进行了标准解剖神经成像方案，69例患者接受了额外的DTI纤维束造影，56人联合DTI-纤维束成像/功能磁共振成像。fMRI程序涉及语言，电机,躯体感觉，感觉运动和视觉映射。DTI-牵引成像涉及电机的纤维跟踪，感官,语言和视觉途径。术后1个月，DTI-trutography患者更有可能表现出PND的改善或保留（分别为p=0.004和p=0.007）。6个月时,联合DTI-纤维束成像/fMRI患者更有可能出现完整的PND消退(p<0.001).低度病变患者（N=102），结合DTI-纤维束成像/fMRI更有可能在1个月和6个月时经历PND的完全消退（分别为p=0.001和p<0.001）。合并DTI-纤维束成像/fMRI的高级别病变患者（N=140）更有可能在6个月时解决PND（p=0.005）。有运动症状的患者（N=80）更有可能在6个月时使用DTI-trutography或DTI-trutography/fMRI组合（分别为p=0.008和p=0.004），两种成像方案之间没有显着差异（p=1）。有感觉症状的患者（N=44）更有可能在6个月时使用DTI-trutography/fMRI组合经历PND完全缓解（p=0.004）。术中神经影像学模式对术前癫痫发作患者没有显着影响（N=47）。合并DTI-纤维束成像/fMRI的患者在6个月的随访中观察到PND恶化。我们的结果强烈支持DTI-trutography和fMRI在接受脑切除手术的患者中的联合使用，以改善其术后临床状况。
