European Radiology:fMRI,为脑肿瘤患者的语言功能“保驾护航”!

2022-02-09 shaosai MedSci原创

据估计,每年约有33万人确诊中枢神经系统恶性肿瘤,在过去的25年里,发病率增加了约17%。对于大多数类型的脑部肿瘤,外科手术是首选术式之一,但对于病人来说,生活质量是决定是否接受手术的一个关键方面。

据估计,每年约有33万人确诊中枢神经系统恶性肿瘤,在过去的25年里,发病率增加了约17%。对于大多数类型的脑部肿瘤,外科手术是首选术式之一,但对于病人来说,生活质量是决定是否接受手术的一个关键方面。语言能力和理解力是术后生活质量的重要组成部分。因此,术前对语言功能定位的评估以及在病人清醒的情况下评估大脑皮层映射至关重要。

近年来,由于功能磁共振成像(fMRI)的日益普及,人们对语言处理的大脑表征的认识有了巨大的飞跃。fMRI语言任务的评估是无创可复制的,已被多项研究证明是建立大脑功能语言侧化和肿瘤之间相互作用的有用工具。

到目前为止,对健康参与者以及患有脑部病变患者的交叉脑小脑语言激活的研究主要集中在隐蔽性语言生产范式上,即单词生产任务如动词生成(VG)任务。VG任务可能有两个VG范式主要缺点。首先,由于失语症患者的语言区域内或附近存在病变,该任务对他们来说可能太难完成。第二,作为一个隐蔽的范式,该任务无法被监控。因此,很难确定病人是否正确地完成了任务,以及由此产生的语言激活是否可靠。一些替代的语言范式是语义和语音联想决定任务(SA和PA),这对严重失语症患者来说更容易执行,并可实现监测各自的任务表现。虽然这些任务已经在临床fMRI中实现,但与此任务相关的交叉小脑语言激活仍不明确

近日,发表在European Radiology杂志的一项研究探讨了动词生成fMRI任务的交叉小脑语言侧化激活在语义和语音任务中可视化的情况为为临床术前精准定位肿瘤功能区并提高患者预后提供了可能

本研究对定位在不同皮质部位的脑瘤患者(n = 71)进行了三种语言范式的评估,即VG任务以及按压按钮反应的语义(SA)和语音(PA)联想任务。在不同的皮层区域和小脑中的相应语言激活被分配了侧重点。使用Cohen's kappa测试了这两个新任务和动词生成任务之间的侧重点的一致性。 

两项任务在皮质和小脑的侧向性上与患者的动词生成任务有明显的一致性。此外,McNemar测试证实在整个受试者群体中,大脑皮层和小脑存在交叉激活。 

 三个任务的患者小脑语言表示。 该图显示了每个任务的脑小脑激活具有特定侧化组合的受试者数量。 在皮层或小脑中未显示任何激活的受试者不代表。

本研究表明,SA和PA任务是判断术前交叉脑小脑语言的有用工具。该技术可提高显著提高患者的预后,使脑瘤患者从中受益。

原文出处

Ishani Thakkar,Leonardo Arraño-Carrasco,Barbara Cortes-Rivera,et al.Alternative language paradigms for functional magnetic resonance imaging as presurgical tools for inducing crossed cerebro-cerebellar language activations in brain tumor patients.DOI:10.1007/s00330-021-08137-9

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    2022-04-29 feather89
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    2022-02-11 yangjxjc
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