Lee C C, Ward H A, Sharbrough F W, Meyer F B, Marsh W R, Raffel C, So E L, Cascino G D, Shin C, Xu Y, Riederer S J, Jack C R
Department of Diagnostic Radiology, Mayo Foundation, Rochester, MN 55905, USA.
AJNR Am J Neuroradiol. 1999 Sep;20(8):1511-9.
Presurgical sensorimotor mapping with functional MR imaging is gaining acceptance in clinical practice; however, to our knowledge, its therapeutic efficacy has not been assessed in a sizable group of patients. Our goal was to identify how preoperative sensorimotor functional studies were used to guide the treatment of neuro-oncologic and epilepsy surgery patients.
We retrospectively reviewed the medical records of 46 patients who had undergone preoperative sensorimotor functional MR imaging to document how often and in what ways the imaging studies had influenced their management. Clinical management decisions were grouped into three categories: for assessing the feasibility of surgical resection, for surgical planning, and for selecting patients for invasive functional mapping procedures.
Functional MR imaging studies successfully identified the functional central sulcus ipsilateral to the abnormality in 32 of the 46 patients, and these 32 patients are the focus of this report. In epilepsy surgery candidates, the functional MR imaging results were used to determine in part the feasibility of a proposed surgical resection in 70% of patients, to aid in surgical planning in 43%, and to select patients for invasive surgical functional mapping in 52%. In tumor patients, the functional MR imaging results were used to determine in part the feasibility of surgical resection in 55%, to aid in surgical planning in 22%, and to select patients for invasive surgical functional mapping in 78%. Overall, functional MR imaging studies were used in one or more of the three clinical decision-making categories in 89% of tumor patients and 91% of epilepsy surgery patients.
Preoperative functional MR imaging is useful to clinicians at three key stages in the preoperative clinical management paradigm of a substantial percentage of patients who are being considered for resective tumor or epilepsy surgery.
术前利用功能磁共振成像进行感觉运动区映射在临床实践中越来越被认可；然而，据我们所知，尚未在大量患者群体中评估其治疗效果。我们的目标是确定术前感觉运动功能研究如何用于指导神经肿瘤和癫痫手术患者的治疗。
我们回顾性分析了46例接受术前感觉运动功能磁共振成像的患者的病历，以记录成像研究影响其治疗管理的频率和方式。临床治疗管理决策分为三类：评估手术切除的可行性、手术规划以及选择患者进行侵入性功能映射程序。
功能磁共振成像研究成功识别出46例患者中32例患侧的功能性中央沟，这32例患者是本报告的重点。在癫痫手术候选患者中，功能磁共振成像结果部分用于确定70%患者拟行手术切除的可行性，43%用于辅助手术规划及52%用于选择患者进行侵入性手术功能映射。在肿瘤患者中，功能磁共振成像结果部分用于确定55%患者手术切除的可行性，22%用于辅助手术规划及78%用于选择患者进行侵入性手术功能映射。总体而言，89%的肿瘤患者和�1%的癫痫手术患者在三个临床决策类别中的一个或多个中使用了功能磁共振成像研究。
术前功能磁共振成像在很大比例的考虑进行肿瘤切除或癫痫手术的患者术前临床管理模式的三个关键阶段对临床医生有用。
