Meyer Philipp T, Sturz Laszlo, Schreckenberger Mathias, Spetzger Uwe, Meyer Georg F, Setani Keyvan S, Sabri Osama, Buell Udalrich
Department of Nuclear Medicine, Aachen University of Technology, Aachen, Germany.
Eur J Nucl Med Mol Imaging. 2003 Jul;30(7):951-60. doi: 10.1007/s00259-003-1186-1. Epub 2003 May 14.
In patients scheduled for the resection of perisylvian brain tumours, knowledge of the cortical topography of language functions is crucial in order to avoid neurological deficits. We investigated the applicability of statistical parametric mapping (SPM) without stereotactic normalisation for individual preoperative language function brain mapping using positron emission tomography (PET). Seven right-handed adult patients with left-sided brain tumours (six frontal and one temporal) underwent 12 oxygen-15 labelled water PET scans during overt verb generation and rest. Individual activation maps were calculated for P<0.005 and P<0.001 without anatomical normalisation and overlaid onto the individuals' magnetic resonance images for preoperative planning. Activations corresponding to Broca's and Wernicke's areas were found in five and six cases, respectively, for P<0.005 and in three and six cases, respectively, for P<0.001. One patient with a glioma located in the classical Broca's area without aphasic symptoms presented an activation of the adjacent inferior frontal cortex and of a right-sided area homologous to Broca's area. Four additional patients with left frontal tumours also presented activations of the right-sided Broca's homologue; two of these showed aphasic symptoms and two only a weak or no activation of Broca's area. Other frequently observed activations included bilaterally the superior temporal gyri, prefrontal cortices, anterior insulae, motor areas and the cerebellum. The middle and inferior temporal gyri were activated predominantly on the left. An SPM group analysis ( P<0.05, corrected) in patients with left frontal tumours confirmed the activation pattern shown by the individual analyses. We conclude that SPM analyses without stereotactic normalisation offer a promising alternative for analysing individual preoperative language function brain mapping studies. The observed right frontal activations agree with proposed reorganisation processes, but they may also reflect an unspecific recruitment of the right-sided Broca's homologue in the effort to perform the task.
对于计划切除大脑外侧裂周围脑肿瘤的患者，了解语言功能的皮质定位对于避免神经功能缺损至关重要。我们研究了不进行立体定向标准化的统计参数映射（SPM）在使用正电子发射断层扫描（PET）进行个体术前语言功能脑图谱绘制中的适用性。7名患有左侧脑肿瘤的右利手成年患者（6例额叶肿瘤和1例颞叶肿瘤）在明显的动词生成和静息状态下接受了12次氧-15标记水PET扫描。在不进行解剖学标准化的情况下，计算P<0.005和P<0.001时的个体激活图，并将其叠加到个体的磁共振图像上用于术前规划。对于P<0.005，分别在5例和6例中发现了与布罗卡区和韦尼克区相对应的激活；对于P<0.001，分别在3例和6例中发现了相应激活。1例位于经典布罗卡区的胶质瘤患者无失语症状，其相邻的额下回皮质和右侧与布罗卡区同源的区域出现激活。另外4例左侧额叶肿瘤患者也出现了右侧布罗卡同源区的激活；其中2例出现失语症状，2例仅表现出布罗卡区微弱激活或无激活。其他常见的激活包括双侧颞上回、前额叶皮质、前岛叶、运动区和小脑。颞中回和颞下回主要在左侧被激活。对左侧额叶肿瘤患者进行的SPM组分析（P<0.05，校正）证实了个体分析所示的激活模式。我们得出结论，不进行立体定向标准化的SPM分析为分析个体术前语言功能脑图谱研究提供了一种有前景的替代方法。观察到的右侧额叶激活与提出的重组过程一致，但它们也可能反映了在执行任务过程中对右侧布罗卡同源区的非特异性募集。
