Bizzi Alberto, Blasi Valeria, Falini Andrea, Ferroli Paolo, Cadioli Marcello, Danesi Ugo, Aquino Domenico, Marras Carlo, Caldiroli Dario, Broggi Giovanni
Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
Radiology. 2008 Aug;248(2):579-89. doi: 10.1148/radiol.2482071214. Epub 2008 Jun 6.
To prospectively determine the sensitivity and specificity of functional magnetic resonance (MR) imaging for mapping language and motor functions in patients with a focal mass adjacent to eloquent cortex, by using intraoperative electrocortical mapping (ECM) as the reference standard.
The ethics committee approved the study, and patients gave written informed consent. Thirty-four consecutive patients (16 women, 18 men; mean age, 43.2 years) were included who met the following three criteria: They had a focal mass in or adjacent to eloquent cortex of the language or motor system, they had the ability to perform the functional MR imaging task, and they had to undergo surgery with intraoperative ECM. Functional MR imaging with verb generation (n = 17) or finger tapping of the contralateral hand (n = 17) was performed at 1.5 T with a block design and an echo-planar gradient-echo T2*-weighted sequence. Cortex essential for language or hand motor functions was mapped with ECM. A site-by-site comparison between functional MR imaging and ECM was performed with the aid of a neuronavigational device. Sensitivity and specificity were calculated according to task performed, histopathologic findings, and tumor grade. Exact 95% confidence intervals were calculated for each sensitivity and specificity value.
For 34 consecutive patients, there were 28 with gliomas, two with metastases, one with meningioma, and three with cavernous angiomas. A total of 251 cortical sites were tested with ECM; overall functional MR imaging sensitivity and specificity were 83% and 82%, respectively. Sensitivity (65%) was lower and specificity (93%) was higher in World Health Organization grade IV gliomas compared with grade II (sensitivity, 93%; specificity, 79%) and III (sensitivity, 93%; specificity, 76%) gliomas. At 3 months after surgery, language proficiency was unchanged in 15 patients; functionality of the contralateral arm was unchanged in 14 patients and improved in one patient.
Functional MR imaging is a sensitive and specific method for mapping language and motor functions.
以前瞻性方式，通过将术中脑皮质电图（ECM）作为参考标准，确定功能磁共振（MR）成像在绘制与明确皮质相邻的局灶性肿块患者语言和运动功能方面的敏感性和特异性。
伦理委员会批准了本研究，患者签署了书面知情同意书。纳入了连续34例患者（16例女性，18例男性；平均年龄43.2岁），他们符合以下三项标准：在语言或运动系统的明确皮质内或其附近有局灶性肿块；有能力执行功能MR成像任务；必须接受术中ECM的手术。在1.5 T下采用组块设计和回波平面梯度回波T2 *加权序列进行动词生成（n = 17）或对侧手手指轻敲（n = 17）的功能MR成像。用ECM绘制对语言或手部运动功能至关重要的皮质。借助神经导航设备对功能MR成像和ECM进行逐点比较。根据执行的任务、组织病理学发现和肿瘤分级计算敏感性和特异性。为每个敏感性和特异性值计算确切的95%置信区间。
连续34例患者中，28例患有胶质瘤，2例患有转移瘤，1例患有脑膜瘤，3例患有海绵状血管瘤。总共用ECM测试了251个皮质位点；功能MR成像的总体敏感性和特异性分别为83%和82%。与二级（敏感性93%；特异性79%）和三级（敏感性93%；特异性76%）胶质瘤相比，世界卫生组织四级胶质瘤的敏感性（65%）较低，特异性（93%）较高。术后3个月，15例患者的语言能力未改变；14例患者对侧手臂的功能未改变，1例患者有所改善。
功能MR成像是绘制语言和运动功能的一种敏感且特异的方法。
