Shurtleff Hillary, Warner Molly, Poliakov Andrew, Bournival Brian, Shaw Dennis W, Ishak Gisele, Yang Tong, Karandikar Mahesh, Saneto Russell P, Browd Samuel R, Ojemann Jeffrey G
Department of Neurology, Seattle Children's Hospital, Seattle, Washington, USA.
J Neurosurg Pediatr. 2010 May;5(5):500-6. doi: 10.3171/2009.11.PEDS09248.
The authors describe their experience with functional MR (fMR) imaging in children as young as 5 years of age, or even younger in developmental age equivalent. Functional MR imaging can be useful for identifying eloquent cortex prior to surgical intervention. Most fMR imaging clinical work has been done in adults, and although children as young as 8 years of age have been included in larger clinical series, cases in younger children are rarely reported.
The authors reviewed presurgical fMR images in eight patients who were 8 years of age or younger, six of whom were 5 or 6 years of age. Each patient had undergone neuropsychological testing. Three patients functioned at a below-average level, with adaptive functioning age scores of 3 to 4 years. Self-paced finger tapping (with passive movement in one patient) and silent language tasks were used as activation tasks. The language task was modified for younger children, for whom the same (not novel) stimuli were used for extensive practice ahead of time and in the MR imaging unit. Patient preparation involved techniques such as having experienced staff present to work with patients and providing external management during imaging. Six of eight patients had extensive training and practice prior to the procedure. In the two youngest patients, this training included use of a mock MR unit.
All cases yielded successful imaging. Finger tapping in all seven of the patients who could perform it demonstrated focal motor activation in the frontal-parietal region, with expected activation elsewhere, including in the cerebellum. Three of four patients had the expected verb generation task activations, with left-hemisphere dominance, including a 6-year-old child who functioned at the 3-year, 9-month level. The only child (an 8-year-old) who was not prepared prior to the imaging session for the verb generation task failed this task due to movement artifact.
Despite the challenges of successfully using fMR imaging in very young and clinically involved patients, these studies can be performed successfully in children with a chronological age of 5 or 6 years and a developmental age as young as 3 or 4 years.
作者描述了他们对年仅5岁甚至发育年龄更小的儿童进行功能磁共振成像（fMR）的经验。功能磁共振成像有助于在手术干预前识别明确的皮质。大多数功能磁共振成像临床工作是在成人中开展的，虽然8岁及以下儿童已被纳入较大规模的临床系列研究，但年龄更小儿童的病例报道很少。
作者回顾了8名8岁及以下患者的术前功能磁共振成像图像，其中6名患者年龄为5或6岁。每名患者均接受了神经心理学测试。3名患者的功能处于平均水平以下，适应性功能年龄评分为3至4岁。采用自我节奏的手指敲击（1名患者为被动运动）和无声语言任务作为激活任务。针对年幼儿童对语言任务进行了修改，提前在磁共振成像单元中使用相同（非新颖）的刺激对他们进行大量练习。患者准备工作包括安排经验丰富的工作人员与患者合作以及在成像过程中进行外部管理等技术。8名患者中有6名在检查前接受了广泛的训练和练习。在最年幼的2名患者中，这种训练包括使用模拟磁共振单元。
所有病例均成功完成成像。7名能够进行手指敲击的患者均显示额顶叶区域有局灶性运动激活，其他部位包括小脑也有预期的激活。4名患者中有3名在动词生成任务中有预期的激活，以左半球为主，其中包括一名功能水平为3岁9个月的6岁儿童。唯一一名在成像检查前未为动词生成任务做好准备的儿童（一名8岁儿童）因运动伪影未能完成该任务。
尽管在非常年幼且有临床问题的患者中成功使用功能磁共振成像存在挑战，但这些研究可以在实际年龄为5或6岁、发育年龄低至3或4岁的儿童中成功进行。
