Willemse Ronald B, Pouwels Petra J W, Barkhof Frederik, Vandertop W Peter
Department of Neurosurgery, VU University Medical Centre, Amsterdam, The Netherlands.
Br J Neurosurg. 2011 Apr;25(2):210-7. doi: 10.3109/02688697.2010.522742. Epub 2010 Oct 27.
Volume rendering (VR) of three-dimensional (3D) fluid-attenuated inversion recovery (FLAIR) magnetic resonance (MR) images shows regional intensity differences, reflecting the central sulcus (CS) region and occipital cortex. The purpose of this study was to determine whether 3D FLAIR with VR could be used as an alternative method to localise the CS region in comparison with functional and conventional MR-imaging in patients with perirolandic glioma.
Eleven patients with intracranial gliomas were studied with single-slab 3D FLAIR including VR and conventional T1-weighted imaging. In all patients, preoperative functional magnetic resonance imaging (fMRI) was performed with a motor paradigm of the hand. The hypo-intense central gyri on 3D FLAIR with VR were interpreted as the CS area. Localisation of the motor hand knob on anatomical images and fMRI results were used for identification of the primary motor cortex.
Anatomical localisation of the motor hand knob on T1-weighted images was possible in 91% of both hemispheres. In 73% of the affected hemispheres (AH) and 91% of the unaffected hemispheres (UH) the hand knob and CS region could be identified on 3D FLAIR axial and VR images, respectively. With one exception, fMRI activation confirmed the CS region as observed with 3D FLAIR with VR.
Volume rendering of 3D FLAIR MR images shows central hypo-intensities frequently corresponding with the CS region. Two-dimensional localisation of the CS region on conventional T1-weighted images and fMRI seems favourable compared to 3D FLAIR. However, in selected cases, especially where fMRI is not possible or feasible, volume rendering with 3D FLAIR may enhance the 3D visualisation of gliomas in relation to the CS region which can be used as an alternative method in the presurgical structural and functional evaluation of neurosurgical patients.
三维（3D）液体衰减反转恢复（FLAIR）磁共振（MR）图像的容积再现（VR）显示出区域强度差异，反映中央沟（CS）区域和枕叶皮质。本研究的目的是确定与功能磁共振成像和传统磁共振成像相比，采用VR的3D FLAIR是否可作为定位中央沟区域的替代方法，用于治疗中央沟周围胶质瘤的患者。
对11例颅内胶质瘤患者进行单层面3D FLAIR（包括VR）和传统T1加权成像检查。所有患者均采用手部运动范式进行术前功能磁共振成像（fMRI）。将采用VR的3D FLAIR上低信号的中央回解释为中央沟区域。利用解剖图像上运动手区的定位和fMRI结果来识别初级运动皮层。
在91%的双侧半球中，可在T1加权图像上对运动手区进行解剖定位。在73%的患侧半球（AH）和91%的健侧半球（UH）中，分别可在3D FLAIR轴位图像和VR图像上识别出手区和中央沟区域。除1例例外，fMRI激活证实了采用VR的3D FLAIR所观察到的中央沟区域。
3D FLAIR MR图像的容积再现显示中央低信号，常与中央沟区域相对应。与3D FLAIR相比，在传统T1加权图像和fMRI上对中央沟区域进行二维定位似乎更具优势。然而，在某些特定情况下，尤其是无法或不可行进行fMRI时，采用3D FLAIR的容积再现可增强胶质瘤相对于中央沟区域的三维可视化，这可作为神经外科患者术前结构和功能评估的替代方法。
