Department of Neuroradiology, University of Heidelberg Medical School, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
Eur Radiol. 2011 Jul;21(7):1517-25. doi: 10.1007/s00330-011-2067-9. Epub 2011 Jan 28.
Reliable imaging of eloquent tumour-adjacent brain areas is necessary for planning function-preserving neurosurgery. This study evaluates the potential diagnostic benefits of presurgical functional magnetic resonance imaging (fMRI) in comparison to a detailed analysis of morphological MRI data.
Standardised preoperative functional and structural neuroimaging was performed on 77 patients with rolandic mass lesions at 1.5 Tesla. The central region of both hemispheres was allocated using six morphological and three functional landmarks.
fMRI enabled localisation of the motor hand area in 76/77 patients, which was significantly superior to analysis of structural MRI (confident localisation of motor hand area in 66/77 patients; p < 0.002). FMRI provided additional diagnostic information in 96% (tongue representation) and 97% (foot representation) of patients. FMRI-based presurgical risk assessment correlated in 88% with a positive postoperative clinical outcome.
Routine presurgical FMRI allows for superior assessment of the spatial relationship between brain tumour and motor cortex compared with a very detailed analysis of structural 3D MRI, thus significantly facilitating the preoperative risk-benefit assessment and function-preserving surgery. The additional imaging time seems justified. FMRI has the potential to reduce postoperative morbidity and therefore hospitalisation time.
对毗邻肿瘤的脑区进行可靠成像，对于规划保留神经功能的神经外科手术是必要的。本研究评估了术前功能磁共振成像（fMRI）与详细分析形态磁共振成像（MRI）数据相比的潜在诊断优势。
在 1.5T 磁共振扫描仪上对 77 例 Rolandic 肿块病变患者进行了标准化的术前功能和结构神经影像学检查。使用六个形态学和三个功能学标志将两个半球的中央区域进行了分配。
fMRI 能够在 76/77 例患者中定位运动手区，明显优于对结构 MRI 的分析（66/77 例患者中运动手区的定位具有信心；p<0.002）。fMRI 在 96%（舌代表区）和 97%（足代表区）的患者中提供了额外的诊断信息。基于 fMRI 的术前风险评估与术后临床阳性结果的相关性为 88%。
与对结构 3D-MRI 进行非常详细的分析相比，常规术前 fMRI 能够更好地评估脑肿瘤与运动皮层之间的空间关系，从而显著促进术前风险效益评估和保留功能的手术。额外的成像时间是合理的。fMRI 有可能降低术后发病率，从而缩短住院时间。
