Negwer Chiara, Ille Sebastian, Hauck Theresa, Sollmann Nico, Maurer Stefanie, Kirschke Jan S, Ringel Florian, Meyer Bernhard, Krieg Sandro M
Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
TUM-Neuroimaging Center, Munich, Germany.
Brain Imaging Behav. 2017 Jun;11(3):899-914. doi: 10.1007/s11682-016-9563-0.
Diffusion tensor imaging fiber tracking (DTI FT) is used to visualize subcortical fiber tracts. Yet, there is no standard at hand to visualize language-involved subcortical fibers reliably. Thus, this study investigates the feasibility of using language-related cortical areas identified via repetitive navigated transcranial magnetic stimulation (rTMS) to seed DTI FT of subcortical language tracts. From 2011 to 2014, 37 patients with left-hemispheric perisylvian lesions were examined. Language-positive rTMS stimulation spots were integrated in the deterministic tractography software (BrainLAB, iPlanNet 3.0) as objects and used as seed regions for DTI FT. Tractography was then performed in each patient with 77 different combinations of fiber lengths (40 - 100 mm) and fractional anisotropy (FA; 0.01 - 0.5). The rTMS-based DTI FT identified all commonly known subcortical language tracts, such as the corticonuclear tract, arcuate fascicle, uncinate fascicle, superior longitudinal fascicle, inferior longitudinal fascicle, arcuate fibers, commissural fibers, corticothalamic fibers, and the fronto-occipital fascicle. In 32 patients (86.5 %), each above-named tract could be visualized, while at least 6 out of these 9 tracts were identified in each patient. A fiber length of 100 mm and an FA of 0.1 or 0.15 provided optimal visualization by revealing 125 and 61 individually tracked fibers per visualized language tract and 90 % and 73 % of all language-related tracts, respectively. This study proves the feasibility of rTMS-based DTI FT for subcortical language tracts, provides suitable settings, and shows its easy and standardizable application for the visualization of every language tract in 86.5 % of patients.
扩散张量成像纤维追踪（DTI FT）用于可视化皮质下纤维束。然而，目前尚无可靠地可视化涉及语言的皮质下纤维的标准方法。因此，本研究探讨了通过重复导航经颅磁刺激（rTMS）确定的与语言相关的皮质区域作为皮质下语言束DTI FT种子点的可行性。2011年至2014年，对37例左侧大脑外侧裂周围病变患者进行了检查。将语言阳性的rTMS刺激点作为对象整合到确定性纤维束成像软件（BrainLAB，iPlanNet 3.0）中，并用作DTI FT的种子区域。然后，对每位患者进行纤维长度（40 - 100毫米）和分数各向异性（FA；0.01 - 0.5）的77种不同组合的纤维束成像。基于rTMS的DTI FT识别出了所有常见的皮质下语言束，如皮质核束、弓状束、钩束、上纵束、下纵束、弓状纤维、连合纤维、皮质丘脑纤维和额枕束。在32例患者（86.5%）中，可以可视化上述每条束，而每位患者至少能识别出这9条束中的6条。纤维长度为100毫米、FA为0.1或0.15时，每条可视化语言束分别显示125条和61条单独追踪的纤维，以及所有语言相关束的90%和73%，从而提供了最佳的可视化效果。本研究证明了基于rTMS的DTI FT用于皮质下语言束的可行性，提供了合适的设置，并表明其在86.5%的患者中可视化每条语言束具有简便且可标准化的应用。
