Department of Radiology, Seoul National University Hospital, Seoul, Korea.
Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
Korean J Radiol. 2023 Jun;24(6):553-563. doi: 10.3348/kjr.2022.1001.
Functional magnetic resonance imaging (fMRI) and diffusion tensor imaging-derived tractography (DTI-t) contribute to the localization of language areas, but their accuracy remains controversial. This study aimed to investigate the diagnostic performance of preoperative fMRI and DTI-t obtained with a simultaneous multi-slice technique using intraoperative direct cortical stimulation (DCS) or corticocortical evoked potential (CCEP) as reference standards.
This prospective study included 26 patients (23-74 years; male:female, 13:13) with tumors in the vicinity of Broca's area who underwent preoperative fMRI and DTI-t. A site-by-site comparison between preoperative (fMRI and DTI-t) and intraoperative language mapping (DCS or CCEP) was performed for 226 cortical sites to calculate the sensitivity and specificity of fMRI and DTI-t for mapping Broca's areas. For sites with positive signals on fMRI or DTI-t, the true-positive rate (TPR) was calculated based on the concordance and discordance between fMRI and DTI-t.
Among 226 cortical sites, DCS was performed in 100 sites and CCEP was performed in 166 sites. The specificities of fMRI and DTI-t ranged from 72.4% (63/87) to 96.8% (122/126), respectively. The sensitivities of fMRI (except for verb generation) and DTI-t were 69.2% (9/13) to 92.3% (12/13) with DCS as the reference standard, and 40.0% (16/40) or lower with CCEP as the reference standard. For sites with preoperative fMRI or DTI-t positivity (n = 82), the TPR was high when fMRI and DTI-t were concordant (81.2% and 100% using DCS and CCEP, respectively, as the reference standards) and low when fMRI and DTI-t were discordant (≤ 24.2%).
fMRI and DTI-t are sensitive and specific for mapping Broca's area compared with DCS and specific but insensitive compared with CCEP. A site with a positive signal on both fMRI and DTI-t represents a high probability of being an essential language area.
功能磁共振成像（fMRI）和基于弥散张量成像的纤维束示踪（DTI-t）有助于语言区域的定位，但它们的准确性仍存在争议。本研究旨在探讨使用术中直接皮质刺激（DCS）或皮质-皮质诱发电位（CCEP）作为参考标准的同时多层采集技术获得的术前 fMRI 和 DTI-t 的诊断性能。
本前瞻性研究纳入了 26 例肿瘤位于布罗卡区附近的患者（23-74 岁；男：女，13:13），他们均接受了术前 fMRI 和 DTI-t 检查。对 226 个皮质部位进行了术前（fMRI 和 DTI-t）与术中语言定位（DCS 或 CCEP）的逐个部位比较，以计算 fMRI 和 DTI-t 对布罗卡区的定位的灵敏度和特异性。对于在 fMRI 或 DTI-t 上有阳性信号的部位，根据 fMRI 和 DTI-t 的一致性和不一致性计算真阳性率（TPR）。
在 226 个皮质部位中，100 个部位进行了 DCS 检查，166 个部位进行了 CCEP 检查。fMRI 和 DTI-t 的特异性分别为 72.4%（63/87）至 96.8%（122/126）。以 DCS 为参考标准时，fMRI（除动词生成外）和 DTI-t 的灵敏度分别为 69.2%（9/13）至 92.3%（12/13），以 CCEP 为参考标准时灵敏度为 40.0%（16/40）或更低。对于术前 fMRI 或 DTI-t 阳性的部位（n=82），当 fMRI 和 DTI-t 一致时 TPR 较高（以 DCS 和 CCEP 为参考标准时，TPR 分别为 81.2%和 100%），而当 fMRI 和 DTI-t 不一致时 TPR 较低（≤24.2%）。
与 DCS 相比，fMRI 和 DTI-t 对布罗卡区的定位具有较高的灵敏度和特异性，而与 CCEP 相比，特异性高但灵敏度较低。在 fMRI 和 DTI-t 上均有阳性信号的部位更有可能是重要的语言区。
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