Pujol J, Conesa G, Deus J, López-Obarrio L, Isamat F, Capdevila A
Magnetic Resonance Center of Pedralbes, Barcelona, Spain.
J Neurosurg. 1998 May;88(5):863-9. doi: 10.3171/jns.1998.88.5.0863.
The authors sought to evaluate the advantages and limitations of functional magnetic resonance (fMR) imaging when it was used regularly in the clinical context to identify the central sulcus.
A 1.5-tesla MR system comprising a spoiled gradient recalled acquisition in the steady-state functional sequence and a cross-hand cancellation analysis method were used to evaluate 50 surgical candidates with centrally located space-occupying lesions in the brain. Three-dimensional (3-D) models of the patient's head and brain showing the relative position of the tumor and the eloquent cortex were obtained in each case. A selective and reproducible focal activation was found, indicating the probable central sulcus position in 41 patients (82%). Direct cortical stimulation confirmed the fMR findings in 100% of 22 intraoperatively assessed patients. Failure to identify the central sulcus occurred in 18% of cases and was mainly a consequence of intrinsic damage in the primary sensorimotor region that resulted in severe hand paresis.
Although specific factors were identified that contributed to reduced sensitivity of fMR imaging in the clinical context, the present study supports functional assessment and 3-D representation of specific surgical situations as generally feasible in common practice.
作者试图评估功能磁共振成像（fMR）在临床环境中常规用于识别中央沟时的优势和局限性。
使用一台1.5特斯拉的磁共振系统，该系统包括稳态功能序列中的扰相梯度回波采集和交叉手抵消分析方法，对50例脑内中央部位有占位性病变的手术候选患者进行评估。在每个病例中，获得了患者头部和大脑的三维（3-D）模型，显示肿瘤和明确皮层的相对位置。在41例患者（82%）中发现了选择性且可重复的局灶性激活，表明可能的中央沟位置。在22例术中评估的患者中，100%的患者经直接皮层刺激证实了fMR结果。18%的病例未能识别中央沟，主要是由于初级感觉运动区的内在损伤导致严重手部麻痹。
尽管确定了一些导致fMR成像在临床环境中敏感性降低的特定因素，但本研究支持在常规实践中，对特定手术情况进行功能评估和三维呈现总体上是可行的。
