Roux F E, Ranjeva J P, Boulanouar K, Manelfe C, Sabatier J, Tremoulet M, Berry I
Service de Neuroradiologie, INSERM 455, Hôpital Purpan, Toulouse.
Neurochirurgie. 1998 Apr;44(2):94-100.
To evaluate the capabilities and the limitations of motor functional magnetic resonance imaging (FMRI) in the presurgical planning of the cerebral tumors located in or near the motor homunculus and to correlate each type of activation with the histologic characteristics of each tumor.
FMRI was performed in 17 patients (14 adults and 3 children), without motor deficit, presenting with various intra cerebral tumors. Three FMRI activation paradigms were used, controlateral to the lesion: ballistic opposition of the fingers, flexion-extension of the foot and click of the tongue. Four patients, without motor deficit, with cerebral tumors far from the motor homunculus were used as control group to look for non specific activations. In all cases, the histopathology of the tumor was known accurately.
In 11 patients with infiltrating tumors, the activated areas were clearly displaced. They were often intratumoral and scattered in correlation with the degree of infiltration. Two patients with non infiltrating tumors (meningioma) showed extratumoral shift of the activated areas. Four patients presenting cerebral tumors far from the homunculus motor did not show intratumoral activation. The supplementary motor area and the ipsilateral primary motor cortex were also sometimes activated during the motor tasks. The task of the tongue was often artifacted, probably because of the head motion.
These preliminary results suggest that the histopathologic characteristics of a tumor and especially its microscopic structure plays a role, with others factors, on the motor functional area organization. In a small number of cases, the data obtained from the FMRI could be used intraoperatively, with a neuronavigation system.
评估运动功能磁共振成像（FMRI）在位于运动小人区或其附近的脑肿瘤术前规划中的能力和局限性，并将每种激活类型与每种肿瘤的组织学特征相关联。
对17例无运动功能障碍的患者（14例成人和3例儿童）进行了FMRI检查，这些患者患有各种脑内肿瘤。使用了三种FMRI激活范式，均位于病变对侧：手指的弹道式对抗、足部的屈伸以及舌头的点击动作。选取4例无运动功能障碍且脑肿瘤远离运动小人区的患者作为对照组，以寻找非特异性激活。在所有病例中，肿瘤的组织病理学均已明确知晓。
在11例浸润性肿瘤患者中，激活区域明显移位。它们常位于肿瘤内，并根据浸润程度分散分布。2例非浸润性肿瘤（脑膜瘤）患者显示激活区域向肿瘤外移位。4例脑肿瘤远离运动小人区的患者未显示肿瘤内激活。在运动任务期间，辅助运动区和同侧初级运动皮层有时也会被激活。舌头的任务经常出现伪影，可能是由于头部运动所致。
这些初步结果表明，肿瘤的组织病理学特征，尤其是其微观结构，与其他因素一起，对运动功能区的组织发挥作用。在少数情况下，从FMRI获得的数据可在术中与神经导航系统一起使用。
