本文選題：彌散張量成像　切入點：功能磁共振　出處：《安徽醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的采用術(shù)中直接皮層下電刺激技術(shù)(DsCS),驗證并對比以功能磁共振運動激活區(qū)為感興趣區(qū)示蹤(BOLD-fMRI guided DTI-FT)的錐體束和以傳統(tǒng)解剖初級運動皮層為感興趣區(qū)進(jìn)行示蹤的錐體束,并進(jìn)一步探討以功能磁共振運動激活區(qū)為感興趣區(qū)示蹤錐體束方法和以傳統(tǒng)解剖初級運動皮層為感興趣區(qū)進(jìn)行示蹤的錐體束方法的精確性及可靠性,以改進(jìn)以傳統(tǒng)方法重建的纖維傳導(dǎo)束為界的手術(shù)方法,使功能區(qū)手術(shù)更準(zhǔn)確、安全、有效,大大降低該類手術(shù)的神經(jīng)功能障礙發(fā)生率并有效控制癲癇發(fā)作。方法對18例涉及中央?yún)^(qū)的病變性癲癇患者行BOLD-fMRI及DTI檢查,BOLD-fMRI采用手的大拇指食指對指運動和足的拇指背屈運動作為任務(wù)刺激。所有數(shù)據(jù)進(jìn)行離線后處理,使用stealthviz軟件對DTI數(shù)據(jù)進(jìn)行后處理,得到FA圖及DEC圖,并將BOLD-fMRI激活區(qū)圖像與DEC圖像融合,以BOLD-fMRI運動激活區(qū)、大腦腳為感興趣的改進(jìn)方法和以中央前回、大腦腳為感興趣區(qū)的傳統(tǒng)方法分別示蹤錐體束。功能神經(jīng)導(dǎo)航引導(dǎo)下實施皮層下電刺激,術(shù)中記錄同一電刺激陽性點與兩種方法成像下的錐體束之間的距離,并比較兩種方法所成像的錐體束與DsCS的符合率,最后在皮層下電刺激輔助下切除病變及致癇皮層,保留功能皮層及錐體束。結(jié)果除1例患者按BOLD-fMRI激活區(qū)示蹤成像錐體束方法失敗,1例電刺激結(jié)果陰性,余患者均成功使用兩種方法成像錐體束,并應(yīng)用于術(shù)中在功能神經(jīng)導(dǎo)航引導(dǎo)下的皮質(zhì)電刺激輔助下行病灶切除術(shù)。兩種方法成像錐體束與DsCS的符合率分別為74%和58%,23個DsCS陽性位點距離兩種方法成像的錐體束之間的平均最短距離分別為(4.5±2.5)mm和(6.4±2.4)mm,因改進(jìn)方法成像的錐體束比傳統(tǒng)方法成像的錐體束在相同刺激強度下離同一電刺激陽性點較短,故相對更準(zhǔn)確(t=0.573,P=0.0120.05),且改進(jìn)成像方法與皮層下電刺激的符合率也高于傳統(tǒng)方法(χ2=7.804,P=0.0080.05)。手術(shù)全切除16例,次全切除2例,術(shù)后5例患者病變對側(cè)肢體暫時性偏癱,3例上肢暫時性偏癱,余10例患者手術(shù)前后肌力無改變,術(shù)后1周6例肢體運動同術(shù)前或較術(shù)前好轉(zhuǎn),余2例仍有偏癱,Fugl-Meyer評分平均92.1分,WAB言語功能評分平均94.3,術(shù)后口服1～2種抗癲癇藥物,癲癇控制滿意。結(jié)論對于涉及中央?yún)^(qū)的病變性癲癇手術(shù),以功能磁共振運動激活區(qū)為感興趣區(qū)示蹤錐體束的方法,在準(zhǔn)確性及可靠性上優(yōu)于傳統(tǒng)的錐體束示蹤方法,在神經(jīng)導(dǎo)航輔助下可同時保護(hù)功能皮層和錐體束并切除病變,但仍需聯(lián)合應(yīng)用皮層及皮層下電刺激技術(shù),更加有助于妥善處理病變并有效保護(hù)腦功能區(qū),從而避免術(shù)后永久性神經(jīng)功能障礙,改善癲癇控制效果。
[Abstract]:Objective to verify and compare the intraoperative direct subcortical electrical stimulation (DsCSA) technique in detecting the pyramidal tracer of BOLD-fMRI guided DTI-FTI with the functional magnetic resonance (fMRI) activation region as the region of interest and the conventional anatomical primary motor cortex as the tracer of the region of interest. The accuracy and reliability of the pyramidal tracer method using the fMRI motion-activated region as the region of interest and the traditional anatomical primary motor cortex as the tracer of the region of interest were also discussed. In order to make the operation of functional area more accurate, safe and effective by improving the traditional method of reconstruction of fiber conduction bundle as the boundary, The incidence of neurologic dysfunction was greatly reduced and seizures were effectively controlled. Methods 18 patients with central lesion epilepsy were examined by BOLD-fMRI and DTI using thumb index finger movement and thumb movement of the foot. Digital dorsiflexion movement as a task stimulus. All data were treated offline, Using stealthviz software to post-process DTI data, FA map and DEC map were obtained, and the BOLD-fMRI activation region image was fused with DEC image. The improvement method of BOLD-fMRI motor activation area, brain foot and precentral gyrus were used. The traditional method of tracing the pyramidal tracer tracts the pyramidal tract respectively. Guided by functional neuronavigation, subcortical electrical stimulation was performed. The distance between the positive spot of the same electrical stimulation and the pyramidal bundle under the imaging of the two methods was recorded during the operation. The coincidence rate between the pyramidal tracts and DsCS was compared. Finally, the lesion and epileptiform cortex were excised with subcortical electrical stimulation. Results except for the failure of BOLD-fMRI tracer imaging of pyramidal tract in one patient and negative electrical stimulation in 1 case, the other two methods were successfully used for the imaging of pyramidal tract. The coincidence rates of two methods for imaging pyramidal tract and DsCS were 74% and 58, respectively. The distance between 23 DsCS positive sites and two imaging methods were 74% and 58, respectively. The average shortest distance between beams was 4.5 鹵2.5mm and 6.4 鹵2.4mm, respectively. Because the pyramidal bundle with the improved method was shorter than that of the conventional method at the same stimulus intensity, the positive point of the same electrical stimulation was shorter than that of the conventional method. Therefore, it is more accurate than the traditional method (蠂 ~ 2 / 7.804 / P ~ (0.0080.05)), and the coincidence rate between the improved imaging method and subcortical electrical stimulation is higher than that of the traditional method (蠂 ~ 2 / 7.804). Total resection was performed in 16 cases, subtotal resection in 2 cases, and temporary hemiplegia in the contralateral extremities in 3 cases after operation, and 3 cases with temporary hemiplegia in the contralateral extremities after operation. There was no change in muscle strength in the remaining 10 patients before and after operation, 6 patients with limb movement improved before and after operation, 2 patients with hemiplegia with Fugl-Meyer score averaging 92.3 with WAB speech function score, and 1 with 1 antiepileptic drugs taken orally after operation, the other 2 patients still had hemiplegia and the average score of Fugl-Meyer score was 92.3. Conclusion the method of tracking pyramidal tract in the area of motor activation of functional magnetic resonance (fMRI) is superior to the traditional tracer method in accuracy and reliability for epileptic surgery involving the central region. The functional cortex and pyramidal tract can be protected and excised with the aid of neuronavigation, but it is still necessary to apply the technique of electrical stimulation of cortex and subcortical simultaneously, which is more helpful for the proper management of the lesions and the effective protection of the functional areas of the brain. In order to avoid postoperative permanent neurological dysfunction, improve epilepsy control effect.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R651.1

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