Application Of Functional Magnetic Resonance Imaging In The Treatment Of Space-occupying Lesions In Cerebral Cortex Functional Areas

Objectives:By accurate identification and display of white matter fiber tracts of pathological changes all round space-occupying lesions and the cerebral cortex functional areas using Functional Magnetic Resonance Imaging, establishing a reasonable surgical procedures and postoperative radiotherapy plans, when the lesions are fully removed under the microscope, important neural structure around is dissected and neurological function is protected to the greatest extent to reduce the postoperative neurological deficits and deterioration ratio effectively. Based on this, clinical value of functional magnetic resonance imaging in the treatment of the space-occupying lesions in cerebral cortex functional area is deeply discussed, combined with literature review. Methods:26 patients with space-occupying lesions located in or adjacent to cortical functional areas are chosen.14 cases of meningioma,6 cases of glioma, 4 cases of metastatic tumors and 2 cases of brain abscess are classified according to lesion nature.16 patients with frontal lobe lesions (lesions involving the cortical motor areas and/or exercise-induced language center),3 patients with temporal lobe lesions (involving temporal lobe language rear hub by varying degrees),2 patients with frontal and parietal lobe lesions (accumulating by cortical motor and sensory centre at the same time) and 5 patients with parietal lobe lesions (violating sensory cortex) are classified by lesion site. All the patients underwent preoperative functional magnetic resonance imaging to clarify the relationship between lesion and the surrounding cortex and assess the damage extent of the cortical functional areas.1.5T MRI,8-channel head coil are applied. Somatic motor, sensory function area lesions DTI scan using the SE-EPI sequence,15 the direction of applied diffusion gradients (b= 1000s/mm2), BOLD-fMRI using single-shot EPI sequence, blocks of stimulus paradigm, resting, and Activate each for 20 seconds, each repeated 5 times. Make a fist with both hands and thumb respectively refer to rounds of the campaign; movement, sensory language function areas central lesions DTI scan using the SE-EPI sequence, six directions of diffusion weighted acquisition (b= 1000 s/mm2), BOLD-fMRI using single-shot EPI sequence, blocks of stimulation mode, resting period with a view to stimulate each for 30s, a total of 5 cycles. The basis of the functional magnetic resonance images, in the PC, with the Volume-one software for DTI and fMRI integration, analysis of fMRI and DTI showed lesions and cerebral motor area and the relationship between white matter fiber bundles. Based on these results the best surgical program is formed:a reasonable balance between the extent and cortical lesions removed to protect the relationship between functional areas, the maximum protection of cortical functional areas to reduce disability. After the DTI and BOLD-fMRI circumstances reviewed, an objective assessment of the prognosis and the radiotherapy program are made. In order to better the statistical comparison,20 patients with the functional areas of early cortical space occupying lesions are chosen at the same time. The beginning of disability rate (after the first time in neurological deficits), complex disability rate (postoperative neurological deficits increase), tumor resection rate were respectively analyzed statistically. Results:The functional magnetic resonance imaging technology can effectively display the white matter fiber tracts of pathological changes all round space-occupying lesions and the cerebral cortex functional areas. Based on the relationships between lesion and the surrounding vital structures, close, involving the violation, invasion damage, and reasonable development of surgical programs; fully removal of mobilized, squeezed, twisting of the cerebral cortex functional areas and the pathological changes of white matter fiber tracts during surgery; palliative resection for infiltration damage, surrounding the motor function areas and important pathological changes in white matter fiber tracts. Full-cut lesions in 21 cases (meningioma patients are to achieve full-cut), subtotal resection in 3 cases, partial resection in 2 cases (all cases of brain abscess).4 cases with new postoperative neurological dysfunction (limb paresis in 3 cases, incomplete nature of language dysfunction in 1 case, early disability rate 4/26), the original 6 cases of aggravated neurological dysfunction (including the complete paralysis of limbs in 5 cases, complete two cases of aphasia, sensory aphasia in 1, complex disability rate (6/26)). With perioperative review of DTI and BOLD-fMRI, corticospinal tract fiber bundles increased in the number of 12 cases, activation intensity of postoperative motor function and range of activation increased in 15 cases compared with those of pre-operation.Follow-up visit from 6 months to 1 year after the operation shows except 1 case with complete paralysis of limbs having not recovered, the remaining patients having neurological deficits completely recovered or returned to preoperative levels in 15 days-3 months. Conclusion:DTI and BOLD-fMRI is an effective but not invasive cortical localization of brain function. This method can identify precisely white matter fiber tracts of pathological changes all round space-occupying lesions and the cerebral cortex functional areas involving the functional area or adjacent space-occupying lesions. The detailed surgical plan in accordance with that can effectively reduce the postoperative morbidity and improve prognosis. At the same time, by the examination of early postoperative functional magnetic resonance imaging, objective evaluation of the prognosis and guide of postoperative radiotherapy can be achieved. To sum up, micro-surgery combined with DTI and BOLD-fMRI and the joint guidance of cortical functional areas can avoid artificial damage of intraoperative nerve function; try to improve patient postoperative quality of life and reduce the rate of tumor recurrence after the removal of diseased tissue. Post-operation review of DTI and BOLD-fMRI may be an objective understanding of prognosis and can guide ray angle and radiation dose during radiation treatment and avoid damage of neurological function caused by excessive exposure of the functional area.