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Objective To verify the accuracy of blood oxygenation level dependent (BOLD)-based activation using electrocortical stimulation mapping (ESM) and explore the value of language fMRI in the navigating operation of neurosurgery. Methods In 8 cases with brain tumors,BOLD-fMRI examinations were done before the operations. Under the state of awake anesthesia,the patients were aroused and ESM was conducted. Point-to-point comparison between the BOLD signal activations and the ESM was carried out under the surveillance of the neuro-navigation technology. In order to observe the sensibility and specificity of BOLD activations, the location of BOLD activations and the point of ESM was compared to calculate the stimulating positive points inside the regions of BOLD signals(real positive), outside BOLD regions(pseudo-negative), the stimulating negative points inside the regions of BOLD signals(pseudo-positive), and outside BOLD region(real negative). Two kinds of criteria for assessment were used. One was that the positive stimulating points were located in BOLD regions, and the other was that the positive stimulating points were located within 1 cm around the range of BOLD regions. Removal of the lesions were conducted with the tissue 1 cm around the language region preserved, and the cortex inside 0.5-1.0 cm distance from the positive points were retained. Results Of the 8 cases, only 6 finished the tasks. Among them, 3 cases were with astrocytoma of grade 2,2 were with astrocytoma of grade 3, and one with glioblastoma. The total number of stimulating points was 48, among which the positive points were 11. When the first criteria was applied, the sensitivity was 72.7% (8/11), and the specificity was 81.8% (30/37). When the second criteria was applied, the sensitivity was 82.0% (9/11),and the specificity was 75.6% (28/37). Follow-up after operation showed no aphasia occurred. Conclusions BOLD-fMRI had a high sensitivity and specificity in displaying the language regions. But due to the great variation of brain language area among the people, we need more studies of large sample to obtain enough experience before it can be used clinically.
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Objective To study the values of HMRS and DTI technology for detecting brain damage in heroin-dependent patients.Methods The routine MRI,HMRS and DTI were performed in 7 heroin abuser8 and 8 healthy volunteers without the history of drug abuse.The regions of interest(ROI) were selected in the gray matter and white matter of prefrontal lobe in HMRS exam,and the ratio of NAA/ Cr、Cho/Cr and Cho/NAA were measured respectively.For the DTI,six ROIs were selected,and the values of fractional anisotropy(FA)and ADC were calculated respectively.The independent samples t test was used for the statistics.Results No abnormality was found in the routine MRI.The ratio of NAA/Cr decreased in the prefrontal lobe.the values were 1.40±0.16 in gray matter and 1.72±0.41 in white matter 0f the drug group.1.57±0.09 and 2.08±0.21 in the control group on HMRS examiation.The differenee between the two groups had statistical significance(t=2.183,2.190,P<0.05)On DTI examination,the values of FA decreased in GCC,SCC and AIC,each was 0.70±0.04,0.76±0.41,0.55±0.03 in drug group,and 0.76±0.03,0.82±0.03,0.64±0.03 in controlgroup.The difference betweenthetwo groups had statistical significance(t=3.830,3.713,5.555,P<0.05).The value8 of ADC increased in SCC,PIC and EC in drug group,each Was(8.18±0.48)×10-4,(7.54±0.22)×10-4,(7.72±0.30)× 10-4and(7.50±0.26)×10-4,(7.154-0.20)×10-4,(7.19±0.39)×10-4mm2/s in control group respectively.The difference between tlle two groups had statistical significance(t=3.477,3.507,2.895, P<0.05).Conclusion The early abnormalities of the brain in heroin-induced patients can be found combining HMRS and DRI.
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Objective To investigate the underlying mechanism of motor recovery of the hemiplegic lower extremity in stroke patients. Methods The brain activation pattern during sequential extension-flexion of the affect-ed knee of 7 stroke patients and 8 healthy subjects was observed by blood-oxygen- level-dependent fMRI (BOLD-fM-RI) and analyzed by microsoft SPM5. Results When executing unilateral knee flexion-extension, contralateral paracentral lobe and contralateral supplementary motor area and right temporal gyms and inferior parietal lobes of both sides were significantly activated in all the healthy subjects, while the ipsilateral parietal lobe BA7 and BA5 were sig-nificantly activated in 6 of the 7 stroke patients. Conclusions Sequential extension-flexion of the affected knee of stroke patients was probably dependent on the activation of BA7 and BA5 in the intact side. Compensatory activation of the intact hemisphere might be one of the main mechanisms for the paretic lower extremity motor recovery in stroke patients.
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Objective To explore and evaluate the value of transcatheter closure procedure in con-genital heart diseases. Methods Transcatheter closure was performed in 12 patients with congenital heart diseases including 6 ventricular spetal defect (VSD), 4 atrial septal defect (ASD), 2 patent ductus arteriosus (PDA), by the Amplaztzer occlusion device under local or general anesthesia. Results The procedure was successful in all patients outcoming with the disappearance of cardiac murmur. All of them could get out of the bed within 6 to 12 hours postoperatively, and were discharged from hospital after 4 to 6 days.Conclusions Transcatheter treatment of congenital cardiac defects by Amplatzer occlusion device is less traumatic, with good effect, simul taneously.