fNIRS对颅内占位性病变的功能区定位和神经可塑性研究

发布时间：2018-03-07 11:11

本文选题：功能性近红外脑成像　切入点：皮层功能重组　出处：《清华大学》2015年博士论文　论文类型：学位论文

【摘要】：功能性近红外脑成像(functional near-infrared spectroscopy,fNIRS)是一种无创性光学脑功能成像技术,可检测脑皮层中的氧合血红蛋白(oxygenated hemoglobin,Oxy-Hb)和脱氧血红蛋白(deoxygenated hemoglobin,Deoxy-Hb)浓度的变化。fNIRS具有检测环境接近生活环境、对运动伪迹不敏感、时间分辨率较高等优点,其缺点是空间分辨率差,但fNIRS与T1加权核磁共振结构像数据结合后可明显提高空间定位准确性。目前,fNIRS对功能区脑占位性病变患者的运动皮层的功能检测与功能磁共振成像(functional magnetic resonance imaging,fMRI)空间定位一致性尚不清楚,使用功能影像技术对脑肿瘤患者的运动皮层激活及可塑性进行研究对患者的治疗具有重要意义。为了检测fNIRS与fMRI对中央区脑占位病变的运动皮层激活的空间定位的一致性,本论文使用fNIRS对中央区脑占位性病变患者的双侧额顶叶区域的氧合反应进行了检测,分别依据Oxy-Hb和Deoxy-Hb的变化生成激活图。将fNIRS的结果与任务态fMRI的结果进行比较。结果表明,当患者进行肿瘤对侧手抓握运动时,使用fNIRS和fMRI在肿瘤侧初级感觉运动皮层(primary sensorimotor cortex,PSMC)、肿瘤对侧PSMC检测到的激活概率相当;Oxy-Hb与fMRI在运动皮层激活反应的一致性较Deoxy-Hb高;Oxy-Hb仅在2例患者未发现补充运动区(supplementary motor area,SMA)激活。为了研究中央区脑肿瘤患者PSMC激活及皮层功能重组状况,本论文使用fNIRS对纳入的17例中央区脑肿瘤患者和9例志愿者的双侧额顶叶区域进行检测,采用肿瘤对侧手部抓握任务,对PSMC的Oxy-Hb进行比较并计算偏侧指数。结果发现,对照组激活最强的部位位于对侧PSMC,患者组虽然在组分析上肿瘤侧Oxy-Hb显著高于非肿瘤侧,但肿瘤侧PSMC激活变异较大,从偏侧性减弱甚至到偏侧性逆转。患者组PSMC偏侧指数显著低于对照组。PSMC偏侧指数与患手Fugl-Meyer指数正相关,即患手功能越差其PSMC的偏侧性越趋向于健侧。本研究得出如下结论:Oxy-Hb与fMRI对PSMC的激活反应的检测结果一致性高。Oxy-Hb在少数患者未能检测出与fMRI一致的SMA激活,可能与SMA的部分解剖位置较为深在有关。中央区脑肿瘤患者在进行肿瘤对侧手部运动时,肿瘤侧PSMA激活减弱,肿瘤侧PSMC激活偏侧性向健侧偏移,PSMC的偏侧性改变程度与肿瘤对侧手部功能受损的程度有关。
[Abstract]:Functional near infrared brain imaging (FNIR) is a noninvasive optical imaging technique for the detection of oxygenated hemoglobulin (Oxy-Hb) and deoxyhemoglobulin (Deoxy-Hb) concentrations in the cortex. FNIRS has the ability to detect changes in the concentrations of oxygenated hemoglobulin and deoxy-Hb in the cerebral cortex. FNIRS has the ability to detect environmental proximity to the living environment. It is insensitive to motion artifacts and has high time resolution, but its disadvantages are poor spatial resolution. However, the accuracy of spatial localization can be improved by combining fNIRS with T1-weighted MRI data. At present, FNIRS is used to detect the function of motor cortex and functional magnetic resonance imagingfMRI space in patients with brain occupying lesions in the functional area. Location consistency is not clear, It is important to study the activation and plasticity of motor cortex in patients with brain tumor by using functional imaging technique. In order to detect the consistency between fNIRS and fMRI in the spatial localization of motor cortex activation in central brain occupying lesions. In this study, fNIRS was used to detect the oxygenation response in bilateral frontal and parietal lobe regions in patients with central cerebral space-occupying lesions. Activation maps were generated according to the changes of Oxy-Hb and Deoxy-Hb, respectively. The results of fNIRS were compared with those of task-based fMRI. When the patient has a contralateral grip on the tumor, Using fNIRS and fMRI in the primary sensorimotor cortexes of the tumor side, the activation probability of the contralateral PSMC was similar. The consistency of the activation response between Oxy-Hb and fMRI in the motor cortex was higher than that in the Deoxy-Hb. Only in 2 patients did not the supplementary motor area be found. In order to study the activation of PSMC and the recombination of cortical function in patients with central brain tumor, In this study, fNIRS was used to detect the bilateral frontal and parietal lobe regions of 17 patients with brain tumors in the central region and 9 volunteers. The Oxy-Hb of PSMC was compared and the hemiplegia index was calculated by using the task of grasping the contralateral hand of the tumor. The most active site in the control group was located in the contralateral PSMC. Although the Oxy-Hb of the tumor side was significantly higher than that of the non-tumor side, the PSMC activation of the tumor side varied significantly in the patient group. The hemiplegic index of the patients was significantly lower than that of the control group. There was a positive correlation between the hemiplegia index and the Fugl-Meyer index of the affected hand. That is, the lower the function of the affected hand, the more the side of PSMC tends to be contralateral. In this study, it is concluded that there is a high consistency between the results of the detection of the activation of PSMC by fMRI and that of the reaction of fMRI to PSMC. Oxy-Hb can not detect SMA activation consistent with that of fMRI in a few patients. It is possible that some anatomical location of SMA is deeply related. The activation of PSMA in the tumor side of brain tumor patients is decreased when the tumor is on the contralateral hand motion. The degree of hemiplegic change of PSMC activated to the contralateral side of the tumor was related to the degree of impairment of the contralateral hand function of the tumor.
【学位授予单位】：清华大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R739.4

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