先天性耳聾嬰幼兒聽覺及語言中樞等相關(guān)腦區(qū)變化的fMRI研究

1、先天性耳聾嬰幼兒聽覺及語言中樞等相關(guān)腦區(qū)變化的fMRI研究        【中文摘要】目的:給予震動(dòng)觸覺刺激后,運(yùn)用fMRI觀察先天性極重度耳聾嬰幼兒聽皮質(zhì)、語言中樞等腦區(qū)的激活范圍與強(qiáng)度,以明確聽皮質(zhì)的功能,初步判定fMRI在評(píng)價(jià)嬰幼兒耳蝸移植術(shù)前聽皮質(zhì)功能的價(jià)值及fMRI所獲得的信息是否能成為評(píng)價(jià)嬰幼兒耳蝸移植效果的猜測指標(biāo),并跟據(jù)腦區(qū)激活情況判定嬰幼兒耳聾后皮質(zhì)重組情況。對(duì)象與方法:極重度感音神經(jīng)性耳聾嬰幼兒19例,其中男10例,女9例,月齡為1238個(gè)月,均勻月齡20.7個(gè)月,所有聾兒均為雙側(cè)先天性極重度感

2、音神經(jīng)性耳聾,雙耳聽力腦干反應(yīng)(auditory brainstem response,ABR)測聽結(jié)果均在91dB以上。所有聾兒均無精神疾病病史,無中樞神經(jīng)系統(tǒng)發(fā)育異常。對(duì)照組3例,其中男2例,女1例,月齡為724個(gè)月,均勻月齡為16.3個(gè)月,其中2例聽力正常,1例右耳聽力正常,左耳聽力ABR測聽結(jié)果為25dB。分別采集SE T1WI橫斷面、GRE-EPI MR功能影像以及3D GRE T1WI影像。采用組塊式方法分別給予右小腿近踝部震動(dòng)觸覺刺激。所有圖像均經(jīng)統(tǒng)計(jì)參數(shù)圖5(statistical parametric mapping 5,SPM5)進(jìn)行后處理,利用SPM5二次統(tǒng)計(jì)模塊(sec

3、ond level analysis)進(jìn)行病人組和對(duì)照組的組內(nèi)分析和組間比較。結(jié)果:給予震動(dòng)觸覺刺激后,極重度感音神經(jīng)性耳聾患兒主要激活腦區(qū)包括:雙側(cè)顳橫回、顳上回、顳中回、顳下回、雙側(cè)中心前、后回、雙側(cè)旁中心小葉、雙側(cè)額中回、額下回、雙側(cè)頂下小葉、雙側(cè)枕葉、雙側(cè)島葉、雙側(cè)梭狀回。正常聽力對(duì)照組主要激活腦區(qū)包括:右側(cè)顳橫回、右側(cè)顳上回、右側(cè)顳中回、左側(cè)枕中回、枕下回、舌回、左側(cè)丘腦,雙側(cè)額中回、雙側(cè)楔葉。在對(duì)極重度感音神經(jīng)性耳聾患兒和對(duì)照組進(jìn)行組間(兩樣本t檢驗(yàn))比較發(fā)現(xiàn),病人組數(shù)據(jù)減往對(duì)照組數(shù)據(jù)時(shí)可見激活的腦區(qū)主要有:雙側(cè)顳橫回、雙側(cè)顳上回、雙側(cè)顳中回、雙側(cè)島葉、雙側(cè)中心前、后回、雙側(cè)扣帶回

4、、雙側(cè)頂下小葉、雙側(cè)頂上小葉、雙側(cè)額上回等,提示極重度感音神經(jīng)性耳聾患兒在接受刺激后動(dòng)用了更多的腦區(qū)而且激活強(qiáng)度明顯增加。結(jié)論:極重度感音神經(jīng)性耳聾嬰幼兒雙側(cè)低級(jí)聽覺皮層及次級(jí)聽覺皮層均可見激活,提示在聽力刺激缺失后雙側(cè)聽覺中樞仍存在一定的功能;給予震動(dòng)觸覺刺激后雙側(cè)顳葉可見激活,提示耳聾后,聾兒聽皮質(zhì)及其相關(guān)腦區(qū)發(fā)生了聽一觸覺重組;與正常聽力對(duì)照組相比,極重度感音神經(jīng)性耳聾嬰幼兒給予震動(dòng)觸覺刺激后具有更多、更大范圍的激活腦區(qū),激活強(qiáng)度更大,提示聾兒的皮質(zhì)系統(tǒng)感知震動(dòng)觸覺刺激的敏感性明顯增加。');【Abstract】 Objective:To observe activation o

5、f the auditory cortex and the Broca's cortex with functional magnetic resonance imaging(fMRI) after given vibrotactile stimulation,to identify the function of the auditory cortex in infants with profoundly congenital sensorineural hearing loss.To investigate initially the role of fMRI in pediatr

6、ic cochlear implantation candidates who were under sedation for evaluation of auditory function.To demonstrate whether the fMRI could be considered a means of assessing residual function in the auditory cortex in infants with profoundly congenital sensorineural hearing loss,and whether fMRI could be

7、 translated into a prognostic indicator for outcome after cochlear implantation in prelingual hearing loss infants and toddlers with residual hearing.According to the activation of the cortex to judge the reorganization of cortex in infants after hearing loss.Materials and Methods:19 profoundly cong

8、enital hearing loss infants,of whom 10 were male,9 were female,the patients were aged from 1238 months with the average age was 20.7 months.All infants were bilateral congenital sensorineural hearing loss,the result of the ABR was more than 91 dB.None of the subjects had mental disease and dysplasia

9、 of the central nervous system.3 hearing subjects were aged from 724 months with the average age was 16.3 months,of whom 2 were male and 1 was female.In this group,the hearing of 2 subjects was normal,and about the hearing of the third subject,the right ear was normal,the ABR result of the left ear

10、was 25dB.All the subjects performed anatomical T1WI,GRE-EPI fMRI with a 1.5T whole body MRI scanner and high-resolution 3D GRE T1WI.All the subjects were given the vibrotactile stimulation on the right leg adjoin with the ankle.In fMRI, block-design paradigm was used.fMRI image analysis was performe

11、d using statistical parameter mapping 5(SPM5),activation foci were superposed on high-resolution T1WI.Group and inter-group analysis were performed using the second level analysis of SPM5.Results:After given the vibrotactile stimulation,the brain areas activated in profoundly congenital hearing loss

12、 infants were:bilateral transverse temporal gyri, superior temporal gyrus,middle temporal gyrus,inferior temporal gyrus,bilateral precentral gyrus,postcentral gyrus,bilateral paracentral lobule,bilateral middle frontal gyrus,inferior frontal gyrus,bilateral inferior parietal lobule,bilateral occipit

13、al lobe,bilateral insular lobe,and bilateral fusiform gyrus and so on.the brain areas activated in control group were:right transverse temporal gyri, superior temporal gyrus,middle temporal gyrus,left middle occipital gyrus,inferior occipital gyrus,lingual gyrus,left thalamus,bilateral middle fronta

14、l gyrus and bilateral cuneus.One-sample t test was used in profoundly congenital hearing loss infants and control group,the activated brain areas were:bilateral transverse temporal gyri, superior temporal gyrus,middle temporal gyrus,bilateral insular lobe,bilateral precentral gyrus,postcentral gyrus

15、,bilateral cingulate gyrus,bilateral inferior parietal lobule,bilateral superior parietal lobule,bilateral superior frontal gyrus.The results indicated that the profoundly congenital hearing loss infants had used more brain areas after given vibrotactile stimulation and the intensity was increased.C

16、onclusions:The bilateral primary and secondary auditory cortex were activated in profoundly congenital hearing loss infants,which meant the bilateral auditory cortex also had function;The bilateral tempral lobe had been activated after given vibrotactile stimulation hearing loss infants meant it had integration of touch and s