MRI를 이용한 전방언어중추판정
MRI-Based Lateralization of Anterior Speech Area
최철, 신창범, 배시현,
소속 상세정보
최철 ( )
전북대학교 의과대학 신경외과학교실
신창범 ( )
전북대학교 의과대학 신경외과학교실
배시현 ( )
전북대학교 의과대학 신경외과학교실
KMID : 0359819980270101385
Abstract
결 론
MRI를 이용한 하전두엽회의 형태학적, 용적학적 비대칭 성은 Wada test에 의한 우성대뇌
판정 결과와 매우 비슷한 결과를 보여주어, MR3를 이용하면 언어에 대한 우성대뇌를 비관
혈적으로 판정할 수 있을 것으로 생각된다. 이 연구가 실질적으로 사용되기 위해서는 더 많
은 환자들에 대한 연구가 지속되어져야 할 것이며. 아울러 최근에 연구가 활발히 진행되고
있는 functional MRI등과 비교 연구하면 보다 더 확실한 연구 결과를 얻을 수 있을 것으로
사료된다.
#초록#
Speech lateralization by Wada is a necessary step in the presurgical evaluation of
patients with intractable epilepsy. It, however, is invasive. We studied the usefulness of
a noninvasive technique : MR-based volumetric and anatomical analysis of talc anterior
speech area as compared to Wada test.
Thirty nine patients wish intractable epilepsy under presurgical evaluation including
Wada test for hemispheric lateralization for language, were studied : patients with left
language dominance (n=20) and right language dominance(n=19). Sagittal and coronal
T1-weighed turbo FLASH scans were acquired. Every image in each patient was
reconstructed and inferior frontal gyrus was identified on the 3D-surface rendered brain.
Than cortical gray matter of inferior frontal gyrus in each image was segmented and
reconstructed using a 3D software(Allegro, ISG, Toronto, Canada). Sulcal and gyral
patterns of the inferior frontal gyrus were evaluated and classified comparing with the
normotive data of Steinmetz. total volume of inferior frontal gyrus(ifg), regional volumes
of pars traingularis(tr) and parsopercularis(op) were obtained. Asymmetry
Quotient(AQ)of interior frontal gyrus. (right-left)/0.5(right left), between left and right
were calculated in each patient AQ from both groups of patients were compared and
data was analysed.
Complicated gyral pattern and presentation of a diagonal sulcus in the pars opercularis
were prominent in the left side in patients with the left hemispheric dominance for
language(p<0.006, p<0.02), and in the right side in patients with the right hemispheric
dominance (p<0.002, p<0.03). in patients with language dominance in the hemisphere,
AQ of each portion of interior speech area showed significant leftward asymmetry(M
:Mean, SEM : standard Error of Mean, Mifg=-0.24 : SEMifg=0.04, Mtr=-0.19 ;
SEMtr=0.09, Mop=-0.26 ; SEMop=0.06). In patients with language dominance in the right
hemisphere, AQ showed mild rightward asymmetry or no asymmetry(Masa=0.21 ;
SEMifg=0.06, Mtr=0.15 ; SEMtr=0.08, Mop=0.24 ; SEMop=0.09). Fisher's Exact test
demonstrated significant value of AQ in each portion of interior frontal gyrus correlated
with hemispheric dominance for language with confidence index(CI) in 95%.
Interestingly, AQ of pars triangularis plus pars opercularis showed the highest
value(p=0.00001) in predicting the language dominant hemisphere.
MRI-based sulcal gyral patterns and volumetric asymmetry of inferior frontal gyrus
correlate with speech lateralization on Wada test This is a promising noninyasiye
technique in hemispheric lateralization for language.
키워드
Wada test; Intractable epilepsy; Inferior frontal gyrus; Anterior speed area;
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