先天性耳聋婴幼儿听觉及语言中枢等相关脑区变化的fMRI研究

1、先天性耳聋婴幼儿听觉及语言中枢等相关脑区变化的fMRI研究        【中文摘要】目的:给予震动触觉刺激后,运用fMRI观察先天性极重度耳聋婴幼儿听皮质、语言中枢等脑区的激活范围与强度,以明确听皮质的功能,初步判定fMRI在评价婴幼儿耳蜗移植术前听皮质功能的价值及fMRI所获得的信息是否能成为评价婴幼儿耳蜗移植效果的猜测指标,并跟据脑区激活情况判定婴幼儿耳聋后皮质重组情况。对象与方法:极重度感音神经性耳聋婴幼儿19例,其中男10例,女9例,月龄为1238个月,均匀月龄20.7个月,所有聋儿均为双侧先天性极重度感

2、音神经性耳聋,双耳听力脑干反应(auditory brainstem response,ABR)测听结果均在91dB以上。所有聋儿均无精神疾病病史,无中枢神经系统发育异常。对照组3例,其中男2例,女1例,月龄为724个月,均匀月龄为16.3个月,其中2例听力正常,1例右耳听力正常,左耳听力ABR测听结果为25dB。分别采集SE T1WI横断面、GRE-EPI MR功能影像以及3D GRE T1WI影像。采用组块式方法分别给予右小腿近踝部震动触觉刺激。所有图像均经统计参数图5(statistical parametric mapping 5,SPM5)进行后处理,利用SPM5二次统计模块(sec

3、ond level analysis)进行病人组和对照组的组内分析和组间比较。结果:给予震动触觉刺激后,极重度感音神经性耳聋患儿主要激活脑区包括:双侧颞横回、颞上回、颞中回、颞下回、双侧中心前、后回、双侧旁中心小叶、双侧额中回、额下回、双侧顶下小叶、双侧枕叶、双侧岛叶、双侧梭状回。正常听力对照组主要激活脑区包括:右侧颞横回、右侧颞上回、右侧颞中回、左侧枕中回、枕下回、舌回、左侧丘脑,双侧额中回、双侧楔叶。在对极重度感音神经性耳聋患儿和对照组进行组间(两样本t检验)比较发现,病人组数据减往对照组数据时可见激活的脑区主要有:双侧颞横回、双侧颞上回、双侧颞中回、双侧岛叶、双侧中心前、后回、双侧扣带回

4、、双侧顶下小叶、双侧顶上小叶、双侧额上回等,提示极重度感音神经性耳聋患儿在接受刺激后动用了更多的脑区而且激活强度明显增加。结论:极重度感音神经性耳聋婴幼儿双侧低级听觉皮层及次级听觉皮层均可见激活,提示在听力刺激缺失后双侧听觉中枢仍存在一定的功能;给予震动触觉刺激后双侧颞叶可见激活,提示耳聋后,聋儿听皮质及其相关脑区发生了听一触觉重组;与正常听力对照组相比,极重度感音神经性耳聋婴幼儿给予震动触觉刺激后具有更多、更大范围的激活脑区,激活强度更大,提示聋儿的皮质系统感知震动触觉刺激的敏感性明显增加。');【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