MRI引导的个性化tDCS规划用于卒中后吞咽运动皮层靶向参与：一项有限元建模研究
MRI-guided personalized tDCS planning for target engagement of the swallowing motor cortex after stroke: a finite-element modeling study.
文献信息
| PMID | 42824124 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Yeun Jie Yoo |
| 作者单位 | Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. |
| 期刊 | Frontiers in neurology |
| SCI 分区 | Q2 |
| IF | 3.5 |
| 研究类型 | 基础研究 · 基础／转化 |
| 所属专科 | 咽喉科 |
中文摘要
背景： 卒中后吞咽困难（PSD）是卒中常见且使人衰弱的后果，影响高达50%的患者，并导致多种医疗并发症。经颅直流电刺激（tDCS）的治疗效果取决于电极蒙太奇和个体间解剖差异。使用基于10-20脑电图（EEG）坐标的标准C5/C6放置来指导电极放置可能导致与目标位置错位。
目的： 为了研究计算建模是否比标准电极放置方法产生更好的电场（EF）参数，以及更小尺寸的电极是否能产生更聚焦的结果，我们比较了针对皮层吞咽区（CSA）的三种tDCS蒙太奇的EF值：（i）优化圆形（Opt-C，半径1.5厘米），（ii）基于EEG的传统圆形（Conv-C，半径1.5厘米），和（iii）传统方形（Conv-S，5×5厘米）电极蒙太奇。
方法： 分析了50名PSD患者的结构MRI数据。使用基于tES LAB 4.0平台生成的三维四面体头部模型的有限元方法（FEM）分析模拟EF分布。在不同蒙太奇之间，我们比较了EF强度（定义为目标ROI内节点上EF的L2范数平均值（Enorm））和靶向特异性聚焦性（定义为目标ROI元素中Enorm值达到或超过相应全脑灰质和白质Enorm分布第75百分位的体积总和）。
结果： 在三种tDCS蒙太奇之间，EF强度（p < 0.001）和靶向特异性聚焦性（p < 0.001）存在显著差异。Opt-C蒙太奇产生了最高的EF强度（中位数：0.3525 V/m；IQR：0.306-0.455）和靶向特异性聚焦性（中位数：104.69 mm3；IQR：88.17-120.31）。此外，小圆形电极比方形电极产生显著更大的EF强度和靶向特异性聚焦性（p < 0.001）。
结论： MRI引导的个性化tDCS规划改善了向皮层吞咽目标的模拟EF递送，并揭示了严重PSD患者与传统C5/C6放置的显著偏差。这些发现支持图像引导的靶向参与作为PSD精准神经调控的框架，但在推断治疗效果之前，需要前瞻性生理和临床验证。
英文摘要
BACKGROUND: Poststroke dysphagia (PSD) is a common, debilitating consequence of stroke that affects up to 50% of patients and leads to multiple medical complications. Transcranial direct current stimulation (tDCS) therapeutic efficacy depends on the electrode montage and interindividual anatomical differences. The use of the standard C5/C6 placement based on 10-20 electroencephalography (EEG) coordinates to guide electrode placements may result in misalignment with the target position.
OBJECTIVE: To investigate whether computational modeling leads to improved electric field (EF) parameters compared with those generated with standard electrode placement methods, and whether smaller sized electrodes can yield more focal results, we compared EF values across three tDCS montages targeting the cortical swallowing area (CSA): (i) optimized circular (Opt-C, 1.5 cm radius), (ii) EEG-based, conventional circular (Conv-C, 1.5 cm radius), and (iii) conventional square (Conv-S, 5 × 5 cm) electrode montages.
METHODS: Structural MRI data from 50 PSD patients were analyzed. EF distributions were simulated using finite element method (FEM) analysis based on three-dimensional tetrahedral head models generated with the tES LAB 4.0 platform. Across montages, we compared EF strength, defined as the mean L2 norm of the EF (Enorm) across nodes within the target ROI, and target-specific focality, defined as the summed volume of target-ROI elements with Enorm values at or above the 75th percentile of the corresponding whole-brain gray and white matter Enorm distribution.
RESULTS: Significant differences in EF strength (p < 0.001) and target-specific focality (p < 0.001) were identified across the three tDCS montages. The Opt-C montage produced the highest EF strength (median: 0.3525 V/m; IQR: 0.306-0.455) and target-specific focality (median: 104.69 mm3; IQR: 88.17-120.31). Additionally, small circular electrodes resulted in significantly greater EF strength and target-specific focality than square electrodes (p < 0.001).
CONCLUSION: MRI-guided personalized tDCS planning improved modeled EF delivery to the cortical swallowing target and revealed significant deviations from conventional C5/C6 placement in patients with severe PSD. These findings support image-guided target engagement as a framework for precision neuromodulation in PSD, while prospective physiological and clinical validation is required before therapeutic efficacy can be inferred.