MR增强扫描在鼻咽癌放疗后放射性脑损伤中的诊断价值  

The diagnostic value of contrast-enhanced MRI in the diagnosis of radiation-induced cerebral injury following radiotherapy for nasopharyngeal carcinoma

作　　者：赵修义[1] 张雪林[2] 闫卫平[2] 孙钢[1] 邓勇[1] 王劲[2] 

机构地区：[1]济南军区总医院放射科,山东济南250031 [2]南方医科大学附属南方医院,广东广州510515

出　　处：《医学影像学杂志》2005年第10期847-850,共4页Journal of Medical Imaging

摘　　要：目的:探讨鼻咽癌放疗后颞叶放射性脑损伤的MR增强扫描表现特点及诊断价值。方法:回顾性分析36例鼻咽癌放疗后颞叶放射性脑损伤患者的临床及MR影像资料。按病变的主要发病部位及MR表现将其分为灰质型及白质型,其中白质型进一步分为白质型Ⅰ期和白质型Ⅱ期。结果:36例放射性脑损伤包括27例白质型及9例灰质型,其中27例白质型包括白质型Ⅰ期18例、白质型Ⅱ期9例。白质型Ⅰ期病例中增强扫描均表现为颞叶底部灰质内为主团块状或散在的斑点状、斑片状实质强化,强化区多位于颞叶底部内侧灰质及颞极区灰质;白质型Ⅱ期病例增强扫描主要表现为花环状强化,占强化病灶的56%,其它主要表现为坏死灶周边及颞叶底部灰质内不规则实质强化。灰质型病例中增强扫描表现为病变区斑点状或结节状强化。结论:鼻咽癌放疗后颞叶放射性脑损伤的强化部位、强化形状及强化范围均具有一定的特征性,增强扫描在放射性脑损伤的诊断及早期征象的发现中有重要价值,应作为常规扫描进行。Objective：To observe the enhanced MRI findings and evaluate its diagnostic value for radiation-induced temporal lobe injury in nasopharyngeal carcinoma. Methods： Thirty-six patients with diagnosis of radiation-induced temporal lobe injury were retrospectively reviewed. All patients were diagnosed by clinical manifestations and MR imaging. The disease was divided into white matter type and gray matter type by the sites and MR appearances of radiation-induced injury, and the white matter type included white matter phase Ⅰ and white matter phase Ⅱ . Results： Of the 36 patients with radiation-induced temporal lobe injury in the series, 27 were defined as white matter type and 9 were defined as gray matter type. And the white matter type of 27 cases included white matter phase Ⅰ in 18 cases and white matter phase Ⅱ in 9 cases. The pattern of enhancement in the white matter phase Ⅰ were of blotch or patch on the bottom of temporal lobes, and the most enhancements were located in the inferomedial portions of the temporal lobes （mainly gray matter）. The lesion showing a ring-enhancement pattern were common in the white matter phase Ⅱ （56%）, and the other pattern of enhancement mainly showed irregularly solid enhancement around the radiation-induced necrosis or on the bottom of temporal lobes. In the gray matter type, the pattern of enhancement were characterized by blotchy or nodular solid enhancement in the gray matter lesions. Conclusion： The contrast-enhanced MRI finds are characteristic in radiation-induced injury following radiotherapy for nasopharyngeal carcinoma. It has important value and clinical significance for enhanced MR scanning to find the early signs and establish diagnosis for radiation-induced injury, and the enhanced MR scanning should be performed as the routine.

关 键 词：放射性损伤 鼻咽癌 磁共振成像 

分 类 号：R739.63[医药卫生—肿瘤] R445.2[医药卫生—临床医学]