MR波谱在鼻咽癌放疗后颅底复发与放射性脑病鉴别诊断中的应用  

Application of MR spectroscopy in differential diagnosis between basicranial tumor recurrence and radiation encephalopathy after radiotherapy for nasopharyngeal carcinoma

作　　者：吕衍春[1] 范卫君[1] 李娴[1] 谢传淼[1] 沈静娴[1] 何浩强[1] 钟锐[1] 

机构地区：[1]中山大学附属肿瘤防治中心医学影像与介入中心华南肿瘤学国家重点实验室,广州510060

出　　处：《中华放射学杂志》2008年第7期714-719,共6页Chinese Journal of Radiology

基　　金：广东省卫生厅医学科研基金（A2005244）

摘　　要：目的应用MR波谱（MRS）对鼻咽癌颅底复发与放射性脑病进行对比研究，探讨MRS对两者的鉴别诊断价值。方法选择鼻咽癌根治性放射治疗后经常规MRI怀疑鼻咽癌颅底复发或放射性脑病患者50例行MRS，其中男44例，女6例，经临床及MRI复查综合诊断，26例为鼻咽癌颅底复发，24例为颞叶放射性脑病。对比分析放疗后复发与放射性脑病之间及其与相对“正常”脑组织之间胆碱（Cho）、N－乙酰天冬氨酸（NAA）、肌酸（cr）、乳酸－脂质（LL）等主要代谢物含量的异同。采用秩和检验对所得数据进行统计分析。结果复发组的Cho／Cr、Cho／NAA、LL／Cr中位数分别为2．22、2．13、1．77，放射性脑病组分别为1．40、1．31、0．57，两者间差异有统计学意义（P值均〈0．01），复发组高于放射性脑病组。肿瘤复发组Cho、Cr、NAA的中位数分别为3366．00、1023．00、1930．00，放射性脑病组分别为2469．50、1864．50、1734．00，3个代谢产物的含量在肿瘤复发与放射性脑病之间差异均无统计学意义（P值均〉0．05）。在取得了“正常”脑组织对比的14个肿瘤复发病例中，复发灶的Cr、NAA、LL、Cho／Cr、Cho／NAA、LI/Cr的中位数分别为1023．00、1930．00、2090、00、3．76、2．13、3．39，“正常”区域分别为2370．00、3012．00、1680．00、1．64、1．17、0．75，两组各参数间差异均有统计学意义（P值均〈0．05），复发灶的LL、Cho／Cr、Cho／NAA、LL／Cr高于“正常”区域，而NAA、Cr低于“正常”区域；在取得了“正常”脑组织对照的12个放射性脑病病例中，放射性脑病的Cho、Cr、NAA、LL、Cho／Cr、LL／Cr的中位数分别为390．00、217．50、427．50、39．00、1．30、0．40，而“正常”脑组织分别为680．00、360．00、610．00、30．00、1．54、0．09，上述参数在放射性脑病与其“正常”区域之间差异有统计学意义，放射Objective To evaluate the value of MR spectroscopy （MRS） in the differential diagnosis between recurrence and radiation encephalopathy after radiotherapy for nasopharyngeal carcinoma （NPC）. Methods Multi-voxel proton MRS was performed on 50 patients with NPC, who were suspected of intracalvarium tumor recurrence or radiation encephalopathy after radiotherapy by conventional MRI, including 44 males and 6 females. Among the 50 patients, 26 cases were finally diagnosised as basicranial tumor recurrence and 24 cases as radiation encephalopathy by clinical and MRI follow-up. The following metabolites, such as Cho, NAA, Cr, lactate and lipid, were analyzed comparatively between basieranial tumor recurrence and radiation encephalopathy（ RE）, and between the lesions and the relative normal brain tissue. Wilcoxon＇s rank sum test was used to analyze the data. Results The median of Cho/Cr, Cho/NAA, LL/Cr in tumor recurrence group were 2. 22, 2. 13, and 1.77, respectively, and 1.40, 1.31, and 0. 57, respectively, in RE group. The difference of Cho/Cr, Cho/NAA, and LL/Cr between the two groups were statistically significant （ P 〈 0. 01 ）. Those in tumor recurrence group were higher than in RE group. The median of Cho, Cr, NAA in tumor recurrence group and in RE group were 3366. 00, 1023.00, 1930. 00 and 2469. 50, 1864.50, 1734.00. There were no significant difference of Cho, Cr, and NAA between the two groups （P 〉0. 05）. In the 14 cases whose normal brain tissue were compared with the recurrent tumor tissue in tumor recurrence group, the median of Cr, NAA, LL, Cho/Cr, Cho/NAA, LI/Cr of recurrent tumor tissue and normal brain tissue were 1023.00, 1930.00, 2090.00, 3.76, 2.13, 3.39 and 2370.00, 3012.00, 1680.00, 1.64, 1.17, 0.75,The difference of Cr, NAA, LL, Cho/Cr, Cho/NAA, LL/Cr between the normal tissue and recurrent tumor tissue were significant （P 〈 0. 05）. LL, Cho/Cr, Cho/NAA, LL/Cr of recurrent tumors were higher than those of the normal brain tissue ,while NAA and Cr of recurrent tumors

关 键 词：鼻咽肿瘤 肿瘤复发 局部 放射疗法 脑损伤 慢性 磁共振波谱学 

分 类 号：R686[医药卫生—骨科学]