鼻咽癌放射治疗过程中颞叶脑损伤的磁共振波谱和扩散张量  

Study on MR spectroscopy and diffusion tensor in radiation induced brain injury of nasopharyngeal carcinoma during course of radiotherapy

作　　者：陈旺生[1] 李建军[1] 王奋[2] 邢增宝[1] 

机构地区：[1]海南省人民医院放射科,海南海口570311 [2]海南省人民医院放疗科,海南海口570311

出　　处：《中华肿瘤防治杂志》2010年第15期1214-1216,共3页Chinese Journal of Cancer Prevention and Treatment

基　　金：海南省自然科学基金(30717)

摘　　要：目的:联合应用磁共振波谱(MRS)和扩散张量成像(DTI)监测鼻咽癌放射治疗过程中物质代谢和微观结构变化。方法:对80例确诊为鼻咽癌并首次接受放射治疗的患者进行放疗前和接受剂量为20、40和60Gy时分别进行常规颅脑MR、双侧颞叶MRS和DTI成像,动态观察不同剂量时颞叶波谱形态、主要代谢物比值以及DTI的表观扩散系数(ADC)和部分各向异性(FA)的变化趋势,并进行分析。结果:NAA/Cho、NAA/Cr和Cho/Cr比值在放疗前分别为1.37±0.11、1.92±0.15和1.43±0.21,在放疗过程中逐渐降低,放疗结束时分别为0.93±0.12、1.04±0.09和1.05±0.13,差异有统计学意义,P=0.006、0.047、0.038。DTI的ADC值由6.342±0.22升高至7.046±0.45,差异无统计学意义,P=0.81;FA值由0.365±0.04降至0.349±0.03,差异有统计学意义,P=0.047。结论:鼻咽癌放射治疗过程中脑损伤首先表现为物质代谢障碍,而后出现微观空间结构上的改变。MRS和DTI能从分子水平评价放射性脑损伤的动态演变过程,为早期干预脑损伤提供客观依据。OBJECTIVE：To monitor the dynamic changes of the metabolism and mirco-structure in the temporal lobe injury during the radiotherapy of nasopharyngeal carcinoma using MR spectroscopy and diffusion tensor imaging （DTI）.METHODS：MRS and DTI were performed after radiation dosages of 20,40 and 60 Gy respectively in 80 cases of initial diagnosis nasopharyngeal carcinoma.Conventional MR scanning was performed before the radiation therapy.The change tendency of the spectroscopy morphology and the ratios of the three main metabolites,the apparent diffusion coefficient （ADC）,and fractional anisotropy （FA） of DTI were observed and analyzed contrastly in different stages.RESULTS：The NAA/Cho,NAA/Cr and Cho/Cr values were 1.37±0.11,1.92±0.15 and 1.43±0.21 respectively before the radiotherapy,and degraded to 0.93±0.12,1.04±0.09,1.05±0.13 at the end of the radiotherapy （P=0.006,0.047,0.038）.The ADC values increased from 6.342±0.22 to 7.046±0.45（P=0.81）,while the FA values decreased from 0.365±0.04 to 0.349±0.03（P=0.047）.CONCLUSIONS：The substance metabolism disorder appearances firstly and then mirco-structure changes during the course of radiotherapy.MRS and DTI can monitor the brain injury dynamicly at the molecule level,and provide objective evidence for preventing it early.

关 键 词：鼻咽肿瘤/放射疗法 脑损伤 磁共振波谱 扩散张量成像 

分 类 号：R739.63[医药卫生—肿瘤]