老年性放射性肝损伤的MRI表现及其相关因素分析  

MRI findings and risk factor analysis of hepatic injury induced by for elderly patients

作　　者：林光武[1] 嵇鸣[1] 叶春涛[1] 臧雪如[1] 朱震方[1] 

机构地区：[1]复旦大学附属华东医院MR室,200040

出　　处：《老年医学与保健》2011年第4期232-235,共4页Geriatrics & Health Care

基　　金：复旦大学附属华东医院科研基金（H-557）

摘　　要：目的探讨老年性放射性肝损伤的MⅪ表现及其相关因素。方法通过前瞻性研究32例老年肝脏恶性肿瘤患者三维适行放疗前、后的临床及Mm资料，探讨老年性放射性肝损伤的M砒表现及其与性别、年龄、是否合并肝硬化、介入治疗、术后复发、靶体积、照射剂量及分割剂量的关系。结果（1）发生放射性肝损伤共24例（占75％），MRI上呈现与照射区分布一致的异常信号，其中21例T1WI呈低信号，T2W呈高信号，动态增强呈轻度或明显强化，部分病灶边缘出现异常灌注征象；3例T1W、T2W均呈低信号，动态增强扫描无强化。（2）放射性肝损伤与照射剂量、分割剂量、照射靶体积明显相关，与性别、年龄、是否合并肝硬化、介入治疗、术后复发与否等因素无显著影响。结论老年性放射性肝损伤MRJ上呈现与照射区分布一致的异常信号及强化特点，放疗靶体积、照射剂量、分割剂量与之呈正相关，随着靶体积、照射剂量、分割剂量的增加，发生机率增加。Objective To investigate the MRI findings and define the risk factors of hepatic injury induced by three dimensional conformal radiation therapy for elderly patients with hepatic malignant tumor. Methods This study recruited 32 patients with hepatic malignant tumor undergoing photon beam radiation. MRI examinations were performed within 1 to 4 months before and after the radiation therapy, and logistic regression was used to analyze the MR/features of hepatic injury to define the correlation of the injury occurrence with such factors such as the patients＇ age, gender, liver cirrhosis, transcatheter arterial embolization （TACE）, postoperative recurrence, total radiation dose, target volume and fractional dose. Results 24 （75%） patients showed MRI features of hepatic injury, displayed the area with abnormal intensity in consistency with the radiation coverage. Among of them, 21 cases manifested slightly lower intensity on T1WI and slightly higher intensity on T2WI. After Gd-DTPA injection, these cases manifested mildly enhancement at arterial phase and with marked enhancement during the portal-venous and delayed phases. 3 cases showed hypo-intensity both on TlWI and T2WI, and without enhancement following Gd-DTPA injection at all phases. The risk factors correlated to the injury occurrence included the total dose, target volume and fractional dose, but not the patients＇ age, gender, liver cirrhosis, TACE, postoperative recurrence differences and radiation induced hepatic injury. Conclusions Dynamic enhanced and plain scan MR imaging can reflect the area with abnormal intensity in consistency with the radiation coverage of radiation induce hepatic injuries. Radiation induced hepatic injury is related to fractional dose, total dose and target volume adopted in radiation therapy. Higher fractional dose, total irradiated dose and larger target volume may lead to increased risk of injury.

关 键 词：三维适形放射治疗 肝肿瘤 MRI 放射性肝损伤 

分 类 号：R735.7[医药卫生—肿瘤]