鼻咽癌放射性脑损伤早期迟发反应期的磁共振波谱研究  

Magnetic Resonance Spectroscopy Features of Brain Radiation-Induced Injury in Delay-Reaction Stage After Nasopharyngeal Carcinoma Radiotherapy

作　　者：陈旺生[1] 李建军[1] 洪澜[2] 邢增宝[1] 王奋[3] 李长清[1] 

机构地区：[1]海南省人民医院放射科,海南海口570311 [2]海南省人民医院妇科,海南海口570311 [3]海南省人民医院放疗科,海南海口570311

出　　处：《武汉大学学报（医学版）》2013年第6期879-883,共5页Medical Journal of Wuhan University

基　　金：国家自然科学基金资助项目(编号:81360233);海南省科技项目资助(编号:ZDXM20130069);海南省自然科学基金项目(编号:812154);海南省卫生厅科研立项课题(编号:2011-23;2012PT-19)

摘　　要：目的:探讨磁共振波谱(MRS)成像在鼻咽癌放射治疗后早期迟发反应期的应用价值。方法:对同期80例确诊为鼻咽癌并首次接受放射治疗(放疗)的47例患者进行放疗前、放疗结束时和放疗结束后的第3,4,6,12月分别进行MRS成像,监测放疗后不同时间点主要代谢物浓度的变化趋势,并与放疗结束时自身数据对照,进行重复测量方差分析。结果:放疗结束时,N-乙酰天冬氨酸(NAA)/肌酸(Cr)、胆碱(Cho)/Cr和NAA/Cho浓度比值较放疗前降低,放疗结束后3月,三者比值进一步减小达到最低点,分别为1.39±0.18,1.27±0.10和1.02±0.14,第4-12月三者比值呈现上升趋势,第12月时三者比值分别为1.63±0.26,1.44±0.07和1.21±0.18,差异具有统计学意义(F值分别为316.02,53.84,286.68,P均<0.01)。与放疗结束后第3月比较,放疗结束后第4,6和12月NAA/Cr值上升的百分比分别为2.12%,20.86%和24.46%;Cho/Cr值上升的百分比分别为2.36%,8.66%和13.39%;NAA/Cho上升的百分比分别为1.96%,25.4%和30.39%。结论:磁共振波谱通过监测代谢物浓度的变化,能无创性反映鼻咽癌放射性脑损伤早期迟发反应期的损伤修复过程,为其预后提供有价值的信息。To study the application value of MR spectroscopy （MRS） in the diagnosis of brain injury in early-reaction stage after nasopharyngeal carcinoma radiotherapy. Methods： MRS were performed before and after radiation in 80 cases with initial diagnosis nasopharyngeal carci- noma clinically and 47 of these cases in the 3th, 4th, 6th and 12th respectively months after treat- ment. The changes tendency of the three main metabolites ratios were observed after radiothera- py. The variance analysis was performed to determine whether there were significance differences among these time points. Results： The ratios of NAA/Cr, Cho/Cr and NAA/Cho decreased at the end of radiotherapy, and went down continually during the first three months after the radio-therapy completed, reached to the lowest points as 1.39±0. 18, 1.27±0. 10, and 1.02±0.14, respectively. During the stage of the 4-12 month after treatment completed, these ratios were ris- ing gradually, reached to 1. 63±0.26, 1.44±0. 07, and 1. 21±0. 18 respectively at the 12th month, and the difference was significant between the 3th and 12th months after treatment （P〈 0.01）. The increment of NAA/Cr in the 4th, 6th and 12th months was 2. 12%, 20.86% and 24.46% respectively from that at the 3th month. These increments of Cho/Cr and NAA/Cho were 2.36%, 8.66%, and 13.39%, respectively, and 1.96%, 25.4% and 30.39%, respective- ly. Conclusion. MRS can reflect the course of recovery of radiation-induced injury of the brain in early delay-reaction stage after nasopharyngeal carcinoma radiotherapy through monitoring brain metabolism level changes, and provide valuable information about its prognosis.

关 键 词：鼻咽肿瘤 放射疗法 脑损伤 预后 磁共振波谱学 

分 类 号：R739.45[医药卫生—肿瘤]