鼻咽癌放射治疗后颞叶1 H-MRS 分析  

Analysis of 1 H-MR specctroscopy of temporal lobe in patients with nasopharyngeal carcinoma after radiotherapy

作　　者：熊炜烽[1] 徐向东[1] 江新青[1] 邱士军[2] 刘国顺[1] 杨蕊梦[1] 谌丹丹[1] 周勇[1] 

机构地区：[1]广州市第一人民医院,广州510180 [2]广州中医药大学第一附属医院,广州510405

出　　处：《放射学实践》2014年第12期1396-1400,共5页Radiologic Practice

基　　金：国家自然科学基金(30770613;81271389;81471251);广东省科技计划项目(2011B060200002)

摘　　要：目的：探讨对鼻咽癌患者放疗后颞叶常规 MRI 上表现正常的脑白质采用1 H-MRS 进行监测的价值。方法：回顾性分析经活检病理证实的75例鼻咽癌患者的临床和影像资料，所有患者均行常规 MRI 和1 H-MRS 检查，且常规MRI 上无明显异常。以放疗前的18例患者作为对照组，放疗后的57例患者为放疗。根据进行 MRS 检查时处于放疗后的不同时期而将放疗组患者分为5个组：1组（放疗后≤3个月，16例）、2组（放疗后3～6个月，12例）、3组（放疗后6～9个月，10例）、4组（放疗后9～12个月，8例）、5组（放疗后＞12个月，11例）。测量每例患者颞叶白质的平均 NAA／Cho、NAA／Cr 和 Cho／Cr，采用单因素方差分析对放疗前及放疗后各组的数据进行分析。结果：各组间 NAA／Cho 和 NAA／Cr的均值间的差异均有统计学意义（F 值分别为8．394、4．855，P 值均＜0．05）。进一步两两比较，放疗后一年内（1～4组）各组中 NAA／Cho 和 NAA／Cr 的均值均较放疗前明显下降，差异有统计学意义（P ＜0．05）；而放疗一年以上组（5组）的平均NAA／Cho 和 NAA／Cr 基本恢复，与放疗前的差异无统计学意义（P ＞0．05）。放疗后各组的平均 Cho／Cr 对比放疗前差异均无统计学意义（P ＞0．05）。结论：对鼻咽癌放疗后患者，1 H-MRS 可以在常规 MRI 发现异常之前检测到脑白质代谢异常，为临床早期诊断提供更多影像学证据。Objectire：To explore the value of 1 H-MR spectroscopy in detecting radiation-induced changes of temporal lobe,which showed normal appearance in white matter （WM）on conventional MRI,in patients after radiation therapy （RT） for nasopharyngeal carcinoma （NPC）.Methods：The clinical and imaging data （with no positive findings in white matter of temporal lobe on conventional MRI）of 75 patients with nasopharyngeal carcinoma proved pathologically by biopsy were ret-rospectively analyzed.All patients underwent conventional MRI and 1 H-MR spectroscopy examinations,including 18 cases before radiotherapy as the control group （pre-RT）and fifty-seven patients after radiotherapy as the post-RT group.The pa-tients in post-RT group were further divided into five groups based on the interval time between the MRS and completion of RT：group 1 （less than 3 months,16 cases）,group 2 （3 to 6 months,12 cases）,group 3 （6 to 9 months,10 cases）,group 4 （9 to 12 months,8 cases）,and group 5 （more than 12 months,11 cases）.The mean NAA/Cho,NAA/Cr and Cho/Cr in bi-lateral temporal lobe were measured and calculated.The three indexes in pre-RT and five post-RT groups were compared by one-way ANOVA test.Results：The NAA/Cho and NAA/Cr in six groups were statistically different （F =8.394、4.855,re-spectively;P〈0.05）.By pairwise comparison,the mean NAA/Cho and NAA/Cr decreased significantly within 1 year after RT （group 1 to 4）when compared with pre-RT group,with statistic significance （P〈0.05）;however,there was no statistic difference between the group 5 and pre-RT group.The mean Cho/Cr in post-RT groups was not significantly different from that in the control group.Conclusion：1 H-MR specctroscopy can provide non-invasive and quantitative methods to detect the metabolic changes in white matter after RT,and may be an useful method for the early diagnosis of brain injury after radio-therapy.

关 键 词：鼻咽部肿瘤 脑疾病 辐射损伤 磁共振波谱学 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]