DTI示踪皮质脊髓束对脑胶质瘤术后放疗方案选择的影响  

The influence of diffusion tensor imaging tracing corticospinal tract in guiding the selection of the postoperative radiotherapy plan for gliomas

作　　者：王明磊[1] 王鹏[1] 夏新舍[2] 黄雪莹[1] 詹茸婷[1] 郭艳红[2] 朱凯[1] 马辉[3] 王晓东[1] 夏鹤春[3] 

机构地区：[1]宁夏医科大学总医院放射科,银川市750004 [2]宁夏医科大学总医院放疗科,银川市750004 [3]宁夏医科大学总医院神经外科,银川市750004

出　　处：《实用医学杂志》2015年第4期610-613,共4页The Journal of Practical Medicine

基　　金：国家自然科学基金资助项目(编号:81260373);宁夏自然科学基金项目(编号:NZ11269)

摘　　要：目的:探讨磁共振扩散张量成像(diffusion tensor imaging,DTI)示踪皮质脊髓束在指导脑胶质瘤术后放疗方案中的应用价值。方法:30例脑胶质瘤术后拟行放疗患者,行常规MRI及DTI扫描。获取皮质脊髓束相关数据并与相应的MR、CT解剖图像融合,导入放疗计划系统并依此勾画靶区、危及器官及皮质脊髓束,分别采用三维适形放疗(3D-CRT)技术与调强放疗(IMRT)技术制定放疗计划并进行比较。结果:在IMRT放疗计划与3D-CRT计划均达到靶区治疗剂量及危及器官保护的情况下,IMRT放疗计划中的患者患侧、健侧皮质脊髓束所受最大辐射剂量和平均辐射剂量均低于3D-CRT放疗计划(P<0.05)。结论:DTI能够明确皮质脊髓束的位置、形态及与脑胶质瘤术后放疗靶区的关系,有助于制定保护性放疗方案,减低皮质脊髓束所受辐射剂量,从而降低放疗后发生神经损伤的可能。Objective To evaluate the application value of diffusion tensor imaging（DTl） tracing corticospinal tract in guiding the selection of the postoperative radiotherapy plan for gliomas. Methods 30 patients with gliomas undmveent routine MRI scanning and DTI before postoperative radiotherapy. Tractography data sets were acquired and fused with corresponding anatomical MR and CT images. The aquired data sets were imported into radiotherapy planning system to aid the delineation of target volume, organs at risk and eorticospinal tract. The radiotherapy plans developed with the IMRT and the 3D-CRT techniques were compared. Results The radiotherapy plans all attained the therapetic dose to the target volume and the protection of the routine organs at risk. In the radiotherapy plans using the IMRT technique, patients＂ ipsilateral, contralateral corticospinal tracts suffered the maximum radiation dose and mean radiation dose were lower than the radiotherapy plans using the 3D-CRT technique （P 〈 0.05）. Conclusions DTI can provide the additional information about the location, shape of eorticospinal tracts and the relationship with postoperative radiotherapy target of glioma,which contributes to the development of protective radiation programs to reduce the corticospinal tract suffered the radiation dose, thereby decreasing the possible nerve damage after radiotherapy.

关 键 词：脑胶质瘤 扩散张量成像 放射治疗 皮质脊髓束 剂量学 

分 类 号：R739.41[医药卫生—肿瘤] R445.2[医药卫生—临床医学]