磁共振弥散加权成像评价唾液腺放射性损伤的可行性  

Evaluation of salivary gland radioactive damage by diffusion deighted dagnetic desonance imaging

作　　者：潘才住[1] 杨凌[1] 马礼钦[1] 陈希[2] 肖友平[3] 李睿[2] 胡彩容[1] 林端瑜[4] 潘建基[1] 

机构地区：[1]福建医科大学教学医院.福建省肿瘤医院放疗科,福建福州350014 [2]福建医科大学省立临床医学院,福建福州350004 [3]福建医科大学教学医院.福建省肿瘤医院放射科,福建福州350014 [4]福建医科大学教学医院.福建省肿瘤医院核医学科,福建福州350014

出　　处：《中华肿瘤防治杂志》2015年第20期1619-1623,共5页Chinese Journal of Cancer Prevention and Treatment

基　　金：福建省自然科学基金(2012J01329;2013J01258);福建省卫生厅临床重点专科(肿瘤放射治疗科)建设项目(2012);国家临床重点专科(肿瘤科)建设项目(2013)

摘　　要：目的基于唾液腺放射性损伤的研究热点问题,采用磁共振弥散加权成像(diffusion weighted magnetic resonance imaging,DW-MRI)技术观察鼻咽癌放疗前后唾液腺(双侧腮腺及颌下腺)ADC值的变化规律,并与唾液腺放射性核素显像技术比较,探讨DW-MRI技术在唾液腺放射性损伤评价方面的价值。方法选择2011-07-01-2012-02-29在福建省肿瘤医院进行调强放疗的首诊鼻咽癌患者30例作为研究对象,其中男23例,女7例。中位年龄47岁,病理类型均为非角化性未分化型癌。入选患者分别于放疗前,放疗第2和4周,放疗结束时,放疗结束后3、6和9个月,行DW-MRI和唾液腺放射性核素显像检查,同时进行口干临床症状分级,采用配对t检验和χ2检验比较不同时间段唾液腺功能的差异,采用Pearson相关分析方法比较3种唾液腺功能评价方法的相关性。结果 30例患者腮腺照射剂量为27.8~35.9Gy,平均31.2Gy,颌下腺照射剂量为46.2~62.8Gy,平均54.7Gy。放疗前腮腺和颌下腺ADC值分别为(0.93±0.13)×10-3 mm^2/s和(1.07±0.15)×10^(-3)mm^2/s。放疗期间腮腺和颌下腺的ADC值均明显升高,于放疗结束后3个月达最高值,分别为(1.32±0.17)×10-3 mm^2/s和(1.55±0.15)×10-3 mm^2/s,此后呈缓慢下降趋势。放疗前腮腺和颌下腺的最大酸反应泌(99mTcO4-)率(Ex)分别为(44.8±21.7)%和(44.9±11.8)%。放疗后腮腺和颌下腺的Ex均显著下降,于放疗结束至放疗后3个月期间达最低值,Ex分别为(5.1±21.3)%和(6.9±19.2)%,此后呈缓慢上升趋势。基于DW-MRI ADC值变化率的腮腺和颌下腺损伤分级与Ex分级存在高度正相关,偏相关系数分别为0.988和0.975,P<0.001。结论DW-MRI在唾液腺放射性损伤功能评价方面与放射性核素显像具有较好的一致性,DW-MRI具有可量化优点,有利于临床进一步开展。OBJECTIVE To observed the changes of DW-MRI ADC value of salivary glands （bilateral parotid and submandihular gland） at different time period in patients with nasopharyngeal carcinoma before and after radiotherapy, compared to salivary gland radionuclide imaging, then assess the value of DW-MRI in the evaluation of salivary gland radiation injury. METHODS A total of 30 patients with nasopharyngeal carcinoma in Fujian Provincial Tumor Hospital from July 2011 to February 2012 was recruited, including 23 male and 7 female, the median age was 47 years （29-67 years old）, and the pathological type was non keratinizing undifferentiated carcinoma, patients were treated with intensity-modulated radiation therapy （IMRT）. DW-MRI scanning and salivary gland radionuclide imaging were done at different time period（before RT, 2-week RT, 4-week RT, at the end of RT, 3-month post-RT, 6-month post-RT and 9-month post- RT） for each patient, clinical symptoms grading of dry mouth according to Radiation Therapy Oncology Group （RTOG） was done at each period. The difference of salivary gland function in different time was compared by paired t test and Chi square test, the correlations among the three methods were analyzed by Pearson correlation analysis. RESULTS In 30 patients, the average radiation dose of parotid gland and submandibular gland were 31.2 Gy （27. 8-35.9 Gy） and 54. 7 Gy （46. 2- 62. 8 Gy）. The ADC value of parotid gland and submandibular gland before radiotherapy were （0. 93±0. 13）×10^-3mm^2/s and （1.07±50. 15）×10^-3mm^2/s. The DW MRI ADC value of both glands were significantly increased after radiation, up to a maximum value at a-month post-RT, then decreased slowly. The ADC; value of parotid gland and submandibular gland were （1.32±50. 17）×10^-3mm^2/s and （1.55±0. 15）×10^-3mm^2/s. Parotid gland and submandibular gland secretion function index-the maximum acid secretion （^99m TcO4^-） rate （Ex） were （44.8± 21.7）% and （44. 9±11.8） % before radiotherapy.

关 键 词：唾液腺 放射性损伤 功能评价 磁共振弥散加权成像 放射性核素显像 

分 类 号：R739.63[医药卫生—肿瘤] R445.2[医药卫生—临床医学]