鼻咽癌放射治疗后颅底骨髓腔反应的CT动态观察  

Computed Tomographic Findings of Skull Base Bony Changes During and After Radiotherapy for Nasopharyngeal Carcinoma

作　　者：许森奎[1,2] 姚文燕[1,2] 耿志君[3,2] 李卉[3,2] 谢传淼[3,2] 

机构地区：[1]中山大学肿瘤防治中心放疗科,广州510060 [2]中山大学华南国家重点实验室 [3]中山大学肿瘤防治中心影像科,广州510060

出　　处：《临床放射学杂志》2016年第8期1171-1175,共5页Journal of Clinical Radiology

摘　　要：目的探讨鼻咽癌(NPC)根治性放疗不同阶段颅底骨髓腔CT值变化的趋势,为NPC患者放疗后CT诊断提供依据并为放疗后颅底骨质改变的长期随访提供参考。方法选取130例NPC患者为研究对象,其中60例放疗前和完成20 Gy、60 Gy剂量治疗时行CT平扫,另70例在放疗前和完成40 Gy剂量治疗时以及完成治疗3个月后行CT增强扫描,在同一断层图像上以颅底骨枕骨斜坡髓腔勾画感兴趣区,并计算出平均CT值,统计CT值不同阶段的变化,动态观察枕骨斜坡骨髓腔对放疗后的急性反应。结果患者在放疗前和完成20 Gy、60 Gy剂量治疗行CT平扫时,斜坡髓腔的平均CT值分别为(177.46±82.62)HU、(175.11±80.17)HU和(160.31±80.70)HU;患者在放疗前和完成40 Gy剂量治疗时以及完成治疗3个月后增强CT扫描时,斜坡髓腔的平均CT值分别为(191.68±82.25)HU、(166.44±77.92)HU和(152.30±80.87)HU;经Anova分析发现,放疗前后颅底骨髓腔的CT值急性期普遍减低,差异有统计学意义(P<0.05),放疗前组与20 Gy组之间的差异没有统计学意义(P>0.05)。结论放疗辐射导致颅底骨髓腔的CT值相应减低,提示放疗后短期内颅底骨质有骨质疏松的变化趋势,对于放疗后出现的放射性骨损伤和病理性骨折的诊断有一定的提示意义,为NPC患者放疗后颅底骨质的长期随诊观察提供了帮助。Objective To explore the computed tomographic（CT） findings of skull base bony changes during and after radiotherapy（RT） for nasopharyngeal carcinoma（NPC）,assist the CT-based diagnosis and long-term follow-up on skull base bony changes after radiotherapy.Methods 130 patients with NPC were included.60 patients had plain CT scan before RT,at 20 Gy and at 60 Gy.The other 70 patients had Enhanced CT scan before RT,at 40 Gy and three months after RT.Region of interest in the marrow cavity of the Clivus bone was selected on the same slice of CT images.The mean CT values were calculated and analyzed.Results For the 60 patients who had plain CT scan,the mean CT values of Clivus marrow cavity were 177.46 ± 82.62,175.11 ± 80.17 and 160.31 ± 80.70 before RT,at 20 Gy and at 60 Gy,respectively.For the 70 patients who had enhanced CT scan,the mean CT values were 191.68 ± 82.25,166.44 ± 77.92 and 152.30 ±80.87 before RT,at 40 Gy and three months after RT,respectively.The CT values were compared with one-way analysis of variance（ANOVA）.The post-irradiation CT values decreased significantly compared with values before RT（P〈0.05）.The values at 20 Gy decreased but not significantly compared with values before RT（P〉0.05）.Conclusion CT values of the Clivus marrow cavity decreased after irradiation,indicating the development of osteoporosis in the skull base bone after radiotherapy in the short term.These findings may be helpful in the diagnosis of radiation-induced bone damage and fracture,as well as the long-term follow-up of skull base bone.

关 键 词：鼻咽癌 放射治疗 颅底骨髓腔 CT值 

分 类 号：R739.63[医药卫生—肿瘤] R730.44[医药卫生—临床医学]