鼻咽癌放射性脑损伤的MR动态磁敏感对比灌注成像  

Magnetic Resonance Dynamic Susceptibility Contrast Perfusion Weighted Imaging on Radiation-induced Brain Injury in Nasopharyngeal Carcinoma

作　　者：李洲[1] 马林[2] 陈旺生[1] 李长清[1] 王飞[1] 李建军[1] 

机构地区：[1]海南省人民医院放射科,海南海口570311 [2]解放军总医院放射科,北京100853

出　　处：《中国医学影像学杂志》2016年第8期561-564,共4页Chinese Journal of Medical Imaging

基　　金：国家自然科学基金(81360233;81560282);海南省重点科技项目(ZDXM201300269)

摘　　要：目的鼻咽癌放射性脑损伤的血流动力学变化机制尚不明确,采用MR动态磁敏感对比灌注成像(DSC-PWI)探索鼻咽癌患者接受放疗过程中和放疗结束后的不同阶段双侧颞叶脑组织血流动力学的动态变化特征。资料与方法回顾性分析80例接受放射治疗的鼻咽癌患者,在放疗前以及放射线剂量达20、40、60 Gy时分别进行DSC-PWI检查,对其中的47例在放疗结束后的第3、6、12个月进行随访。以放疗前自身数据作为协变量进行对照。结果放疗前脑血容量(CBV)和脑血流量(CBF)值分别为(1146.0±73.5)ml/(min·100 g)和(325.2±29.7)ml/(min·100 g),放疗结束时(60 Gy)分别为(1128.3±71.1)ml/(min·100 g)和(314.9±47.5)ml/(min·100 g),差异无统计学意义(P>0.05);放疗后第3个月,CBV和CBF值分别为(1038.4±75.8)ml/(min·100 g)和(284.3±30.7)ml/(min·100 g),与放疗前比较,差异有统计学意义(P<0.001);放疗后第3个月CBV值及CBF值ROC曲线下面积分别为0.867和0.856。放疗后第3个月后至第12个月,CBV和CBF值不同程度地回升,第12个月时两者分别为(1093.5±63.7)ml/(min·100 g)和(296.5±35.7)ml/(min·100 g),低于放疗前水平,但差异无统计学意义(P>0.05)。结论 DSC-PWI的CBV和CBF等灌注指标能从不同角度反映组织的微循环状态和功能,鼻咽癌放射性脑损伤的靶区血管结构和功能相应发生变化,参与了放射性脑损伤。Purpose The mechanism of hemodynamic changes in nasopharyngeal carcinoma with radiation-induced brain injury is not clear. The aim of this study is to explore the hemodynamic characteristics of bilateral temporal lobe brain tissue in different radiotherapy stages during and after the treatment using magnetic resonance dynamic susceptibility contrast perfusion weighted imaging（DSC-PWI）. Materials and Methods DSC-PWI was applied in all 80 patients before radiotherapy and at the radiation dose of 20 Gy, 40 Gy and 60 Gy, respectively. It was also performed for 47 patients in the 3rd, 6th and 12th month after radiotherapy, and compared with data before radiotherapy. Results Before radiotherapy, cerebral blood volume（CBV） and cerebral blood flow（CBF） values were（1146.0±73.5） ml/（min · 100 g） and（325.2±29.7） ml/（min · 100 g）; at the end of radiotherapy（60 Gy radiation dose） they were（1128.3±71.1） ml/（min · 100 g） and（314.9±47.5） ml/（min · 100 g）, there was no significant difference（P0.05）; three months later after radiotherapy, CBV and CBF were（1038.4±75.8） ml/（min · 100 g） and（284.3±30.7） ml/（min · 100 g）, respectively. There was significant difference compared with the value before radiotherapy（P〈0.001）. The area under the curve of ROC of CBV and CBF three months later after radiotherapy was 0.867 and 0.856, respectively. Since the 3rd until the 12th month after radiotherapy, CBV and CBF values increased to（1093.5±63.7） ml/（min · 100 g） and（296.5±35.7） ml/（min · 100 g）, respectively. There was no significant difference compared with the value before radiotherapy（P〉0.05）. Conclusion The CBV and CBF perfusion index of DSC-PWI can reflect tissue microcirculation and function, suggesting that radiation-induced brain injury in nasopharyngeal carcinoma involved corresponding changes of target vascular structure and function in bilateral temporal lobe.

关 键 词：鼻咽肿瘤 辐射损伤 脑疾病 磁共振成像 灌注成像 血流动力学 

分 类 号：R730.42[医药卫生—肿瘤] R739.6[医药卫生—临床医学]