磁共振弥散加权成像评价鼻咽癌调强放疗唾液腺功能的损伤  

Diffusion-weighted Magnetic Resonance Imaging Evaluates Salivary Gland Function Damage in Nasopharyngeal Carcinoma Patients Treated with Intensity-modulated Radiation Therapy

作　　者：刘桂超[1] 胡学锋[1] 赵海[2] 贺小红[2] 滕建建[3] 郭建贵 吴海军 LIU Guichao;HU Xuefeng;ZHAO Hai;HE Xiaohong;TENG Jianjian;GUO Jiangui;WU Haijun(Department of Head and Neck Breast Radiotherapy,The First People’s Hospital of Foshan City,Foshan 528000,China;Department of Radiology,The First People’s Hospital of Foshan City,Foshan 528000,China;Department of Tumor Radiophysics,The First People’s Hospital of Foshan City,Foshan 528000,China)

机构地区：[1]佛山市第一人民医院头颈乳腺放疗科,佛山528000 [2]佛山市第一人民医院影像科,佛山528000 [3]佛山市第一人民医院肿瘤放射物理科,佛山528000

出　　处：《肿瘤防治研究》2019年第10期905-910,共6页Cancer Research on Prevention and Treatment

基　　金：广东省佛山市医学类科技攻关项目(2016AB002401)

摘　　要：目的应用磁共振弥散加权成像技术(DW-MRI)评价鼻咽癌患者调强放疗后唾液腺功能损伤,并对相关因素进行分析。方法入组28例初诊鼻咽癌患者,所有患者行IMRT治疗,分别在放疗前、放疗第4周、放疗结束、放疗后3、6和12月行DW-MRI扫描和口干评级。DW-MRI扫描包括静息状态和酸刺激后。结果放疗后6和12月鼻咽癌患者口干分级与放疗后3月、放疗结束时比较,差异均有统计学意义(均P<0.05)。放疗前腮腺ADC值静息状态、酸刺激第3、6分钟两两比较差异有统计学意义(均P<0.05)。放疗第4周、放疗结束、放疗后3月ADC值总体升高,但酸刺激各时间段差异均无统计学意义(均P>0.05)。放疗后6、12月ADC值总体逐步降低,且再次出现先升高后下降,然后长时间缓慢升高的表现,酸刺激第3和第6分钟时比较差异有统计学意义(均P<0.05)。放疗前酸刺激状态下颌下腺和腮腺类似。分析结果显示:ADC值变化率和唾液腺体积变化率呈正相关;ADC值变化率、唾液腺体积变化率分别和平均剂量呈正相关。结论DW-MRI在评价鼻咽癌调强放疗唾液腺功能损伤方面具有一定的价值。Objective To evaluate salivary gland function damage and analyze related factors by diffusionweighted magnetic resonance imaging(DW-MRI)in patients with nasopharyngeal carcinoma after intensity modulated radiation therapy.Methods Twenty-eight patients with newly-diagnosed nasopharyngeal carcinoma were enrolled.All patients underwent IMRT,and DW-MRI scan and dry mouth rating were performed before radiotherapy,the 4th weeks of radiotherapy,the end of radiotherapy,and 3,6 and 12 months after radiotherapy.DW-MRI scans included resting state and acid stimulation.Results There were significant differences in the grade of dry mouth of nasopharyngeal carcinoma patients between 6,12 months after radiotherapy and 3 months after radiotherapy,the end of radiotherapy(all P<0.05).Before the radiotherapy,the parotid ADC values were statistically significant at rest,acid stimulation at the 3rd and 6th minutes(all P<0.05).At the 4th week of radiotherapy,the end of radiotherapy and 3 months after radiotherapy,the ADC value increased overall,but there was no significant difference in acid stimulation time(all P>0.05).At 6 and 12 months after radiotherapy,the ADC value gradually decreased,and again showed a rise and then decreased,and then slowly increased for a long time.The difference between the 3rd and 6th minutes of acid stimulation was statistically significant(P<0.05).The submandibular glands and parotid glands were similar in acid-stimulated state before radiotherapy.The change rate of ADC value was positively correlated with the change rate of salivary gland volume.The change rates of ADC value and salivary gland volume were positively correlated with the average dose.Conclusion DW-MRI has certain evaluation value on the salivary gland function damage of nasopharyngeal carcinoma treated with intensity-modulated radiotherapy.

关 键 词：鼻咽肿瘤 调强放射治疗 唾液腺 放射性损伤 功能评价 磁共振弥散加权成像 

分 类 号：R739.62[医药卫生—肿瘤] R730.55[医药卫生—临床医学]