鼻咽癌患者放疗后皮肤毒性的多模态超声研究  

Multimodal ultrasound study on skin toxicity of nasopharyngeal carcinoma patients after radiotherapy

作　　者：梁莹 兰美 鲜欣欣 庄敏 李佳密 卢漫[2] Liang Ying;Lan Mei;Xian Xinxin;Zhuang Min;Li Jiami;Lu Man(School of Medical and Life Sciences,Chengdu University of Traditional Chinese Medicine,Chengdu 611137,China;Department of Ultrasound Medical Center,Sichuan Clinical Research Center for Cancer,Sichuan Cancer Hospital&Institute,Sichuan Cancer Center,Affiliated Cancer Hospital of University of Electronic Science and Technology of China,Chengdu 610042,China;Department of Radiation Oncology,Sichuan Clinical Research Center for Cancer,Sichuan Cancer Hospital&Institute,Sichuan Cancer Center,Affiliated Cancer Hospital of University of Electronic Science and Technology of China,Chengdu 610042,China)

机构地区：[1]成都中医药大学医学与生命科学学院,成都611137 [2]四川省肿瘤医院超声医学中心、四川省肿瘤临床医学研究中心、四川省肿瘤医院·研究所、四川省癌症防治中心、电子科技大学附属肿瘤医院,成都610042 [3]四川省肿瘤医院头颈放疗科、四川省肿瘤临床医学研究中心、四川省肿瘤医院·研究所、四川省癌症防治中心、电子科技大学附属肿瘤医院,成都610042

出　　处：《中华超声影像学杂志》2024年第4期315-319,共5页Chinese Journal of Ultrasonography

基　　金：国家重点研发计划(2019YFE0196700);国家自然科学基金(82272015);四川省科技厅重点研发项目(2023YFS0157)。

摘　　要：目的探讨多模态超声在鼻咽癌患者放疗后皮肤毒性评估中的应用价值。方法纳入2022年1月至2023年6月四川省肿瘤医院收治的45位鼻咽癌患者,在放疗前、中、后均行高频超声、彩色多普勒血流显像(CDFI)、微细血流成像(MFI)及弹性成像检查。将放疗前、中、后多模态超声结果与临床评估的皮肤毒性进行比较。结果临床评估放疗1年后皮肤的远期毒性0级23例,1级11例,2级11例,3级0例。放疗期间[(1.88±0.17)mm]、放疗结束后[(1.73±0.13)mm]与放疗前[(1.56±0.17)mm]颈部皮肤相比差异有统计学意义(均P<0.001)。CDFI和MFI均提示放疗期间皮肤真皮层血流信号增多。临床评估的毒性等级和超声定量测量的放疗期间皮肤厚度变化(r_(s)=0.612,P<0.001)、放疗后皮肤厚度变化(r_(s)=0.817,P<0.001)以及皮肤弹性成像之间有较强的相关性(r_(s)=0.866,P<0.001)。放疗后MFI较放疗前减少(P<0.001)。结论多模态超声作为无创的检查方法,可以通过鼻咽癌患者颈部皮肤的厚度、回声、血流及弹性成像评估放疗术中及远期的皮肤毒性,为鼻咽癌患者的皮肤毒性评估提供了一种新的方法。Objective To explore the application value of multimodal ultrasound in the skin toxicity of nasopharyngeal carcinoma patients undergoing radiotherapy.Methods This study included 45 nasopharyngeal carcinoma patients who underwent high-frequency ultrasound,color Doppler flow imaging(CDFI),microvisual flow imaging(MFI),and elastography examinations before,during,and after radiotherapy at Sichuan Cancer Hospital from January 2022 to June 2023.The ultrasound results and the clinical skin toxicity were compared before,during,and after radiotherapy.Results There were 23 patients at level 0,11 patients at level 1,11 patients at level 2 and no patient at level 3 by clilinal evaluation of skin toxicity after radiotherapy.There was a significant difference(all P<0.001)between the neck skin thickness during radiotherapy[(1.88±0.17)mm]and after radiotherapy[(1.73±0.13)mm]compared to the skin before radiotherapy[(1.56±0.17)mm].Both CDFI and MFI indicated the increase of blood flow signals in the dermis during radiotherapy.There was a strong correlation in terms of the toxicity level of clinical evaluation and the quantitative measurement of ultrasound among changes in skin thickness during radiotherapy(r_(s)=0.612,P<0.001),changes in skin thickness after radiotherapy(r_(s)=0.817,P<0.001)and skin elastography(r_(s)=0.866,P<0.001).After radiotherapy,MFI decreased in comparison with before radiotherapy(P<0.001).Conclusions As a non-invasive examination method,multimodal ultrasound can evaluate the skin toxicity of nasopharyngeal carcinoma patients during and after radiotherapy through the thickness,echo,blood flow,and elastic imaging of the neck skin,which provides a new method for evaluating the skin toxicity of nasopharyngeal carcinoma patients.

关 键 词：鼻咽癌 皮肤毒性 多模态超声 微细血流成像 弹性成像 

分 类 号：R739.63[医药卫生—肿瘤] R445.1[医药卫生—临床医学]