中华放射肿瘤学杂志
中華放射腫瘤學雜誌
중화방사종류학잡지
CHINESE JOURNAL OF RADIATION ONCOLOGY
2011年
1期
10-13
,共4页
质子磁共振波谱%弥散加权成像%星形细胞瘤%放射疗法
質子磁共振波譜%瀰散加權成像%星形細胞瘤%放射療法
질자자공진파보%미산가권성상%성형세포류%방사요법
Proton magnetic resonance spectroscopy%Diffusion weighted imaging%Astrocytomas%Radiotherapy
目的 评价两种磁共振功能成像对腩低级星形细胞瘤放疗早期预后判断的应用价值.方法 经手术病理证实的脑低级星形细胞瘤(WHO Ⅰ～Ⅱ级)20例均为术后2～4周内放疗.放疗前、放疗后3个月查MRI质子磁共振波普(1H-MRS)、弥散加权成像(DWI),以后每隔6个月复查.病灶实体区与正常区胆碱(Cho)、N-乙酰天门冬氨酸(NAA)、肌酸(Cr)、表观弥散系数(ADC)相除分别得到rCho、rNAA、rCr、rADC.分别计算进展组(Ⅰ组)、稳定组(Ⅱ组)的rCho/rCr、rCho/rNAA、rADC直,并计算两组rCho/rCr、rCho/rNAA、rADC放疗后3个月与放疗前平均差值.Ⅰ组和Ⅱ组比较用独立样本t检验.结果 随疗2年.放疗后3个月 rCho/rCr、rCho/rNAA值Ⅰ组比Ⅱ组大,分别为1.632∶1.398(t=3.65,P＜0.05)、1.597∶1.223(t=4.24,P＜0.01),rADC值Ⅰ组比Ⅱ组小,分别为1.321∶1.671(t=3.43,P＜0.05).放疗后3个月与放疗前rCho/rCr、rCho/rNAA、rADC平均差值Ⅰ组比Ⅱ组小,分别为0.070∶0.275(t=2.02,P＜0.05)、0.116∶0.375(t=4.21,P＜0.05)、0.032∶0.316(t=3.00,P＜0.05).随访中后期Ⅰ组rCho/rCr、rCho/rNAA逐渐增高,rADC逐渐降低;11～16个月内出现新的不适再次手术或活检病理证实级别升至高级别组.Ⅱ组临床表现及MRI均稳定,rCho/rCr、rCho/rNAA无明显变化或不同程度下降,rADC无明显变化或不同程度上升.结论 1H-MRS、DWI对肭低级星形细胞癌比MRI较早、较准确地反映肿瘤内部代谢变化、生长潜能及对放疗反应,为临床早期判断预后提供有价值帮助.
目的 評價兩種磁共振功能成像對腩低級星形細胞瘤放療早期預後判斷的應用價值.方法 經手術病理證實的腦低級星形細胞瘤(WHO Ⅰ～Ⅱ級)20例均為術後2～4週內放療.放療前、放療後3箇月查MRI質子磁共振波普(1H-MRS)、瀰散加權成像(DWI),以後每隔6箇月複查.病竈實體區與正常區膽堿(Cho)、N-乙酰天門鼕氨痠(NAA)、肌痠(Cr)、錶觀瀰散繫數(ADC)相除分彆得到rCho、rNAA、rCr、rADC.分彆計算進展組(Ⅰ組)、穩定組(Ⅱ組)的rCho/rCr、rCho/rNAA、rADC直,併計算兩組rCho/rCr、rCho/rNAA、rADC放療後3箇月與放療前平均差值.Ⅰ組和Ⅱ組比較用獨立樣本t檢驗.結果 隨療2年.放療後3箇月 rCho/rCr、rCho/rNAA值Ⅰ組比Ⅱ組大,分彆為1.632∶1.398(t=3.65,P＜0.05)、1.597∶1.223(t=4.24,P＜0.01),rADC值Ⅰ組比Ⅱ組小,分彆為1.321∶1.671(t=3.43,P＜0.05).放療後3箇月與放療前rCho/rCr、rCho/rNAA、rADC平均差值Ⅰ組比Ⅱ組小,分彆為0.070∶0.275(t=2.02,P＜0.05)、0.116∶0.375(t=4.21,P＜0.05)、0.032∶0.316(t=3.00,P＜0.05).隨訪中後期Ⅰ組rCho/rCr、rCho/rNAA逐漸增高,rADC逐漸降低;11～16箇月內齣現新的不適再次手術或活檢病理證實級彆升至高級彆組.Ⅱ組臨床錶現及MRI均穩定,rCho/rCr、rCho/rNAA無明顯變化或不同程度下降,rADC無明顯變化或不同程度上升.結論 1H-MRS、DWI對肭低級星形細胞癌比MRI較早、較準確地反映腫瘤內部代謝變化、生長潛能及對放療反應,為臨床早期判斷預後提供有價值幫助.
목적 평개량충자공진공능성상대남저급성형세포류방료조기예후판단적응용개치.방법 경수술병리증실적뇌저급성형세포류(WHO Ⅰ～Ⅱ급)20례균위술후2～4주내방료.방료전、방료후3개월사MRI질자자공진파보(1H-MRS)、미산가권성상(DWI),이후매격6개월복사.병조실체구여정상구담감(Cho)、N-을선천문동안산(NAA)、기산(Cr)、표관미산계수(ADC)상제분별득도rCho、rNAA、rCr、rADC.분별계산진전조(Ⅰ조)、은정조(Ⅱ조)적rCho/rCr、rCho/rNAA、rADC직,병계산량조rCho/rCr、rCho/rNAA、rADC방료후3개월여방료전평균차치.Ⅰ조화Ⅱ조비교용독립양본t검험.결과 수료2년.방료후3개월 rCho/rCr、rCho/rNAA치Ⅰ조비Ⅱ조대,분별위1.632∶1.398(t=3.65,P＜0.05)、1.597∶1.223(t=4.24,P＜0.01),rADC치Ⅰ조비Ⅱ조소,분별위1.321∶1.671(t=3.43,P＜0.05).방료후3개월여방료전rCho/rCr、rCho/rNAA、rADC평균차치Ⅰ조비Ⅱ조소,분별위0.070∶0.275(t=2.02,P＜0.05)、0.116∶0.375(t=4.21,P＜0.05)、0.032∶0.316(t=3.00,P＜0.05).수방중후기Ⅰ조rCho/rCr、rCho/rNAA축점증고,rADC축점강저;11～16개월내출현신적불괄재차수술혹활검병리증실급별승지고급별조.Ⅱ조림상표현급MRI균은정,rCho/rCr、rCho/rNAA무명현변화혹불동정도하강,rADC무명현변화혹불동정도상승.결론 1H-MRS、DWI대눌저급성형세포암비MRI교조、교준학지반영종류내부대사변화、생장잠능급대방료반응,위림상조기판단예후제공유개치방조.
Objective To evaluate the predictive value of proton magnetic resonance spectroscopy (1H-MRS)and diffusion weighted imaging(DWI)in low-grade cerebral astrocytomas. Methods Twenty patients with histological proved low-grade astrocytomas treated with postoperative radiotherapy were evaluated with cMRIMRS, DWI before-and 3 months after radiotherapy respectively, then repeated every six months. rNAA,rCho,rCr,rADC was the ratio of NAA, Cho and Cr in the residual tumors region to the those of normal control region. The difference of rCho/rCr, rCho/rNAA, rADC between deteriorative group(group Ⅰ)and stable groups(group Ⅱ)were calculated both before-and 3months after radiotherapy. Results The value of rCho/rCr, rCho/rNAA were higher in group 1 than those in group Ⅱ 3 months after radiotherapy(t =3.65 and 4. 24,all P ＜ 0. 05), while the value of rADC was lower in group Ⅰ(t = 3.43, P ＜ 0. 05). The mean difference of rCho/rCr,rCho/rNAA, rADC in group Ⅰ were smaller than those in group Ⅱ(t = 2. 02,4. 21 and 3.00,all P ＜0. 05). The value of rCho/rCr,rCho/rNAA increased and rADC decreased gradually in group Ⅰ during follow up, and these patients were histologically proved recurrence within 11 - 16 months.While in group Ⅱ , the value of rCho/rCr, rCho/rNAA decreased and rADC increased gradually or steady.And also with a stable clinical performance and cMRI. Conclusions 1H-MRS and DWI own better predictive value of monitoring tumor metabolism change, growth potential and evaluation response to radiotherapy than conventional MRI in low-grade group astrocytomas.
