CAJ | 학술논문

背景:放射性脑损伤是鼻咽癌放射性治疗(简称放疗)后的严重并发症,其早期诊断目前仍有一定困难,而磁共振波谱(magnetic resonance spectroscopy,MRS)能无创性地检测脑组织细胞代谢,是对放疗后脑损伤检测较理想的手段和方法.目的:探讨磁共振波谱对放射性脑损伤的表达.设计:以诊断为依据,非随机化同期对照研究.单位:中山大学附属第一医院放射科.对象:对1998-10/2002-12临床证实因鼻咽癌行颈部鼻咽部放疗后,在中山大学附属第一医院放射科追踪治疗并行MRI和MRS检测76例(病变组).同期选择无鼻咽癌及放疗史的健康者25例用同样的方法进行检测作对照组.干预:用1.5T MR成像系统和氢波谱采集分析软件,对两组对象行常规?骀 MRI和MRS检测.波谱检测序列:单容积波谱定位序列,激励回波探测法,扫描参数TR 2 000 ms,TE 135 ms,FOV 180 mm×180 mm,感兴趣区取20 mm×20 mm×20 mm(8 cm3),采集时间6.5 min.MRS波峰形态分析,按NAA,Cr,Cho波峰的高低排列不同组合,分Ⅰ型、Ⅱ型和Ⅲ型.波峰积分值分析,取病变中央区、边沿区和正常区的3个主要波峰:NAA峰,Cr峰,Cho峰,用随机的软件包测各自的积分值并分别计算NAA/Cr,NAA/(Cr+Cho)和Cho/Cr的积分值比.主要观察指标:①病变组和对照组不同部位波型.②病变组和对照组不同部位各波峰积分值及其比值.结果:健康对照组MRS波峰形态主要呈Ⅰ型86.67%.病变组:病灶中央区以Ⅱ型为主68.42%,边缘区波形组合以Ⅰ型44.74%和Ⅲ型39.47%为多,正常区以Ⅰ型为主84.21%.病变组各区间的NAA,Cr,Cho,NAA/Cr,sNAA/(Cr+Cho)和Cho/Cr的积分值及比值有统计学差异(P＜0.01).结论:MRS的波形及脑化合物的积分值变化能提示放射性脑损伤的程度.Ⅱ型提示已有放射性脑损伤的存在,Ⅲ型加NAA/Cr,NAA/(Cr+Cho)的比值＜1,则要考虑有放射性脑损伤可能.
배경:방사성뇌손상시비인암방사성치료(간칭방료)후적엄중병발증,기조기진단목전잉유일정곤난,이자공진파보(magnetic resonance spectroscopy,MRS)능무창성지검측뇌조직세포대사,시대방료후뇌손상검측교이상적수단화방법.목적:탐토자공진파보대방사성뇌손상적표체.설계:이진단위의거,비수궤화동기대조연구.단위:중산대학부속제일의원방사과.대상:대1998-10/2002-12림상증실인비인암행경부비인부방료후,재중산대학부속제일의원방사과추종치료병행MRI화MRS검측76례(병변조).동기선택무비인암급방료사적건강자25례용동양적방법진행검측작대조조.간예:용1.5T MR성상계통화경파보채집분석연건,대량조대상행상규?태 MRI화MRS검측.파보검측서렬:단용적파보정위서렬,격려회파탐측법,소묘삼수TR 2 000 ms,TE 135 ms,FOV 180 mm×180 mm,감흥취구취20 mm×20 mm×20 mm(8 cm3),채집시간6.5 min.MRS파봉형태분석,안NAA,Cr,Cho파봉적고저배렬불동조합,분Ⅰ형、Ⅱ형화Ⅲ형.파봉적분치분석,취병변중앙구、변연구화정상구적3개주요파봉:NAA봉,Cr봉,Cho봉,용수궤적연건포측각자적적분치병분별계산NAA/Cr,NAA/(Cr+Cho)화Cho/Cr적적분치비.주요관찰지표:①병변조화대조조불동부위파형.②병변조화대조조불동부위각파봉적분치급기비치.결과:건강대조조MRS파봉형태주요정Ⅰ형86.67%.병변조:병조중앙구이Ⅱ형위주68.42%,변연구파형조합이Ⅰ형44.74%화Ⅲ형39.47%위다,정상구이Ⅰ형위주84.21%.병변조각구간적NAA,Cr,Cho,NAA/Cr,sNAA/(Cr+Cho)화Cho/Cr적적분치급비치유통계학차이(P＜0.01).결론:MRS적파형급뇌화합물적적분치변화능제시방사성뇌손상적정도.Ⅱ형제시이유방사성뇌손상적존재,Ⅲ형가NAA/Cr,NAA/(Cr+Cho)적비치＜1,칙요고필유방사성뇌손상가능.
BACKGROUND: The radiation injury of brain is the severe complication of nasopharyngeal carcinoma(NPC) after radiation therapy. But it is difficulty to diagnose in the early stage. Magnetic resonance spectroscopy(MRS) is sensitive to the cellular metabolism in the tissue of brain, so it is the best method to detect the radiation injury of brain after radiation therapy.OBJECTIVE: To investigate the expression of MRS for the radiation injury of brain.DESIGN: A non-randomized homochronous and controlled trial based on the diagnosis.SETTING: Department of Radiation, the First Affiliated Hospital of Sun Yat-sen University.PARTICIPANTS: As lesion group, 76 patients, who was selected from the Department of Radiation of the First Affiliated Hospital of Sun Yat-sen University, were given follow-up therapy and assayed with MRI and MRS from October 1998 to April 2002. All patients were treated with the radiation therapy of nuchae and nasopharynx after the clinical diagnosis of NPC. As control group, 25 health persons with neither NPC nor the history of radiotherapy were selected and assayed with the same method.INTERVENTIONS: The software of 1.5T MR imaging system and hydrogen(H) spectroscopy were used to assay normal MRI and MRS. The sequences of spectrum were as follows: single volume spectroscopy( SVS ), stimulated-echo acquisition method(STEAM) . And MRI scan parameters consisted of repetition time(TR) =2 000 ms, echo time(TE) = 135 ms, field of view(FOV)= 180 mm × 180 mm, volume of interest(VOI) = 20 mm × 20 mm × 20 mm(8 cm3), and acquisition time = 6.5 minutes. The analysis of MRS peak form: There were 3 types on the basis of different peak values of NAA, Cr and Cho, including type Ⅰ, type Ⅱ and type Ⅲ. The analysis of integral peaks values: Three main integral peak values (NAA, Cr, Cho) were detected and the ratios of NAA/Cr, NAA/(Cr+Cho) and Cho/Cr were calculated by randomization software in central, lateral and normal area of lesion.MAIN OUTCOME MEASURES: ① Forms of different sites in lesion group and control group. ② Peak values and the ratios of different sites in lesion group and control group.RESULTS: Forms of MRS peak was predominantly shown as type Ⅰ pattern(86. 67% ) in healthy control groups. Lesion groups: Type Ⅱ patterns of MRS spectra were mainly found in the centers of focus(68.42% ), and type Ⅰand type Ⅲ were seen in the margins (44. 74% and 39.47% ,respectively ) . Type Ⅰ pattern was mainly found in the normal area(84.21%) . Peak values and ratios of NAA, Cr, Cho, NAA/Cr, NAA/(Ct + Cho) and Cho/C were significant different among different area of the brain ( P ＜ 0. 01 ).CONCLUSION: The patterns of MRS spectra and the changes of integral peak values of metabolism may indicate the degree of the radiation injury of brain. Type Ⅱ spectra demonstrates the existence of the radiation injury of brain. The possibility of radiation injury of brain should be considered if typeⅢ spectra is found and the ratios of NAA/Cr and NAA/(Cr + Cho) are less than one.