CAJ | 학술논문

目的探讨磁共振弥散成像(DWI)及表观弥散系数(ADC)在鼻咽癌颈部淋巴结转移调强放射治疗(intensity modulated radiation therapy,IMRT)前的诊断及其对放化疗反应的监测能力.方法对18例病理确诊的鼻咽癌患者在治疗前、治疗中每周及治疗后1个月行DWI检查.所有患者均接受头颈部IMRT及铂类同步化疗.在DWI上共分析了52枚颈部异常淋巴结,将其分为最短径≥10 mm(32枚)及<10 mm(20枚)两组,测量比较治疗前两组的ADC值是否存在差异,观察所有淋巴结治疗过程中ADC值的动态变化,同时观察比较治疗后残存的颈部淋巴结与正常舌肌的ADC值.结果最短径≥10 mm淋巴结的平均ADC值为(0.71±0.12)×10-3mm/s,与最短径<10 mm者的平均ADC值[(0.73±0.16)×10-3mm/s]差异无统计学意义(t=1.11,P=0.27).治疗前52枚淋巴结的平均ADC值明显低于正常舌肌(t=19.35,P＜0.01).治疗过程中ADC值逐渐上升,以第1、2周改变最明显,以后趋于平稳.治疗后残留淋巴结的ADC值明显增大,与治疗前比较差异有统计学意义(t=12.72,P＜0.01),与正常舌肌比较差异无统计学意义(t=0.34,P=0.73).结论在鼻咽癌IMRT中,DWI对诊断颈部转移性淋巴结以及监测后者对放化疗的反应具有重要参考价值,从而帮助临床医生合理制定并及时更改放疗计划.
목적 탐토자공진미산성상(DWI)급표관미산계수(ADC)재비인암경부림파결전이조강방사치료(intensity modulated radiation therapy,IMRT)전적진단급기대방화료반응적감측능력.방법 대18례병리학진적비인암환자재치료전、치료중매주급치료후1개월행DWI검사.소유환자균접수두경부IMRT급박류동보화료.재DWI상공분석료52매경부이상림파결,장기분위최단경≥10 mm(32매)급<10 mm(20매)량조,측량비교치료전량조적ADC치시부존재차이,관찰소유림파결치료과정중ADC치적동태변화,동시관찰비교치료후잔존적경부림파결여정상설기적ADC치.결과 최단경≥10 mm림파결적평균ADC치위(0.71±0.12)×10-3mm/s,여최단경<10 mm자적평균ADC치[(0.73±0.16)×10-3mm/s]차이무통계학의의(t=1.11,P=0.27).치료전52매림파결적평균ADC치명현저우정상설기(t=19.35,P＜0.01).치료과정중ADC치축점상승,이제1、2주개변최명현,이후추우평은.치료후잔류림파결적ADC치명현증대,여치료전비교차이유통계학의의(t=12.72,P＜0.01),여정상설기비교차이무통계학의의(t=0.34,P=0.73).결론 재비인암IMRT중,DWI대진단경부전이성림파결이급감측후자대방화료적반응구유중요삼고개치,종이방조림상의생합리제정병급시경개방료계화.
Objective To investigate the value of diffusion-weighted magnetic resonance imaging (DWI) and apparent diffusion coefficients (ADC) in detecting metastatic lymph nodes from nasopharyngeal carcinoma (NPC),and predicting the response of these nodes to concurrent chemoradiation (CRT).Methods Eighteen patients with pathologically proven NPC received conventional magnetic resonance imaging (MRI) and DWI before treatment,weekly during treatment,and one month after treatment.DWI was performed using a single-shot echo-planar (SSEPI) MR imaging sequence with b values of 0 and 1500 s/mm2.ADC maps were reconstructed for all patients and ADC values were calculated for each lymph node and tongue muscle.Totally fifty-two morphologically abnormal lymph nodes were analyzed.The ADC values of the metastatic lymph nodes before treatment were compared between those with the short axis≥10 mm (n=32) and those with the short axis<10 mm (n=20),and the dynamic changes in ADC values of the lymph nodes before,during,and after therapy were observed and recorded.Results The average ADC of the 32 lymph nodes with the short axis ≥ 10 mm was (0.71±0.12) x 10-3mm/s,not significantly different from that of the 20 lymph nodes with the short axis < 10 mm [(0.73±0.16) x 10-3mm/s,t = 1.11 ,P =0.27].The average ADC values of these lymph nodes before treatment was significantly lower than that of the tongue muscle (t = 19.35,P < 0.0001).During CRT,the ADC values of the lymph nodes increased gradually,with the most evident change in the first two weeks before reaching a relatively flat plateau thereafter.The ADC value of the residual lymph nodes after CRT was significantly higher than that before treatment (t = 12.72,P < 0.0001),however,not statistically significant different from that of the normal tongue muscle (t = 0.34,P = 0.73).Conclusions DWI plays an important role in diagnosing the metastatic lymph nodes from NPC and is feasible for observation of the early response of the lymph nodes to IMRT,thus helping the clinicians make appropriate treatment planning and replanning in the course of radiotherapy.