CAJ | 학술논문

目的：探讨对鼻咽癌患者放疗后颞叶常规 MRI 上表现正常的脑白质采用1 H-MRS 进行监测的价值。方法：回顾性分析经活检病理证实的75例鼻咽癌患者的临床和影像资料，所有患者均行常规 MRI 和1 H-MRS 检查，且常规MRI 上无明显异常。以放疗前的18例患者作为对照组，放疗后的57例患者为放疗。根据进行 MRS 检查时处于放疗后的不同时期而将放疗组患者分为5个组：1组（放疗后≤3个月，16例）、2组（放疗后3～6个月，12例）、3组（放疗后6～9个月，10例）、4组（放疗后9～12个月，8例）、5组（放疗后＞12个月，11例）。测量每例患者颞叶白质的平均 NAA／Cho、NAA／Cr 和 Cho／Cr，采用单因素方差分析对放疗前及放疗后各组的数据进行分析。结果：各组间 NAA／Cho 和 NAA／Cr的均值间的差异均有统计学意义（F 值分别为8．394、4．855，P 值均＜0．05）。进一步两两比较，放疗后一年内（1～4组）各组中 NAA／Cho 和 NAA／Cr 的均值均较放疗前明显下降，差异有统计学意义（P ＜0．05）；而放疗一年以上组（5组）的平均NAA／Cho 和 NAA／Cr 基本恢复，与放疗前的差异无统计学意义（P ＞0．05）。放疗后各组的平均 Cho／Cr 对比放疗前差异均无统计学意义（P ＞0．05）。结论：对鼻咽癌放疗后患者，1 H-MRS 可以在常规 MRI 发现异常之前检测到脑白质代谢异常，为临床早期诊断提供更多影像学证据。
목적：탐토대비인암환자방료후섭협상규 MRI 상표현정상적뇌백질채용1 H-MRS 진행감측적개치。방법：회고성분석경활검병리증실적75례비인암환자적림상화영상자료，소유환자균행상규 MRI 화1 H-MRS 검사，차상규MRI 상무명현이상。이방료전적18례환자작위대조조，방료후적57례환자위방료。근거진행 MRS 검사시처우방료후적불동시기이장방료조환자분위5개조：1조（방료후≤3개월，16례）、2조（방료후3～6개월，12례）、3조（방료후6～9개월，10례）、4조（방료후9～12개월，8례）、5조（방료후＞12개월，11례）。측량매례환자섭협백질적평균 NAA／Cho、NAA／Cr 화 Cho／Cr，채용단인소방차분석대방료전급방료후각조적수거진행분석。결과：각조간 NAA／Cho 화 NAA／Cr적균치간적차이균유통계학의의（F 치분별위8．394、4．855，P 치균＜0．05）。진일보량량비교，방료후일년내（1～4조）각조중 NAA／Cho 화 NAA／Cr 적균치균교방료전명현하강，차이유통계학의의（P ＜0．05）；이방료일년이상조（5조）적평균NAA／Cho 화 NAA／Cr 기본회복，여방료전적차이무통계학의의（P ＞0．05）。방료후각조적평균 Cho／Cr 대비방료전차이균무통계학의의（P ＞0．05）。결론：대비인암방료후환자，1 H-MRS 가이재상규 MRI 발현이상지전검측도뇌백질대사이상，위림상조기진단제공경다영상학증거。
Objectire:To explore the value of 1 H-MR spectroscopy in detecting radiation-induced changes of temporal lobe,which showed normal appearance in white matter (WM)on conventional MRI,in patients after radiation therapy (RT) for nasopharyngeal carcinoma (NPC).Methods:The clinical and imaging data (with no positive findings in white matter of temporal lobe on conventional MRI)of 75 patients with nasopharyngeal carcinoma proved pathologically by biopsy were ret-rospectively analyzed.All patients underwent conventional MRI and 1 H-MR spectroscopy examinations,including 18 cases before radiotherapy as the control group (pre-RT)and fifty-seven patients after radiotherapy as the post-RT group.The pa-tients in post-RT group were further divided into five groups based on the interval time between the MRS and completion of RT:group 1 (less than 3 months,16 cases),group 2 (3 to 6 months,12 cases),group 3 (6 to 9 months,10 cases),group 4 (9 to 12 months,8 cases),and group 5 (more than 12 months,11 cases).The mean NAA/Cho,NAA/Cr and Cho/Cr in bi-lateral temporal lobe were measured and calculated.The three indexes in pre-RT and five post-RT groups were compared by one-way ANOVA test.Results:The NAA/Cho and NAA/Cr in six groups were statistically different (F =8.394、4.855,re-spectively;P <0.05).By pairwise comparison,the mean NAA/Cho and NAA/Cr decreased significantly within 1 year after RT (group 1 to 4)when compared with pre-RT group,with statistic significance (P <0.05);however,there was no statistic difference between the group 5 and pre-RT group.The mean Cho/Cr in post-RT groups was not significantly different from that in the control group.Conclusion:1 H-MR specctroscopy can provide non-invasive and quantitative methods to detect the metabolic changes in white matter after RT,and may be an useful method for the early diagnosis of brain injury after radio-therapy.