CAJ | 학술논문

目的：通过扩散张量成像(diffusion tensor imaging，DTI)示踪视束、视辐射，探讨其在指导脑胶质瘤术后放疗方案中的应用价值。材料与方法选取30例脑胶质瘤患者，术后拟行放疗前行常规MRI平扫、增强及DTI扫描。获取视束、视辐射的影像学信息与3D T1解剖图像融合，将融合后的3D T1图像导入放疗计划系统并与定位CT匹配，以此勾画放疗靶区、常规危及器官及视束、视辐射。利用调强放疗(intensity modulated radiation therapy，IMRT)技术与三维适形放疗(three dimensional conformal RT，3D-CRT)技术分别制定放疗方案，观察两者结果差异有无统计学意义。结果在保证靶区治疗剂量及常规危及器官保护的情况下，IMRT计划中的患者患侧、健侧视束及视辐射所受辐射剂量均低于3D-CRT放疗计划(P＜0.05)。结论 DTI技术能够显示视束、视辐射与脑胶质瘤术后放疗靶区的关系，可协助选择、制定保护性放疗方案，减少视束、视辐射所受辐射剂量，从而降低放疗后发生视觉功能障碍的风险。
목적：통과확산장량성상(diffusion tensor imaging，DTI)시종시속、시복사，탐토기재지도뇌효질류술후방료방안중적응용개치。재료여방법선취30례뇌효질류환자，술후의행방료전행상규MRI평소、증강급DTI소묘。획취시속、시복사적영상학신식여3D T1해부도상융합，장융합후적3D T1도상도입방료계화계통병여정위CT필배，이차구화방료파구、상규위급기관급시속、시복사。이용조강방료(intensity modulated radiation therapy，IMRT)기술여삼유괄형방료(three dimensional conformal RT，3D-CRT)기술분별제정방료방안，관찰량자결과차이유무통계학의의。결과재보증파구치료제량급상규위급기관보호적정황하，IMRT계화중적환자환측、건측시속급시복사소수복사제량균저우3D-CRT방료계화(P＜0.05)。결론 DTI기술능구현시시속、시복사여뇌효질류술후방료파구적관계，가협조선택、제정보호성방료방안，감소시속、시복사소수복사제량，종이강저방료후발생시각공능장애적풍험。
Objective:To analyze whether the optic tract and the optic radiation showed by diffusion tensor imaging (DTI) can be used to evaluate the value in the guidance of selecting postoperative radiotherapy plan of cerebral gliomas.Materials and Methods: Thirty patients with conifrmed cerebral gliomas underwent conventional and contrast-enhanced MRI and DTI before postoperative radiotherapy. In order to delineate the radiotherapy target volume, organs at risk, optic tract and optic radiation, tractography data sets was fused with correlation MR and CT anatomy image by importing it to radiotherapy planning system. The radiotherapy plans developed with intensity modulated radiation therapy (IMRT) and three- dimensional conformal radiotherapy (3D-CRT) techniques were compared.Results:Both the IMRT and the 3D-CRT plans were ensured the therapeutic dose to the target volume and conventional organs at risk had been protected. The doses patients suffered by using the IMRT plan were lower than that of the 3D-CRT plan both in affected,unaffected side optic tract and optic radiation (P<0.05).Conclusion:DTI can display the location, shape of the optic tract and optic radiation, and the relationship with postoperative radiotherapy target volume of cerebral gliomas, and formulate protective treatment plan to reduce the radiation dose suffered by the optic tract and optic radiation, thereby reducing the visual dysfunction risk after radiotherapy.