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目的:探讨磁共振波谱(MRS)成像在鼻咽癌放射治疗颞叶脑损伤中的应用价值。方法:对2006-07-2009-05期间80例鼻咽癌患者首次接受放射治疗前和接受剂量为20、40和60 Gy放疗剂量时行常规颅脑MR和双侧颞叶MRS成像。波谱成像以T2FLAIR序列为定位图,点分辨法进行多体素采集,动态观察不同剂量时颞叶波谱形态和主要代谢物及比值的变化趋势。结果:所有病例接受放射总剂量60 Gy,MR常规扫描未见明显异常。接受放射剂量20 Gy,部分病例(43/80)波谱形态发生改变,NAA和Cho波峰降低,以NAA更明显,NAA/Cr、Cho/Cr及NAA/Cho值均不同程度降低;40 Gy,大部分病例(56/80)NAA峰高度接近于Cho;60 Gy,67例Cho波峰高于NAA峰,13例Cho峰与NAA峰高度接近。整个治疗过程中,NAA、Cho、NAA/Cr、Cho/Cr及NAA/Cho值随射线剂量增加而降低,三者比值与所接受射线剂量呈负相关,比值差异有统计学意义(P=0.045)。结论:鼻咽癌放射性颞叶脑损伤是动态演变过程,MRS可从物质代谢水平反映不同放疗阶段脑损伤情况。
Objective: To investigate the value of magnetic resonance spectroscopy (MRS) imaging in the treatment of nasopharyngeal carcinoma with temporal lobe brain injury. Methods: Eighty patients with nasopharyngeal carcinoma before radiotherapy and at doses of 20, 40 and 60 Gy were performed conventional magnetic resonance MR imaging and bilateral temporal MRS imaging during the period of 2006-07-2009-05. Spectral imaging T2IRAIR sequence as the location map, point resolution method for voxel collection, dynamic observation of different doses of temporal lobe spectral morphology and the main metabolites and the ratio of trends. Results: The total radiation dose was 60 Gy in all cases. There was no obvious abnormalities in routine MR scan. The radiation dose was 20 Gy, and in some cases (43/80) the morphological changes were observed. The peaks of NAA and Cho were decreased. NAA / Cr, Cho / Cr and NAA / Cho were all decreased to a lesser extent with NAA; In some cases (56/80) NAA peak height close to Cho; 60 Gy, 67 Cho wave peak higher than the NAA peak, 13 Cho peak and NAA peak height close. The values of NAA, Cho, NAA / Cr, Cho / Cr and NAA / Cho decreased with the increase of radiation dose throughout the course of treatment. The ratio of the three was negatively correlated with the dose of radiation received (P = 0.045 ). Conclusion: The temporal lobe brain injury of nasopharyngeal carcinoma is a dynamic process of evolution. MRS can reflect the brain injury of different radiotherapy stages from the level of material metabolism.