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目的探讨鼻咽癌放疗后放射性脑病的磁共振氢波谱(1H-MRS)表现,了解N-乙酰天门冬氨酸(NAA)、肌酸(Cr)和胆碱(Cho)3种物质的代谢规律,为放射性脑病的早期诊断提供方法。方法选取10例健康志愿者作为对照组,21例病理诊断为鼻咽癌并进行根治性放疗后经症状及影像学诊断为放射性脑病的病人作为病例组,用化学位移成像法(CSI)行1H-MRS检查。观察各像素中NAA、Cr和Cho的含量、代谢图及它们之间的比例。结果磁共振成像(MRI)可见放射性脑病病灶中的液化坏死区3种物质含量基本为零,代谢图中无信号;病灶中非液化坏死区NAA轻度升高,Cr和Cho明显降低或为零,NAA代谢图呈高信号,Cr和Cho低信号。病灶周边存在一个区域NAA降低,Cr和Cho升高,NAA/Cr和NAA/Cho<1,代谢图中信号区分不明显。远离可见病灶的区域NAA、Cr和Cho含量及比例正常。结论1H-MRS可显示放射性脑病的物质代谢变化规律,发生变化的区域面积大于MRI中可见病变区,从而为该病的早期诊断提供了可能。
Objective To investigate the 1H-MRS of radiation-induced encephalopathy after radiotherapy for nasopharyngeal carcinoma (NPC) and to investigate the metabolic regulation of three substances (NAA, Cr and Chol) , For the early diagnosis of radiation encephalopathy provide a method. Methods Totally 10 healthy volunteers were selected as control group. Twenty-one patients with nasopharyngeal carcinoma diagnosed as nasopharyngeal carcinoma and undergoing radical radiotherapy and then diagnosed as radiation-induced encephalopathy by symptoms and imaging were selected as the case group and underwent chemical shift imaging (CSI) -MRS check. Observe the contents of NAA, Cr and Cho in each pixel, the metabolic map and the ratio between them. Results Magnetic resonance imaging showed that the content of three substances in liquefied necrotic area of radioactive encephalopathy was almost zero and there was no signal in the metabolic map. The NAA in lesion non-liquefied necrotic area was slightly increased, while the Cr and Cho were significantly reduced or zero , NAA metabolites showed high signal, Cr and Cho low signal. NAA / Cr and NAA / Cho <1 were present in one area around the lesion, while NAA / Cr and NAA / Cho were not significantly differentiated in the metabolic map. NAA, Cr, and Cho levels and ratios were normal in areas far from visible lesions. Conclusion 1H-MRS can show the changes of substance metabolism in radiation encephalopathy. The area of change is larger than that in MRI, which makes it possible to diagnose the disease early.