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目的:联合应用磁共振波谱(MRS)和扩散张量成像(DTI)监测鼻咽癌放射治疗过程中物质代谢和微观结构变化。方法:对80例确诊为鼻咽癌并首次接受放射治疗的患者进行放疗前和接受剂量为20、40和60Gy时分别进行常规颅脑MR、双侧颞叶MRS和DTI成像,动态观察不同剂量时颞叶波谱形态、主要代谢物比值以及DTI的表观扩散系数(ADC)和部分各向异性(FA)的变化趋势,并进行分析。结果:NAA/Cho、NAA/Cr和Cho/Cr比值在放疗前分别为1.37±0.11、1.92±0.15和1.43±0.21,在放疗过程中逐渐降低,放疗结束时分别为0.93±0.12、1.04±0.09和1.05±0.13,差异有统计学意义,P=0.006、0.047、0.038。DTI的ADC值由6.342±0.22升高至7.046±0.45,差异无统计学意义,P=0.81;FA值由0.365±0.04降至0.349±0.03,差异有统计学意义,P=0.047。结论:鼻咽癌放射治疗过程中脑损伤首先表现为物质代谢障碍,而后出现微观空间结构上的改变。MRS和DTI能从分子水平评价放射性脑损伤的动态演变过程,为早期干预脑损伤提供客观依据。
OBJECTIVE: To monitor the changes of substance metabolism and microstructure during radiotherapy of nasopharyngeal carcinoma by using MRS and diffusion tensor imaging (DTI). Methods: Eighty patients diagnosed with nasopharyngeal carcinoma and receiving radiotherapy for the first time underwent radiotherapy before and at doses of 20, 40 and 60 Gy respectively. MR imaging and MR imaging were performed on both sides of the temporal lobe. Dynamic observation of different doses Time temporal wave spectroscopy, the ratio of major metabolites and the trend of apparent diffusion coefficient (ADC) and partial anisotropy (FA) of DTI were analyzed and analyzed. Results: The ratios of NAA / Cho, NAA / Cr and Cho / Cr were 1.37 ± 0.11, 1.92 ± 0.15 and 1.43 ± 0.21 before radiotherapy and decreased gradually during radiotherapy. The ratios of NAA / Cho, Cho and Cr were 0.93 ± 0.12 and 1.04 ± 0.09 And 1.05 ± 0.13, the difference was statistically significant, P = 0.006,0.047,0.038. DTI ADC value increased from 6.342 ± 0.22 to 7.046 ± 0.45, the difference was not statistically significant, P = 0.81; FA value decreased from 0.365 ± 0.04 to 0.349 ± 0.03, the difference was statistically significant, P = 0.047. CONCLUSIONS: The brain injury in nasopharyngeal carcinoma during radiation therapy first manifests as material metabolism disorder, and then changes microscopically. MRS and DTI can assess the dynamic evolution of radiation-induced brain injury at the molecular level, providing an objective basis for early intervention in brain injury.