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目的:研究星形细胞肿瘤术后、分次放疗后急性期及早期迟发反应期MRS上Cho/Cr随剂量、时间的变化趋势。方法:共18例,年龄9~67岁(平均46±14岁),采用GE signa VH/i 3.0T成像系统进行检查,MRS采用多体素PRESS序列。均为术后患者(全切或部分切除),其中胶质母细胞瘤(WHO 4级)7例,间变性星形细胞瘤(WHO 3级)4例,弥漫性星形细胞瘤(WHO 2级)6例,毛细胞型星形细胞瘤(WHO 1级)1例。测量两个体素:≥60Gy区(肿瘤床区)和<40Gy区(对侧正常区)。一般先行常规分割放射治疗,然后进行调强适形放射治疗,靶区总处方剂量为60~68Gy。结果:≥60Gy区的Cho/Cr在放疗至60%总剂量时已经开始降低,并且呈进行性降低(从治疗前的2.521降到治疗后1个月的1.810)。而<40Gy区则先轻度升高,随后降至原来的水平。结论:MRS的Cho/Cr可以对星形细胞肿瘤术后、放疗后急性期和早期迟发反应期的代谢物改变进行检测,有利于对肿瘤治疗后的早期反应进行有效评估。
OBJECTIVE: To study the changes of Cho / Cr with MRS dose and time in acute and early delayed-response stages of astrocytic tumors after fractionated radiotherapy. Methods: A total of 18 patients, aged 9-67 years (mean, 46 ± 14 years), were examined using the GE signa VH / i 3.0T imaging system and the MRS using the multi-voxel PRESS sequence. All patients were undergone total or partial resection, including 7 cases of glioblastoma (WHO grade 4), 4 cases of anaplastic astrocytoma (WHO grade 3), 2 cases of diffuse astrocytoma (WHO 2 Grade) in 6 cases, hairy cell type astrocytoma (WHO grade 1) in 1 case. Two voxels were measured: ≧ 60 Gy region (tumor bed region) and <40 Gy region (contralateral normal region). The general first conventional radiotherapy, then intensity modulated radiotherapy, the total target dose of 60 ~ 68Gy. Results: Cho / Cr in ≥60 Gy region had begun to decrease at radiotherapy to 60% of the total dose and decreased progressively (from 2.521 before treatment to 1.810 at 1 month after treatment). The <40Gy area first slightly increased, then dropped to its original level. CONCLUSIONS: Cho / Cr of MRS can detect the changes of metabolites in astrocytoma after surgery, acute phase and early delayed reaction after radiotherapy, which is helpful to evaluate the early response after tumor therapy.