磁共振扩散加权成像在鼻咽癌放射治疗中的应用

发布时间：2018-05-27 02:07

本文选题：鼻咽癌 + 磁共振扩散加权成像　；参考：《暨南大学》2010年硕士论文

【摘要】： 目的探讨磁共振扩散加权成像(DW-MRI)在鼻咽癌放射治疗中的应用价值。方法 1.收集我院2008年12月至2009年12月经病理证实的鼻咽癌患者38例,放射治疗前均行常规MRI及DW-MRI检查,观察肿瘤原发灶和转移淋巴结的DW-MRI表现,分析肿瘤T分期和转移淋巴结MRI表现与ADC值的关系。 2.收集我院2008年12月至2009年3月经穿刺活检病理确诊鼻咽癌病例15例,在放射治疗前及放射治疗剂量达10Gy、20Gy及40Gy时行磁共振检查(包括常规MRI及DW-MRI),观察肿瘤原发灶及颈部转移淋巴结大小、DW-MRI信号及ADC值的变化。结果 1.38例经病理证实的鼻咽癌患者放疗前DW-MRI序列显示肿瘤原发灶最大层面面积要明显小于增强T1WI脂肪抑制序列(P0.05),而颈部转移淋巴结最大层面面积在DW-MRI序列和增强T1WI序列间无明显差异(P=0.066)；不同T分期的鼻咽癌原发灶ADC值及不同位置和大小转移淋巴结的ADC值之间均无明显差异(P0.05)。 2.15例经病理证实并在我院放射治疗科进行标准放射治疗的鼻咽癌患者肿瘤原发灶及转移淋巴结在放疗后T2WI信号不均匀增高,其ADC值在放疗后逐渐升高,放疗前及放疗剂量达40Gy时ADC值分别为0.690±0.072×10-3mm2／s和0.813±0.091×10-3mm2／s及1.167±0.057×10-3mm2／s和1.802±0.173×10-3mm2／s,且放疗前后各组间的相互差异均有统计学意义(P0.05)；放疗前颈部转移淋巴结最大层面面积为2.58±0.64 cm2,放疗剂量达10Gy时为1.07±0.25 cm2,缩小率为58.5%,而肿瘤原发灶缩小率为2%。结论 1.MR-DWI序列和脂肪抑制增强T1WI序列上勾画肿瘤原发灶及转移淋巴结面积的大小有明显差异,提示DW-MRI序列对于缩小肿瘤放疗靶区勾画面积可能产生影响。 2.鼻咽癌T分期与原发灶的ADC值、癌转移淋巴结的大小位置与其ADC值大小之间无明显相关,无法用ADC值来分别评价肿瘤和转移淋巴结的分期。 3.鼻咽癌原发灶及淋巴结放前放疗后不同阶段DW-MRI表现明显不同且不同步,其ADC值增高趋势均较常规MRI显示的大小变化趋势早而明显。
[Abstract]:Purpose To evaluate the value of diffusion weighted Mr imaging (DW-MRI) in radiotherapy of nasopharyngeal carcinoma (NPC). Method 1. From December 2008 to December 2009, 38 patients with nasopharyngeal carcinoma (NPC) confirmed by pathology from December 2008 to December 2009 in our hospital were examined by routine MRI and DW-MRI before radiotherapy, and the DW-MRI findings of primary tumor and metastatic lymph nodes were observed. To analyze the relationship between T stage and MRI findings of metastatic lymph nodes and ADC value. 2. From December 2008 to March 2009, 15 cases of nasopharyngeal carcinoma confirmed by biopsy and pathology were collected. Magnetic resonance imaging (including routine MRI and DW-MRI) was performed before radiotherapy and at the dose of 10 Gy or 20 Gy and 40Gy. The changes of DW-MRI signal and ADC value in primary tumor and cervical metastatic lymph nodes were observed. Result 1.The DW-MRI sequence of 38 patients with nasopharyngeal carcinoma confirmed by pathology before radiotherapy showed that the maximum area of primary tumor was significantly smaller than that of enhanced T1WI fat suppression sequence (P0.05), while the largest area of cervical metastatic lymph nodes was in DW-MRI sequence and enhanced T1WI sequence. There was no significant difference among the columns (P < 0.066), but there was no significant difference between the ADC values of nasopharyngeal carcinoma at different T stages and the ADC values of metastatic lymph nodes in different locations and sizes (P 0.05). 2.Fifteen patients with nasopharyngeal carcinoma confirmed by pathology and treated with standard radiotherapy in our hospital received standard radiotherapy. The T2WI signal of primary tumor and metastatic lymph nodes increased inhomogeneously after radiotherapy, and the ADC value increased gradually after radiotherapy. ADC values were 0.690 卤0.072 脳 10-3mm2/s and 0.813 卤0.091 脳 10-3mm2/s and 1.167 卤0.057 脳 10-3mm2/s and 1.802 卤0.173 脳 10 ~ (-3) mm ~ (-2) / s before and after radiotherapy for 40Gy, respectively, and there were significant differences between the groups before and after radiotherapy (P < 0.05), the maximum area of cervical metastatic lymph nodes before radiotherapy was 2.58 卤0.64 cm ~ (2), and when the radiation dose reached 10Gy, the maximum area of cervical metastatic lymph nodes was 2.58 卤0.64 cm ~ (2). It was 1.07 卤0.25 cm ~ (2) and the reduction rate was 58.5 cm ~ (2), while that of primary tumor was 2 ~ (th). Conclusion There were significant differences in the size of primary tumor and metastatic lymph nodes between 1.MR-DWI sequence and fat suppression enhanced T1WI sequence, suggesting that DW-MRI sequence might have an effect on the reduction of tumor radiotherapy target area. 2. There was no significant correlation between T stage of nasopharyngeal carcinoma (NPC) and ADC value of primary tumor, size of metastatic lymph node and size of ADC value. ADC value could not be used to evaluate the staging of tumor and metastatic lymph node. 3. The DW-MRI of nasopharyngeal carcinoma (NPC) at different stages of pre-radiotherapy and pre-radiotherapy of lymph nodes was obviously different and out of sync, and the increasing trend of ADC value was earlier and more obvious than that of conventional MRI.
【学位授予单位】：暨南大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R739.63

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