左乳腺癌术后放疗致心脏损伤的心肌血流灌注临床研究

发布时间：2018-04-14 09:10

本文选题：乳腺癌 + 术后放射治疗　；参考：《山西医科大学》2017年硕士论文

【摘要】：目的:研究左侧乳腺癌术后放疗致心脏损伤的发生情况,探讨单光子发射计算机断层扫描门控心肌灌注显像在左乳癌术后放疗致心脏损伤诊断中的价值。并且分析相关心脏毒性与剂量-体积因子的相关性。方法:对曾就诊于我科的左乳癌术后放疗后患者进行随访,收集并筛选符合条件的患者,行~(99)Tc~m-MIBI同日法单光子发射计算机断层扫描门控心肌灌注显像检查,由两位有经验的核医学科医师读取运动+静息心肌灌注显像数据结果,运用QGS/QPS软件进行定量分析,判断患者是否出现心功能异常或心肌灌注缺损。并对这些患者放疗的剂量-体积数据进行分析,了解心脏毒性与其是否关联。结果:10例左乳腺癌术后放疗后患者参加了这项研究。就本次心肌灌注显像检查来看,在10例中有3例出现了心肌灌注缺损或减低,且都位于心尖段,而同时进行的其他心脏相关检查并未发现心功能异常,因此单光子发射计算机断层扫描门控心肌灌注显像可作为诊断放射性心脏损伤的检查方法。相比没有心肌灌注缺损或减低的患者,在出现心肌灌注缺损或减低的患者中,V39-V41有显著增高(p0.05),这说明心脏高剂量受照体积百分比可能是诱发放射性心脏损伤的重要因素。结论:左乳腺癌放疗可能会诱发心脏损伤。~(99)Tc~m-MIBI单光子发射计算机断层扫描门控心肌灌注显像检查可以检测放疗后心脏损伤的发生。V39、V40、V41可能是诱发放射性心脏损伤的一个重要的因素。
[Abstract]:Objective: to study the incidence of cardiac injury induced by radiotherapy in patients with left breast cancer, and to evaluate the diagnostic value of single photon emission computed tomography gated myocardial perfusion imaging (SPECT) in the diagnosis of postoperative radiation-induced cardiac injury in patients with left breast cancer.The correlation between cardiac toxicity and dose-volume factor was analyzed.Methods: patients with left breast cancer who had been treated in our department after postoperative radiotherapy were followed up. The eligible patients were collected and screened, and the gated myocardial perfusion imaging was performed by single photon emission computed tomography (SPECT) on the same day.The results of exercise resting myocardial perfusion imaging were read by two experienced physicians in nuclear medicine. Quantitative analysis was carried out with QGS/QPS software to determine whether the patients had abnormal cardiac function or myocardial perfusion defect.Dose-volume data from these patients were analyzed to see if cardiac toxicity was associated with it.Results 10 patients with left breast cancer after postoperative radiotherapy participated in the study.The myocardial perfusion imaging showed that 3 of the 10 patients had myocardial perfusion defect or decrease, and all of them were located at the apical segment, while other cardiac related examinations did not show cardiac dysfunction.Therefore, single photon emission computed tomography gated myocardial perfusion imaging can be used as a diagnostic method for radiation-induced cardiac injury.Compared with those with no myocardial perfusion defect or decrease, V39-V41 was significantly increased in patients with myocardial perfusion defect or decrease, indicating that the percentage of heart irradiated volume at high dose may be an important factor in inducing radiation-induced cardiac injury.Conclusion: left breast cancer radiotherapy may induce cardiac injury. Tccm-MIBI gated myocardial perfusion imaging can be used to detect cardiac injury after radiotherapy. V39 V40V41 may be an important factor in radiation-induced cardiac injury.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.9

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