本文選題：磁共振涎管成像　切入點(diǎn)：彌散加權(quán)磁共振成像　出處：《復(fù)旦大學(xué)》2010年碩士論文

【摘要】： 磁共振影像對(duì)鼻咽癌放療前后涎腺功能的評(píng)價(jià)研究 【目的】探索磁共振涎管成像(MRS)和彌散加權(quán)磁共振成像(DW MRI)兩種影像方法評(píng)價(jià)鼻咽癌放療前后涎腺(腮腺、下頜下腺)功能的可行性,與患者主觀(guān)評(píng)價(jià)的相關(guān)性。結(jié)合鼻咽癌不同治療策略(單純放療和放化療序貫治療)分析化療對(duì)口干嚴(yán)重程度的影響。 【方法】2009年8月至2010年3月間,病理證實(shí)且無(wú)遠(yuǎn)處轉(zhuǎn)移的初治鼻咽癌患者進(jìn)入研究。Ⅰ、Ⅱa期患者采用單純放療,Ⅲ、Ⅳ期患者采用誘導(dǎo)化療+放療+輔助化療各2療程。放療采用IMRT技術(shù),鼻咽部總劑量66 Gy(T1-2)/30次或70.4 Gy(T3-4)/32次,2.2 Gy/次,5次/周。TPF方案：多西他賽60mg/m2 ivgttd1,順鉑25mg/m2 ivgtt d1-3,5-氟脲嘧啶2500 mg/m2 civ120h。每3周重復(fù)。放療前、后患者分別行MRS和DW MRI檢測(cè)雙側(cè)腮腺和頜下腺功能。應(yīng)用一種MRS評(píng)分系統(tǒng)對(duì)患者放療前后及酸刺激前后涎腺導(dǎo)管進(jìn)行評(píng)分,并結(jié)合RTOG/EORTC口干標(biāo)準(zhǔn)和EORTC QLQ-C30和QLQ-HN35量表進(jìn)行分析。 【結(jié)果】共17例患者進(jìn)入研究(單純放療組5例和序貫放化療組12例)。所有患者均完成預(yù)期的放射治療及化療。所有患者雙側(cè)腮腺平均受照劑量為39.04Gy(SD,3.75Gy),雙側(cè)頜下腺平均受照劑量為57.83Gy(SD,2.95Gy)。治療后,QLQ-C30量表顯示序貫放化療組除惡心嘔吐較單純放療組明顯加重外,其余各領(lǐng)域生活質(zhì)量無(wú)統(tǒng)計(jì)學(xué)意義上的下降。QLQ-HN35量表的9項(xiàng)口干相關(guān)癥狀領(lǐng)域/條目前者比后者評(píng)分明顯升高(即生活質(zhì)量降低),差異有統(tǒng)計(jì)學(xué)意義(P均0.05)。得到高質(zhì)量MRS圖像,酸刺激涎腺導(dǎo)管評(píng)分升高,放療后導(dǎo)管評(píng)分下降,對(duì)酸刺激反應(yīng)較放療前差。放療后酸刺激前后腮腺導(dǎo)管評(píng)分差值兩組間有統(tǒng)計(jì)學(xué)差異(P=0.023),且與QLQ-C30量表的總生活質(zhì)量領(lǐng)域有正相關(guān)性(rs=0.485,p=0.049),與QLQ-HN35量表中的口干條目有負(fù)相關(guān)性(rs=-0.486,p=0.048)。放療前腮腺表觀(guān)彌散系數(shù)(apparent diffusion coefficient, ADC)平均值為(1.16±0.18)×10-3mm2/s,酸刺激后ADC值升高([1.27±0.18]×10-3mm2/s,P0.001)。放療后相同時(shí)間點(diǎn)ADC值較放療前升高。放療后酸刺激后ADC值較靜息時(shí)升高([1.98±0.27]×10-3mm2/s vs. [1.27±0.18[×10-3mm2/s, P0.001)。放療前在酸刺激后的最初5分鐘,76.5%的腮腺ADC值呈上升趨勢(shì),最大值出現(xiàn)時(shí)間個(gè)體差異較大,約在6min-21min范圍內(nèi)。放療后腮腺酸刺激后ADC值變化呈無(wú)序性。將序貫放化療組患者腮腺按平均受照劑量(Dmean)為≤39Gy和39Gy分為2組,兩組腮腺導(dǎo)管酸刺激前后得分差值差異有統(tǒng)計(jì)學(xué)意義(P=0.016)。將序貫放化療組患者腮腺按V35≤52%(中位值)和52%分為2組,兩組腮腺導(dǎo)管酸刺激前后得分差值差異有統(tǒng)計(jì)學(xué)意義(P=0.041)。 【結(jié)論】MRS和DW MRI可以無(wú)創(chuàng)檢測(cè)涎腺放療前后功能變化,用來(lái)評(píng)價(jià)鼻咽癌患者放療后口干嚴(yán)重程度有巨大的潛力。TPF方案序貫放化療口干早期反應(yīng)較單純放療嚴(yán)重。減少腮腺照射劑量,有利于早期腮腺功能特別是酸刺激后分泌功能的保護(hù)。
[Abstract]:Evaluation of salivary gland function of nasopharyngeal carcinoma before and after radiotherapy by magnetic resonance imaging
[Objective] to explore the magnetic resonance sialography (MRS) and diffusion-weighted magnetic resonance imaging (DW MRI) two imaging methods evaluated before and after radiotherapy for nasopharyngeal carcinoma of salivary gland (parotid gland, submandibular gland function) the feasibility of correlation with subjective evaluation of patients with nasopharyngeal carcinoma. Combined with different treatment strategies (radiotherapy and chemotherapy sequential therapy) analysis of the effect of chemotherapy on xerostomia severity.
[Methods] from August 2009 to March 2010, confirmed by pathology and metastasis of nasopharyngeal carcinoma were enrolled into the study. First, patients in stage a were treated with radiotherapy, III, IV were treated with induction chemotherapy + radiotherapy + chemotherapy 2 radiotherapy treatment. Using IMRT technology, the total dose of nasopharynx in 66 Gy (T1-2) /30 or 70.4 Gy (T3-4) /32, 2.2 Gy/, 5 times / week.TPF: Docetaxel 60mg/m2 ivgttd1, cisplatin 25mg/m2 IVGTT d1-3,5- fluorouracil 2500 mg/m2 civ120h. was repeated every 3 weeks. Before radiotherapy, patients underwent MRS and DW MRI detection of bilateral parotid and submandibular gland function. Application of a MRS scoring system to score the patients before and after radiotherapy before and after acid stimulation of salivary duct, and combined with the RTOG/EORTC standard and EORTC QLQ-C30 dry mouth and QLQ-HN35 scale were analyzed.
[results] a total of 17 patients entered the study (radiotherapy group 5 cases and sequential chemotherapy group 12 cases). All patients completed radiotherapy and chemotherapy. All patients expected bilateral parotid mean dose of 39.04Gy (SD, 3.75Gy), bilateral submandibular gland the average dose of 57.83Gy (SD, 2.95Gy). After treatment, the QLQ-C30 scale showed sequential chemoradiotherapy in addition to nausea and vomiting compared with radiotherapy alone group was significantly increased, the quality of life was no significant decline in the scale of 9.QLQ-HN35 dry mouth symptoms related to field / the score was significantly higher than the latter (i.e., reduced quality of life), there was statistical significance the difference (P < 0.05). To obtain high quality MRS images, acid stimulation of salivary gland were increased after radiotherapy, catheter score decreased, the acid stimulation than before radiotherapy. Radiotherapy after acid stimulation before and after parotid duct score differences between the two groups had statistical difference ISO (P=0.023), and there is a positive correlation with the total quality of life scale of QLQ-C30 (rs=0.485, p=0.049), a negative correlation with the QLQ-HN35 scale in dry mouth (rs=-0.486, p=0.048). The entry before radiotherapy of parotid gland and apparent diffusion coefficient (apparent diffusion, coefficient, ADC) average (1.16 + 0.18) * 10-3mm2/s, ADC increased after acid stimulation ([1.27 + 0.18] * 10-3mm2/s, P0.001) after radiotherapy. At the same time ADC value higher than before radiotherapy. Radiotherapy after acid stimulation ADC values were elevated resting ([1.98 + 0.27] + 0.18[* 10-3mm2/s vs. [1.27 * 10-3mm2/ s, P0.001) before radiotherapy after acid stimulation in. The first 5 minutes, 76.5% of the parotid gland ADC value increased, the maximum time of individual differences, approximately in the range of 6min-21min. The parotid gland after radiotherapy after acid stimulation ADC value change with the disorder. The sequential chemotherapy group according to the average dose of parotid gland (Dmean) is less than or equal to 39Gy and 3 9Gy were divided into 2 groups, statistically significant difference of scores of the two groups before and after acid stimulation of parotid duct (P=0.016). The sequential chemoradiotherapy group patients with parotid gland by V35 is less than or equal to 52% (median 52%) and divided into 2 groups, statistically significant difference of scores of the two groups before and after acid stimulation of parotid duct (P= 0.041).
[Conclusion] MRS and DW MRI can be noninvasive detection of salivary gland function changes before and after radiotherapy, to evaluate the severity of xerostomia in patients with nasopharyngeal carcinoma after radiotherapy has the potential to.TPF huge sequential chemotherapy xerostomia early response compared with radiotherapy alone. Seriously reduce the parotid irradiation dose, is conducive to the early parotid gland function especially the protection of secretory function after acid stimulation.

【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2010
【分類(lèi)號(hào)】：R739.63

【參考文獻(xiàn)】

相關(guān)期刊論文 前8條

1 林端瑜;唐明燈;潘建基;張春;金星;;核素顯像法觀(guān)察放射治療對(duì)鼻咽癌患者腮腺功能的影響[J];福建醫(yī)藥雜志;2006年03期

2 劉英杰;胡國(guó)清;;頭頸部腫瘤放療后口腔干燥機(jī)理研究進(jìn)展[J];實(shí)用醫(yī)藥雜志;2006年09期

3 白永瑞,姚原,陸冬青,王香果,陳音,吳國(guó)華;鼻咽癌患者放療后口腔干燥的相關(guān)因素分析[J];上海第二醫(yī)科大學(xué)學(xué)報(bào);2003年S1期

4 何霞云;章英劍;應(yīng)紅梅;胡超蘇;何少琴;;鼻咽癌調(diào)強(qiáng)放療患者腮腺功能的動(dòng)態(tài)觀(guān)察[J];復(fù)旦學(xué)報(bào)(醫(yī)學(xué)版);2009年03期

5 何霞云;潘自強(qiáng);何少琴;環(huán)素蘭;付慈熹;劉泰福;;超分割后程加速放療鼻咽癌長(zhǎng)期結(jié)果分析[J];中華放射腫瘤學(xué)雜志;2006年06期

6 史瑞華,漆劍頻,馮定義,鄒明麗,胡軍武,朱文珍,夏黎明,王承緣;MR涎管造影臨床研究及應(yīng)用[J];中華放射學(xué)雜志;2004年08期

7 趙竹陶,王松靈,朱宣智;唾液量的檢測(cè)[J];中華口腔醫(yī)學(xué)雜志;1998年05期

8 孫曉南;陳愛(ài)中;謝聰穎;金獻(xiàn)測(cè);吳式t;張萍;李煥斌;;鼻咽癌調(diào)強(qiáng)放療腮腺功能變化與放射劑量、體積的關(guān)系[J];中華醫(yī)學(xué)雜志;2006年32期

，

本文編號(hào)：1674081