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目的探讨鼻咽癌患者放疗后常规MRI表现正常的颞叶脑白质微结构及血流动力学的变化特征。方法对56例常规MRI表现正常的鼻咽癌患者行全脑弥散张量成像(diffusion tensor imaging,DTI)及颞叶动态磁敏感性对比增强MR灌注成像(dynamic susceptibility contrast-enhanced perfusion MR imaging,DSCE-MR)检查。以放射治疗前14例患者作为对照组,放射治疗后42例患者按放疗后不同时期分为3组,每组14例:组1(0～6个月)、组2(6～12个月)、组3(>12个月)。测量放疗前后各组患者颞叶脑白质的部分各向异性分数(FA)及相对血流量(rCBF),采用单因素方差分析比较组间差异。结果对照组及放疗后各组的FA值分别为0.48±0.04、0.37±0.03、0.42±0.04和0.43±0.03,组间差异有统计学意义(F值为13.897,P<0.01)。进一步两两比较,放疗后各组FA值与放疗前相比均降低(P<0.05或P<0.01),放疗后6～12个月组、放疗后>12个月组均比放疗后0～6个月组升高(P<0.05或P<0.01)。对照组及放疗后各组rCBF值分别为23.21±3.67、17.56±3.01、18.58±3.48和20.34±2.59,组间差异有统计学意义(F值为8.714,P<0.01),放疗后各组rCBF值均比放疗前降低(P<0.05或P<0.01),放疗后>12个月组比放疗后0～6个月组升高(P<0.05)。结论 DTI及DSCE灌注成像可以从微观水平反映放射性脑损伤,可作为其早期动态监测评价的手段;血管损伤参与了早期放射性脑损伤。
Objective To investigate the changes of temporal lobe white matter microstructure and hemodynamics after conventional radiotherapy in patients with nasopharyngeal carcinoma. Methods Fifty-six patients with normal nasopharyngeal carcinoma (NPC) underwent routine MRI with diffusion tensor imaging (DTI) and dynamic contrast-enhanced magnetic resonance MR perfusion imaging (DSCE -MR) check. Forty-two patients in each group were divided into three groups according to different periods after radiotherapy: group 1 (0 to 6 months), group 2 (6 to 12 months ), Group 3 (> 12 months). The anisotropy fraction (FA) and relative blood flow (rCBF) of temporal white matter in each group were measured before and after radiotherapy. The differences between groups were compared using one-way ANOVA. Results The FA values of the control group and the groups after radiotherapy were 0.48 ± 0.04, 0.37 ± 0.03, 0.42 ± 0.04 and 0.43 ± 0.03, respectively. The difference between the two groups was statistically significant (F = 13.897, P <0.01). After a further pairwise comparisons, the FA values in all groups after radiotherapy were significantly lower than those before radiotherapy (P <0.05 or P <0.01) 6 months group increased (P <0.05 or P <0.01). The rCBF values of the control group and the radiotherapy group were 23.21 ± 3.67,17.56 ± 3.01,18.58 ± 3.48 and 20.34 ± 2.59 respectively, with significant difference (F = 8.714, P <0.01). The rCBF (P <0.05 or P <0.01). After 12 months of radiotherapy, the values were higher than those of 0 ~ 6 months after radiotherapy (P <0.05). Conclusion DTI and DSCE perfusion imaging can reflect radiation brain injury at the microscopic level, which can be used as a means of early dynamic monitoring and evaluation. Vascular damage is involved in early radiation brain injury.