| 严森祥,严丹方,杨劲松,孙晓丽,陆中杰,廖芯标,谢静静.磁共振弥散成像在鼻咽癌颈部淋巴结转移调强放射治疗中的应用[J].中华放射医学与防护杂志,2011,31(3):312-316 |
| 磁共振弥散成像在鼻咽癌颈部淋巴结转移调强放射治疗中的应用 |
| Use of diffusion-weighted magnetic resonance imaging in cervical lymph node metastasis from nasopharyngeal carcinoma patients receiving intensity modulated radiation therapy |
| 投稿时间：2010-09-28 |
| DOI：10.3760/cma.j.issn.0254-5098.2011.03.016 |
| 中文关键词: 磁共振弥散加权成像 表观弥散系数 颈部淋巴结 鼻咽癌 调强放射治疗 |
| 英文关键词:Diffusion-weighted magnetic resonance imaging Apparent diffusion coefficient Cervical lymph nodes Nasopharyngeal carcinoma Intensity modulated radiation therapy |
| 基金项目:浙江省科技计划(491010-J30818) |
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| 中文摘要: |
| 目的 探讨磁共振弥散成像(DWI)及表观弥散系数(ADC)在鼻咽癌颈部淋巴结转移调强放射治疗(intensity modulated radiation therapy, IMRT)前的诊断及其对放化疗反应的监测能力。方法 对18例病理确诊的鼻咽癌患者在治疗前、治疗中每周及治疗后1个月行DWI检查。所有患者均接受头颈部IMRT及铂类同步化疗。在DWI上共分析了52枚颈部异常淋巴结,将其分为最短径≥10 mm (32枚) 及<10 mm(20枚)两组,测量比较治疗前两组的ADC值是否存在差异,观察所有淋巴结治疗过程中ADC值的动态变化,同时观察比较治疗后残存的颈部淋巴结与正常舌肌的ADC值。结果 最短径≥10 mm淋巴结的平均ADC值为(0.71±0.12)×10-3mm/s,与最短径<10 mm者的平均ADC值[(0.73±0.16)×10-3mm/s]差异无统计学意义(t= 1.11, P =0.27)。治疗前52枚淋巴结的平均ADC值明显低于正常舌肌(t=19.35, P <0.01)。治疗过程中ADC值逐渐上升,以第1、2周改变最明显,以后趋于平稳。治疗后残留淋巴结的ADC值明显增大,与治疗前比较差异有统计学意义( t= 12.72, P <0.01),与正常舌肌比较差异无统计学意义(t= 0.34, P =0.73)。结论 在鼻咽癌IMRT中,DWI对诊断颈部转移性淋巴结以及监测后者对放化疗的反应具有重要参考价值,从而帮助临床医生合理制定并及时更改放疗计划。 |
| 英文摘要: |
| Objective To investigate the value of diffusion-weighted magnetic resonance imaging (DWI) and apparent diffusion coefficients (ADC) in detecting metastatic lymph nodes from nasopharyngeal carcinoma (NPC), and predicting the response of these nodes to concurrent chemoradiation (CRT). Methods Eighteen patients with pathologically proven NPC received conventional magnetic resonance imaging (MRI) and DWI before treatment, weekly during treatment, and one month after treatment. DWI was performed using a single-shot echo-planar (SSEPI) MR imaging sequence with b values of 0 and 1500 s/mm2. ADC maps were reconstructed for all patients and ADC values were calculated for each lymph node and tongue muscle. Totally fifty-two morphologically abnormal lymph nodes were analyzed. The ADC values of the metastatic lymph nodes before treatment were compared between those with the short axis≥10 mm (n=32) and those with the short axis<10 mm (n=20), and the dynamic changes in ADC values of the lymph nodes before, during, and after therapy were observed and recorded. Results The average ADC of the 32 lymph nodes with the short axis ≥10 mm was (0.71±0.12)×10-3 mm/s, not significantly different from that of the 20 lymph nodes with the short axis <10 mm [(0.73±0.16)×10-3 mm/s, t= 1.11, P =0.27]. The average ADC values of these lymph nodes before treatment was significantly lower than that of the tongue muscle (t=19.35, P <0.0001). During CRT, the ADC values of the lymph nodes increased gradually, with the most evident change in the first two weeks before reaching a relatively flat plateau thereafter. The ADC value of the residual lymph nodes after CRT was significantly higher than that before treatment (t= 12.72, P <0.0001),however, not statistically significant different from that of the normal tongue muscle (t= 0.34, P =0.73). Conclusions DWI plays an important role in diagnosing the metastatic lymph nodes from NPC and is feasible for observation of the early response of the lymph nodes to IMRT, thus helping the clinicians make appropriate treatment planning and replanning in the course of radiotherapy. |
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