| 张玉,张青波,赵超云,王晓东,赵婷,朱凯.血氧依赖功能磁共振成像联合IMRT技术在胶质瘤术后放疗语言功能区保护中的应用[J].中华放射医学与防护杂志,2021,41(12):931-936 |
| 血氧依赖功能磁共振成像联合IMRT技术在胶质瘤术后放疗语言功能区保护中的应用 |
| The application of blood oxygen level dependent functional magnetic resonance imaging (BOLD-fMRI) to the protection of language functional area during postoperative IMRT of cerebral gliomas |
| 投稿时间：2021-05-14 |
| DOI：10.3760/cma.j.issn.0254-5098.2021.12.009 |
| 中文关键词: 血氧水平依赖磁共振功能成像 语言功能区 脑胶质瘤 调强放射疗法 |
| 英文关键词:Blood oxygen level-dependent functional magnetic resonance imaging Language functional area Cerebral gliomas Intensity-modulated radiotherapy |
| 基金项目:国家自然科学基金项目（81260373）；宁夏自然科学基金（NZ16272） |
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| 中文摘要: |
| 目的 探讨血氧依赖功能磁共振成像（blood oxygen level dependent functional magnetic resonance imaging，BOLD-fMRI）联合调强放疗（IMRT）技术对单侧额、颞叶脑胶质术后放疗患者的语言功能区保护的临床应用价值。方法 选取27例单侧额、颞叶脑胶质瘤术后放疗患者，放疗前行定位CT及BOLD-fMRI检查，在定位CT及3D T1融合图上勾画出语言功能区。运用IMRT技术制定常规放疗计划和语言功能区保护性放疗计划，比较分析两种计划PTV的最大辐射剂量（Dmax）、平均辐射剂量（Dmean）、靶区适形度（CI）、剂量均匀性（HI）以确保保护性放疗计划达到放疗标准，再比较分析语言功能区所受的Dmax、Dmean，分析保护性放疗计划语言功能区的Dmax、Dmean的变化。结果 常规放疗计划和保护性放疗计划PTV的CI、HI、Dmax及Dmean差异均无统计学意义（P>0.05）。与常规放疗计划相比，保护性放疗计划中患者的Wernicke区和Broca区（健侧及患侧）的Dmax、Dmean有所降低，其中健侧降低明显，差异有统计学意义（t=3.073~12.707，P<0.05）。结论 BOLD-fMRI联合IMRT技术既能保证脑胶质瘤术后放疗患者的靶区治疗剂量又能降低语言功能区的辐射剂量。汉语朗读任务及段落理解任务作为脑肿瘤术后患者语言功能区的刺激模式，任务简单，效果确切。 |
| 英文摘要: |
| Objective To investigate the clinical application value of blood oxygen level dependent functional magnetic resonance imaging (BOLD-fMRI) to the protection of language function in patients with unilateral frontal and temporal lobes glioma receiving postoperative intensity modulation radiation therapy (IMRT). Methods A total of 27 patients with unilateral frontal and temporal lobe gliomas were treated with postoperative radiotherapy. The planning CT and BOLD-fMRI were performed before radiotherapy, and the language functional areas were delineated based on the fused images of 3D T1 and CT. IMRT technology was used to develop radiotherapy plans with and without language function area protection, naming conventional and protective radiotherapy plans respectively. The maximum radiation dose (Dmax), average radiation dose (Dmean), target conformal (CI) and dose uniformity (HI) of PTV of the two plans were compared and analyzed to ensure that the protective radiotherapy plan could meet the radiotherapy standard. Then, the Dmax and Dmean of the language function area were compared and analyzed to evaluate whether the Dmax and Dmean of the language function area were decreased in the protective radiotherapy plan. Results There were no significant differences in CI, HI, Dmax and Dmean of PTV between the conventional radiotherapy plan and protective radiotherapy plan (P>0.05). There were statistically significant differences in Dmax and Dmean of Wernicke's and Broca's (healthy side and affected side) between the conventional radiotherapy plan and protective radiotherapy plan (t=3.073-12.707, P<0.05). Dmax and Dmean of Wernicke's and Broca's (healthy side and affected side) were decreased in the protective radiotherapy plan compared with the conventional radiotherapy plan, and the decrease was significant in the healthy side. Conclusions BOLD-fMRI combined with IMRT can not only guarantee the target dose of patients with glioma receiving postoperative radiotherapy, but also reduces the radiation dose to the language function area. Chinese reading task and paragraph comprehension task are the stimulation mode of language function in patients after brain tumor surgery. These tasks are simple and the effect is accurate. |
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