本文關(guān)鍵詞： 血氧水平依賴功能磁共振成像 運(yùn)動(dòng)皮層區(qū) 腦星形細(xì)胞瘤 放射治療 劑量保護(hù)　出處：《寧夏醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的探討在制定腦星形細(xì)胞瘤術(shù)后放療計(jì)劃時(shí)，血氧水平依賴功能磁共振成像（Blood Oxygenation Level Dependent Functional Magnetic Resonance Imaging，BOLD-fMRI）指導(dǎo)實(shí)施運(yùn)動(dòng)皮層區(qū)劑量保護(hù)，進(jìn)而達(dá)到功能保護(hù)的臨床應(yīng)用價(jià)值，并通過BOLD-fMRI研究腦星形細(xì)胞瘤及其外科腫瘤切除術(shù)對運(yùn)動(dòng)區(qū)的影響。 方法27例腦星形細(xì)胞瘤術(shù)后擬行進(jìn)一步放療患者，瘤灶鄰近運(yùn)動(dòng)皮層區(qū)，行常規(guī)MRI及BOLD-fMRI檢查。以BOLD-fMRI檢查結(jié)果（腦皮層運(yùn)動(dòng)功能區(qū)的激活圖像）為指導(dǎo)將運(yùn)動(dòng)皮層區(qū)的位置、范圍標(biāo)記于放療定位CT上，并將其作為危及器官（Organsat Risk，OAR）處理，即在確保靶區(qū)投照劑量的前提下盡量減少運(yùn)動(dòng)區(qū)的受照劑量，進(jìn)而制定具有針對性區(qū)域保護(hù)作用的放療計(jì)劃，并與未行此保護(hù)的常規(guī)計(jì)劃進(jìn)行運(yùn)動(dòng)區(qū)受照劑量對比；并通過分析BOLD-fMRI檢查所得運(yùn)動(dòng)功能區(qū)激活圖，了解星形細(xì)胞瘤及其外科手術(shù)對腦皮層運(yùn)動(dòng)區(qū)的影響。 結(jié)果①本組中18例靶區(qū)與正常生理狀態(tài)下運(yùn)動(dòng)區(qū)距離較近，其中15例病灶呈明顯浸潤狀態(tài)，并推擠甚至部分破壞運(yùn)動(dòng)區(qū)，通過“城垛樣”時(shí)間-信號(hào)強(qiáng)度曲線確定的術(shù)后運(yùn)動(dòng)區(qū)相較于正常生理狀態(tài)下的解剖位置及對側(cè)未受腫瘤及手術(shù)影響的相應(yīng)部位出現(xiàn)移位，9例運(yùn)動(dòng)區(qū)部分破壞的病例，其患側(cè)運(yùn)動(dòng)激活區(qū)明顯減小，6例激活信號(hào)出現(xiàn)在非傳統(tǒng)運(yùn)動(dòng)區(qū)。②保護(hù)性較非保護(hù)性計(jì)劃在運(yùn)動(dòng)皮層區(qū)的平均受照劑量減低程度：患側(cè)—最少0.76%、最多59.20%、平均30.78%，健側(cè)—最少23.33%、最多68.30%、平均48.07%；減低程度的變異系數(shù)，患側(cè)71.41%，健側(cè)36.71%；兩種計(jì)劃在雙側(cè)分別行配對t檢驗(yàn)，結(jié)果均為P0.05；9例因患側(cè)運(yùn)動(dòng)區(qū)與靶區(qū)毗鄰甚至部分重疊，故其平均劑量減低程度較小，最少0.76%、最多18.61%、平均12.21%。 結(jié)論應(yīng)用BOLD-fMRI技術(shù)，，能夠在放療前直觀的了解腦星形細(xì)胞瘤及其外科切除術(shù)對運(yùn)動(dòng)皮層區(qū)的影響；并在腦星形細(xì)胞瘤術(shù)后放療計(jì)劃的制定中，在保證靶區(qū)治療劑量的同時(shí)，盡量減低運(yùn)動(dòng)區(qū)受量，進(jìn)而使相應(yīng)運(yùn)動(dòng)功能的保護(hù)成為可能，最終提高患者的生存質(zhì)量。
[Abstract]:Objective to explore in the development of brain astrocytoma postoperative radiotherapy plan, blood oxygenation level dependent functional magnetic resonance imaging (Blood Oxygenation Level Dependent Functional Magnetic Resonance Imaging, BOLD-fMRI) the implementation of motor cortex dose guidance, and achieve the function of protecting the clinical value of BOLD-fMRI, and through the study of brain astrocytoma and its surgical tumor resection effect operation on the motor area.
Methods 27 cases of astrocytoma patients after undergoing further radiotherapy in patients with tumors near the motor cortex, underwent MRI and BOLD-fMRI examination. The examination results of BOLD-fMRI (activation of the motor cortex of the brain image) as the guide to the motor cortex position range of markers in radiotherapy on CT, and as the organs at risk (Organsat Risk, OAR), which in order to ensure the target projection dose under the premise of minimizing the dose of sports area, and has formulated plans for the protection of regional radiotherapy, conventional plan and not for the protection of motor area dose contrast; and through the analysis of BOLD-fMRI examination the motor cortex activation map, to understand the effect of astrocytoma and its surgical operation on the motor area of the cerebral cortex.
The results from the group of motor areas in 18 cases, the target and the normal physiological state is near, including 15 cases of lesions showed obvious infiltration, and even push the partial destruction of motor area, the corresponding parts are determined by the "battlements" time signal intensity curve of the postoperative anatomical position and normal physiological state of motor area compared to the next on the side without tumor and the effects of the operation shift, cases of partial destruction of the motor area in 9 cases, the ipsilateral motor activation areas decreased significantly, 6 cases of activation signals appeared in the non traditional sports area. The protection of a non protected plan average in the motor cortex area dose level: ipsilateral - at least 0.76%, up to 59.20%, average 30.78%, contralateral - at least 23.33%, up to 68.30%, average 48.07%; reduce the coefficient of variation of the degree of ipsilateral contralateral 36.71%; 71.41%, two respectively in the plan of bilateral paired t test results were P0.05 9 cases were adjacent to the target area and even partially overlapped, so the average dose decreased slightly, at least 0.76%, up to 18.61%, with an average of 12.21%.
Conclusion the application of BOLD-fMRI technology in radiotherapy intuitive understanding of brain astrocytoma and its surgical resection effect on motor cortex; and in astrocytoma postoperative radiotherapy planning, to ensure the target dose at the same time, to reduce motor area by volume, and make corresponding protection of motor function possible, eventually improve the life quality of patients.

【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R445.2;R739.41

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