【摘要】：目的：通過動(dòng)態(tài)監(jiān)測鼻咽癌轉(zhuǎn)移性淋巴結(jié)化放療過程中表觀彌散系數(shù)（ADC）值的變化，探討彌散加權(quán)成像（DWI）對化放療療效的價(jià)值。 方法：研究對象為30例經(jīng)穿刺活檢病理證實(shí)鼻咽癌伴頸部淋巴結(jié)轉(zhuǎn)移的患者，所有患者均接受鉑類化療及頭頸部調(diào)強(qiáng)適形放射治療（IMRT）正規(guī)鼻咽癌化放療治療方案。依據(jù)化放療原則，制定MRI檢查計(jì)劃，分別在治療前、治療中每3周一次及治療結(jié)束1個(gè)月后（即第1次化療前1天、第2次化療前1天、第1次放療前1天、第15次放療當(dāng)天及第30次放療當(dāng)天、治療結(jié)束1個(gè)月后共6次）各個(gè)時(shí)間點(diǎn)進(jìn)行MRI常規(guī)及DWI檢查。當(dāng)b值取800s/mm2時(shí)，觀察頸部轉(zhuǎn)移性淋巴結(jié)治療過程中ADC值的動(dòng)態(tài)變化，同時(shí)治療前淋巴結(jié)與治療后殘留的淋巴結(jié)ADC值的差異，并分別比較治療前后兩組淋巴結(jié)與正常舌肌的ADC值差異，統(tǒng)計(jì)學(xué)分析采用兩獨(dú)立樣本t檢驗(yàn)。 結(jié)果： 1.治療前107枚淋巴結(jié)的平均ADC值[（0.789±0.022）×10-3mm2/s]明顯低于治療前正常舌肌ADC值[（1.391±0.031）×10-3mm2/s]，兩者間差異具有統(tǒng)計(jì)學(xué)意義（t=33.3，，p0.001）。 2.治療過程中轉(zhuǎn)移性淋巴結(jié)平均ADC值逐漸上升，以第1次放療至第15放療期間最明顯。 3.治療后殘留淋巴結(jié)的平均ADC值[1.410±0.074）×10-3mm2/s]明顯增高，與治療前淋巴結(jié)比較差異有統(tǒng)計(jì)學(xué)意義（t=178.0，p0.001）；與治療后正常舌肌比較差異無統(tǒng)計(jì)學(xué)意義（t=0.8，p=0.445）。 結(jié)論： 1.通過MRI DWI監(jiān)測鼻咽癌轉(zhuǎn)移性淋巴結(jié)的ADC值的變化，結(jié)合其形態(tài)學(xué)改變，早期監(jiān)測鼻咽癌轉(zhuǎn)移性淋巴結(jié)化放療療效影像學(xué)指標(biāo)成為可能，第1次放療至第15次放療轉(zhuǎn)移性淋巴結(jié)平均ADC值變化對區(qū)分化放療反應(yīng)性較敏感，可作為有效的時(shí)間監(jiān)測點(diǎn)，從而指導(dǎo)臨床合理制定并及時(shí)優(yōu)化化療方案或放療計(jì)劃。 2.通過DWI動(dòng)態(tài)監(jiān)測鼻咽癌轉(zhuǎn)移性淋巴結(jié)化放療療效的評(píng)估，為臨床個(gè)體化提供依據(jù)，同時(shí)為研究其他腫瘤提供研究基礎(chǔ)。 3.對不能得到病理證實(shí)的淋巴結(jié)，可通過測量ADC值對其性質(zhì)提供判定依據(jù)。
[Abstract]:Objective: to investigate the value of diffusion weighted imaging (DWI) in the therapeutic effect of metastatic lymph node chemoradiotherapy for nasopharyngeal carcinoma (NPC) by monitoring the change of apparent diffusion coefficient (ADC). Methods: thirty patients with nasopharyngeal carcinoma (NPC) with cervical lymph node metastasis confirmed by biopsy were treated with platinum chemotherapy and head and neck intensity modulated conformal radiotherapy (IMRT). According to the principle of chemoradiotherapy, the plan of MRI examination was made, before treatment, once every 3 weeks during treatment and 1 month after the end of treatment (i.e. 1 day before the first chemotherapy, 1 day before the second chemotherapy, 1 day before the first radiotherapy, 1 day before the first chemotherapy, 1 day before the first radiotherapy, respectively). MRI and DWI were performed at each time point on the 15th radiotherapy day and the 30th radiotherapy day, 1 month after the end of the treatment. When b value was taken from 800s/mm2, the dynamic changes of ADC were observed during the treatment of metastatic lymph nodes in the neck, and the difference of ADC value between the pre-treatment lymph nodes and the residual lymph nodes after treatment was also observed. The ADC values of lymph node and normal tongue muscle were compared before and after treatment, and two independent samples t test were used for statistical analysis. Results: 1. The mean ADC value of 107 lymph nodes before treatment [(0.789 鹵0.022) 脳 10-3mm2/s] was significantly lower than that of normal tongue muscle before treatment [(1.391 鹵0.031) 脳 10-3mm2/s]. 2. The mean ADC value of metastatic lymph nodes increased gradually during the treatment, especially during the first radiotherapy to the 15th radiotherapy. 3. The mean ADC value of residual lymph nodes after treatment [1.410 鹵0.074 脳 10-3mm2/s] was significantly higher than that before treatment. There was no significant difference between the normal tongue muscle and the normal tongue muscle after treatment (t 0. 8%, P < 0. 445). Conclusion: 1. MRI DWI was used to monitor the changes of ADC value in metastatic lymph nodes of nasopharyngeal carcinoma (NPC). Combined with morphological changes, it was possible to monitor the therapeutic effects of chemoradiotherapy on metastatic lymph nodes of nasopharyngeal carcinoma (NPC) at early stage. The change of mean ADC value of metastatic lymph nodes from the first to the 15th radiotherapy is sensitive to the regional differentiation and radiotherapy reactivity and can be used as an effective time monitoring point to guide clinical rational formulation and timely optimization of chemotherapy or radiotherapy plans. 2. The evaluation of therapeutic effect of metastatic lymph node chemoradiotherapy on nasopharyngeal carcinoma (NPC) by dynamic monitoring by DWI provides evidence for clinical individualization as well as research basis for other tumors. 3. For lymph nodes which can not be confirmed by pathology, the nature of lymph nodes can be judged by measuring ADC value.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R739.63

【參考文獻(xiàn)】

相關(guān)期刊論文 前8條

1 胡偉漢,張國義,劉立志,吳湖炳,李立,高遠(yuǎn)紅,潘q

本文編號(hào)：2404871