本文選題：磁共振涎管成像　切入點：彌散加權磁共振成像　出處：《復旦大學》2010年碩士論文

【摘要】： 磁共振影像對鼻咽癌放療前后涎腺功能的評價研究 【目的】探索磁共振涎管成像(MRS)和彌散加權磁共振成像(DW MRI)兩種影像方法評價鼻咽癌放療前后涎腺(腮腺、下頜下腺)功能的可行性,與患者主觀評價的相關性。結合鼻咽癌不同治療策略(單純放療和放化療序貫治療)分析化療對口干嚴重程度的影響。 【方法】2009年8月至2010年3月間,病理證實且無遠處轉移的初治鼻咽癌患者進入研究。Ⅰ、Ⅱa期患者采用單純放療,Ⅲ、Ⅳ期患者采用誘導化療+放療+輔助化療各2療程。放療采用IMRT技術,鼻咽部總劑量66 Gy(T1-2)/30次或70.4 Gy(T3-4)/32次,2.2 Gy/次,5次/周。TPF方案：多西他賽60mg/m2 ivgttd1,順鉑25mg/m2 ivgtt d1-3,5-氟脲嘧啶2500 mg/m2 civ120h。每3周重復。放療前、后患者分別行MRS和DW MRI檢測雙側腮腺和頜下腺功能。應用一種MRS評分系統(tǒng)對患者放療前后及酸刺激前后涎腺導管進行評分,并結合RTOG/EORTC口干標準和EORTC QLQ-C30和QLQ-HN35量表進行分析。 【結果】共17例患者進入研究(單純放療組5例和序貫放化療組12例)。所有患者均完成預期的放射治療及化療。所有患者雙側腮腺平均受照劑量為39.04Gy(SD,3.75Gy),雙側頜下腺平均受照劑量為57.83Gy(SD,2.95Gy)。治療后,QLQ-C30量表顯示序貫放化療組除惡心嘔吐較單純放療組明顯加重外,其余各領域生活質量無統(tǒng)計學意義上的下降。QLQ-HN35量表的9項口干相關癥狀領域/條目前者比后者評分明顯升高(即生活質量降低),差異有統(tǒng)計學意義(P均0.05)。得到高質量MRS圖像,酸刺激涎腺導管評分升高,放療后導管評分下降,對酸刺激反應較放療前差。放療后酸刺激前后腮腺導管評分差值兩組間有統(tǒng)計學差異(P=0.023),且與QLQ-C30量表的總生活質量領域有正相關性(rs=0.485,p=0.049),與QLQ-HN35量表中的口干條目有負相關性(rs=-0.486,p=0.048)。放療前腮腺表觀彌散系數(shù)(apparent diffusion coefficient, ADC)平均值為(1.16±0.18)×10-3mm2/s,酸刺激后ADC值升高([1.27±0.18]×10-3mm2/s,P0.001)。放療后相同時間點ADC值較放療前升高。放療后酸刺激后ADC值較靜息時升高([1.98±0.27]×10-3mm2/s vs. [1.27±0.18[×10-3mm2/s, P0.001)。放療前在酸刺激后的最初5分鐘,76.5%的腮腺ADC值呈上升趨勢,最大值出現(xiàn)時間個體差異較大,約在6min-21min范圍內。放療后腮腺酸刺激后ADC值變化呈無序性。將序貫放化療組患者腮腺按平均受照劑量(Dmean)為≤39Gy和39Gy分為2組,兩組腮腺導管酸刺激前后得分差值差異有統(tǒng)計學意義(P=0.016)。將序貫放化療組患者腮腺按V35≤52%(中位值)和52%分為2組,兩組腮腺導管酸刺激前后得分差值差異有統(tǒng)計學意義(P=0.041)。 【結論】MRS和DW MRI可以無創(chuàng)檢測涎腺放療前后功能變化,用來評價鼻咽癌患者放療后口干嚴重程度有巨大的潛力。TPF方案序貫放化療口干早期反應較單純放療嚴重。減少腮腺照射劑量,有利于早期腮腺功能特別是酸刺激后分泌功能的保護。
[Abstract]:Evaluation of salivary gland function of nasopharyngeal carcinoma before and after radiotherapy by magnetic resonance imaging
[Objective] to explore the magnetic resonance sialography (MRS) and diffusion-weighted magnetic resonance imaging (DW MRI) two imaging methods evaluated before and after radiotherapy for nasopharyngeal carcinoma of salivary gland (parotid gland, submandibular gland function) the feasibility of correlation with subjective evaluation of patients with nasopharyngeal carcinoma. Combined with different treatment strategies (radiotherapy and chemotherapy sequential therapy) analysis of the effect of chemotherapy on xerostomia severity.
[Methods] from August 2009 to March 2010, confirmed by pathology and metastasis of nasopharyngeal carcinoma were enrolled into the study. First, patients in stage a were treated with radiotherapy, III, IV were treated with induction chemotherapy + radiotherapy + chemotherapy 2 radiotherapy treatment. Using IMRT technology, the total dose of nasopharynx in 66 Gy (T1-2) /30 or 70.4 Gy (T3-4) /32, 2.2 Gy/, 5 times / week.TPF: Docetaxel 60mg/m2 ivgttd1, cisplatin 25mg/m2 IVGTT d1-3,5- fluorouracil 2500 mg/m2 civ120h. was repeated every 3 weeks. Before radiotherapy, patients underwent MRS and DW MRI detection of bilateral parotid and submandibular gland function. Application of a MRS scoring system to score the patients before and after radiotherapy before and after acid stimulation of salivary duct, and combined with the RTOG/EORTC standard and EORTC QLQ-C30 dry mouth and QLQ-HN35 scale were analyzed.
[results] a total of 17 patients entered the study (radiotherapy group 5 cases and sequential chemotherapy group 12 cases). All patients completed radiotherapy and chemotherapy. All patients expected bilateral parotid mean dose of 39.04Gy (SD, 3.75Gy), bilateral submandibular gland the average dose of 57.83Gy (SD, 2.95Gy). After treatment, the QLQ-C30 scale showed sequential chemoradiotherapy in addition to nausea and vomiting compared with radiotherapy alone group was significantly increased, the quality of life was no significant decline in the scale of 9.QLQ-HN35 dry mouth symptoms related to field / the score was significantly higher than the latter (i.e., reduced quality of life), there was statistical significance the difference (P < 0.05). To obtain high quality MRS images, acid stimulation of salivary gland were increased after radiotherapy, catheter score decreased, the acid stimulation than before radiotherapy. Radiotherapy after acid stimulation before and after parotid duct score differences between the two groups had statistical difference ISO (P=0.023), and there is a positive correlation with the total quality of life scale of QLQ-C30 (rs=0.485, p=0.049), a negative correlation with the QLQ-HN35 scale in dry mouth (rs=-0.486, p=0.048). The entry before radiotherapy of parotid gland and apparent diffusion coefficient (apparent diffusion, coefficient, ADC) average (1.16 + 0.18) * 10-3mm2/s, ADC increased after acid stimulation ([1.27 + 0.18] * 10-3mm2/s, P0.001) after radiotherapy. At the same time ADC value higher than before radiotherapy. Radiotherapy after acid stimulation ADC values were elevated resting ([1.98 + 0.27] + 0.18[* 10-3mm2/s vs. [1.27 * 10-3mm2/ s, P0.001) before radiotherapy after acid stimulation in. The first 5 minutes, 76.5% of the parotid gland ADC value increased, the maximum time of individual differences, approximately in the range of 6min-21min. The parotid gland after radiotherapy after acid stimulation ADC value change with the disorder. The sequential chemotherapy group according to the average dose of parotid gland (Dmean) is less than or equal to 39Gy and 3 9Gy were divided into 2 groups, statistically significant difference of scores of the two groups before and after acid stimulation of parotid duct (P=0.016). The sequential chemoradiotherapy group patients with parotid gland by V35 is less than or equal to 52% (median 52%) and divided into 2 groups, statistically significant difference of scores of the two groups before and after acid stimulation of parotid duct (P= 0.041).
[Conclusion] MRS and DW MRI can be noninvasive detection of salivary gland function changes before and after radiotherapy, to evaluate the severity of xerostomia in patients with nasopharyngeal carcinoma after radiotherapy has the potential to.TPF huge sequential chemotherapy xerostomia early response compared with radiotherapy alone. Seriously reduce the parotid irradiation dose, is conducive to the early parotid gland function especially the protection of secretory function after acid stimulation.

【學位授予單位】：復旦大學
【學位級別】：碩士
【學位授予年份】：2010
【分類號】：R739.63

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