本文選題：涎腺 + 磁共振成像��； 參考：《復(fù)旦大學(xué)》2013年博士論文

【摘要】：第一部分 磁共振擴散加權(quán)成像評價涎腺功能的初步研究 目的探討利用磁共振擴散加權(quán)成像評價不同生理狀態(tài)下涎腺功能的可行性。材料與方法對30例涎腺功能正常的初診鼻咽癌患者行DW-EPI掃描,b值取0、400、600、800、1000s·mm-2。先于靜息狀態(tài)下對腮腺及頜下腺各掃描一次,然后給患者含服VitC100mg×6片,于酸刺激狀態(tài)下重復(fù)對腮腺掃描7次,每次間隔18s。手動勾劃包含整個腮腺或頜下腺的ROI, ADC值取選擇包含最大截面的三個層面的平均值。用配對t檢驗比較靜息狀態(tài)下腮腺和頜下腺ADC值的差別,以及酸刺激前后腮腺ADC值的變化。 結(jié)果靜息狀態(tài)下,腮腺的ADC值(1.23±0.12×10-3mm2/s)顯著低于頜下腺(1.34±0.07×10-3mm2/s, P0.001)。酸刺激后第一次掃描腮腺ADC值為1.41±0.19×10-3mm2/s,高于靜息時基值(P0.001)。隨后ADC值在基值上波動,酸刺激后ADC的最小值為1.24±0.14×10-3mm2/s,與基值比較差異無統(tǒng)計學(xué)意義(P=0.189)；最大值為1.49±0.20×10-3mm2/s,7次掃描的平均值為1.36±0.17×10-3mm2/s,均與基值差異有統(tǒng)計學(xué)意義(P0.001)。 結(jié)論MRDWI通過ADC值的量化,可觀察到正常涎腺酸刺激前后的功能變化。 第二部分 磁共振擴散加權(quán)成像結(jié)合酸刺激對放療前后涎腺功能的評價 目的探討利用磁共振擴散加權(quán)成像結(jié)合酸刺激在評估頭頸部腫瘤患者放療前后涎腺功能中的價值。 材料與方法對23例接受調(diào)強放射治療的鼻咽癌患者于放療前、放療后1周及放療后1年進(jìn)行MRDWI檢查,并在相同時間點根據(jù)RTOG/EORTC放射損傷分級標(biāo)準(zhǔn)對患者的臨床癥狀進(jìn)行口干評級。DWI掃描b值取0、400、600、800、1000s·mm-2。每次檢查先于靜息狀態(tài)下對腮腺及頜下腺各掃描一次,然后給患者含服維生素C100mg×6片,于酸刺激狀態(tài)下重復(fù)對腮腺掃描7次,每次間隔18s。測量腮腺的靜息ADC值、酸刺激后最大值、最小值、平均值、ADC升高值和酸刺激后ADC達(dá)峰時間,以及頜下腺的ADC值,觀察放療前后的變化,并結(jié)合患者的口干評級作對比研究。 結(jié)果放療中腮腺的平均受照劑量(40.82±4.60Gy)明顯低于頜下腺(59.78±3.58Gy,P0.001)。放療后1周,所有患者的口干評級由0級升為2級,放療后1年有13例患者口干評級降為1級,10例仍為2級。所有患者的腮腺ADC值均于放療后1周先升高(P0.001),然后于放療后1年下降(P0.001)；酸刺激后達(dá)峰時間及頜下腺ADC值放療后升高(均為P0.001),未出現(xiàn)明顯下降(分別為P=0.957,P=0.581)。與放療前對酸刺激的反應(yīng)相同,放療后1周、放療后1年腮腺酸刺激后ADC值升高(均為P0.001),靜息值與ADC最小值無明顯差異。 根據(jù)放療后1年口干評級分組,口干1級患者腮腺受照平均劑量明顯低于口干2級患者(P0.001),但兩組之間頜下腺無明顯差異(P=0.100)。對于腮腺,放療后1周,口干1級患者酸刺激后ADC最小值、平均值和達(dá)峰時間低于口干2級患者(分別為P=0.012,P=0.025,P=0.019),且口干2級患者靜息ADC值低于酸刺激后ADC最小值(P=0.037)；放療后1年,口干1級患者酸刺激后ADC升高值高于口干2級患者(P=0.048)。對于頜下腺,放療后1周,口干1級患者ADC值高于口干2級患者(P=0.013)；放療后1年,口干1級患者ADC值有下降(P=0.017),而口干2級患者ADC值未見明顯回落(P=0.222)。 結(jié)論ADC值是涎腺功能損傷的一項敏感指標(biāo),并可以早期反映出臨床口干評級的變化。MRDWI有可能成為一種新的無創(chuàng)監(jiān)測涎腺功能及口干嚴(yán)重程度的客觀檢查方法。第三部分 三維FRFSE序列在MR涎管成像中的應(yīng)用及酸刺激前后的對比研究 目的評估磁共振(MR)涎管成像中三維快速恢復(fù)快速自旋回波序列(3D-FRFSE)對涎腺導(dǎo)管系統(tǒng)的顯示,并通過酸刺激前后的對比研究優(yōu)化MR涎管成像的技術(shù)。材料與方法采用3.0T磁共振儀和八通道頭頸聯(lián)合線圈對27例涎腺功能正常的初診鼻咽癌患者進(jìn)行磁共振檢查。MR涎管成像中使用3D-FRFSE序列,掃描范圍包含雙側(cè)腮腺和頜下腺,成像時間約8-9分鐘。所有患者先于靜息狀態(tài)下掃描一次,然后給患者含服維生素C100mg×6片,于酸刺激后再重復(fù)掃描一次。觀察涎管分支的顯示情況,根據(jù)涎管系統(tǒng)評分標(biāo)準(zhǔn)對涎管可見度進(jìn)行評分,并比較酸刺激前后的差異。 結(jié)果使用3D-FRFSE序列進(jìn)行MR涎管成像可以清晰顯示腮腺及頜下腺的導(dǎo)管系統(tǒng),部分腮腺甚至可以顯示出腺內(nèi)三級分支。靜息狀態(tài)下腮腺和頜下腺二級分支的顯示率分別為61.1%、20.4%,酸刺激后分別提高為85.2%、31.5%(P0.001,P=0.031)。靜息狀態(tài)下腮腺和頜下腺導(dǎo)管可見度評分分別為3.57±0.63、1.83±0.38,酸刺激后分別為4.85±0.66、2.46±0.69,均高于其靜息狀態(tài)導(dǎo)管評分(均為P0.001)。 結(jié)論MR涎管成像中3D-FRFSE序列可以成功顯示涎管系統(tǒng),且酸刺激后導(dǎo)管的顯示更佳。 第四部分 MR涎管成像對頭頸部腫瘤放療后口干癥中涎管損傷的隨訪研究 目的探討利用磁共振涎管成像評價頭頸部腫瘤放療后口干癥的可行性及其臨床價值。 材料與方法對21例接受調(diào)強放射治療的鼻咽癌患者于放療前、放療后1周及放療后1年進(jìn)行MR涎管成像檢查,并在相同時間點根據(jù)RTOG/EORTC放射損傷分級標(biāo)準(zhǔn)對患者的臨床癥狀進(jìn)行口干評級。MR涎管成像中使用3D-FRFSE序列,掃描范圍包含雙側(cè)腮腺和頜下腺,成像時間約8-9分鐘。所有患者先于靜息狀態(tài)下掃描一次,然后給患者含服維生素C100mg×6片,于酸刺激后再重復(fù)掃描一次。根據(jù)涎管系統(tǒng)評分標(biāo)準(zhǔn)對涎管可見度進(jìn)行評分,并比較放療前后靜息及酸刺激后涎管評分的差異。結(jié)果所有患者腮腺的平均受照劑量(39.73±4.30Gy)明顯低于頜下腺(59.34± 3.24Gy,P0.001)。放療后1周,所有患者的口干評級由0級升為2級,放療后1年有12例患者口干評級降為1級,9例仍為2級。所有患者的腮腺及頜下腺靜息導(dǎo)管評分和酸刺激后導(dǎo)管評分均于放療后1周降低(均為P0.001),放療后1年腮腺導(dǎo)管評分較前回升(靜息P=0.002,酸刺激后P=0.001),但頜下腺導(dǎo)管評分未見明顯改善(靜息P=0.070,酸刺激后P=0.698)。與放療前對酸刺激的反應(yīng)相同,放療后1周、放療后1年酸刺激后腮腺及頜下腺評分均高于靜息狀態(tài)(均為P0.001)。 根據(jù)放療后1年口干評級分組,口干1級患者腮腺受照平均劑量明顯低于口干2級患者(P=0.008),但兩組之間頜下腺無明顯差異(P=0.962)。放療后1年,口干1級患者腮腺導(dǎo)管的顯示好于口干2級患者,但兩組之間頜下腺導(dǎo)管的顯示無明顯差異。 結(jié)論MR涎管成像可以成功顯示放療前后涎管系統(tǒng)的變化,并反映出不同程度口干之間的差異,有潛力成為評估涎腺功能和隨訪放療后口干癥的一種新的無創(chuàng)性檢查方法。
[Abstract]:Part one
Evaluation of salivary gland function by diffusion weighted imaging
Objective to evaluate the feasibility of using magnetic resonance diffusion weighted imaging to evaluate the function of salivary glands in different physiological states. Materials and methods were used to scan 30 cases of nasopharyngeal carcinoma with normal function of salivary gland with DW-EPI. The value of B was 04006008001000s mm-2. before the parotid and submaxillary glands were scanned once in resting state, and then the patients were given VitC100mg 6 slices were repeated to the parotid gland for 7 times in the acid stimulation state, and each interval 18s. manually outlined the ROI containing the whole parotid or submandibular gland. The ADC value selected the average of the three layers containing the maximum cross section. The parotid and submandibular gland ADC values in the resting state were compared with the paired t test, and the changes of the parotid gland ADC value before and after acid stimulation were compared.
Results the ADC value (1.23 + 0.12 * 10-3mm2/s) of parotid gland was significantly lower than that of the submandibular gland (1.34 + 0.07 x 10-3mm2/s, P0.001). The ADC value of the parotid gland was 1.41 + 0.19 x 10-3mm2/s after the acid stimulation, which was higher than the resting time base value (P0.001). Then the ADC value fluctuated on the base value, and the minimum value of ADC was 1.24 + 0.14 x 10-3mm2/s after acid stimulation and the base value. The difference was not statistically significant (P=0.189), the maximum value was 1.49 + 0.20 x 10-3mm2/s, the average value of the 7 scan was 1.36 + 0.17 x 10-3mm2/s, and the difference was statistically significant (P0.001).
Conclusion MRDWI can be used to quantify the function of normal salivary glands before and after acid stimulation by quantifying ADC values.
The second part
Evaluation of salivary gland function before and after radiotherapy by diffusion weighted imaging combined with acid stimulation
Objective to evaluate the value of magnetic resonance diffusion-weighted imaging combined with acid stimulation in evaluating salivary gland function before and after radiotherapy for patients with head and neck cancer.
Materials and methods 23 cases of nasopharyngeal carcinoma were examined by MRDWI before radiotherapy, 1 weeks after radiotherapy and 1 years after radiotherapy, and at the same time point, the.DWI scan b value of the patients' clinical symptoms was evaluated by the b value of 04006008001000s. Mm-2. before the resting state. The parotid gland and submandibular gland were scanned once, and then the patients were given vitamin C100mg x 6, repeated parotid scan 7 times under acid stimulation, 18s. at each interval, the resting ADC value of parotid gland, the maximum value, the minimum value, the mean value after acid stimulation, the ADC peak time after the acid stimulation and the ADC value of the submandibular gland, and the observation of the radiation of the submandibular gland. The changes were compared with the patients' dry mouth rating.
Results the average exposure dose of parotid gland in radiotherapy (40.82 + 4.60Gy) was significantly lower than that of submandibular gland (59.78 + 3.58Gy, P0.001). 1 weeks after radiotherapy, the dry mouth rating of all patients increased from 0 to 2. 13 patients had a 1 level of dry mouth rating in 1 years after radiotherapy. 10 cases were still 2. The ADC value of the parotid gland in all patients increased first (P0.001) after radiotherapy (P0.001), and then at the end of the radiotherapy (P0.001). 1 years after radiotherapy (P0.001), peak time and ADC value of submandibular gland increased after radiotherapy (all P0.001), and no significant decrease was found (P=0.957, P=0.581, respectively). The response to acid stimulation was the same as before radiotherapy. 1 weeks after radiotherapy, the value of ADC increased after 1 years of parotid acid stimulation (P0.001), and there was no significant difference between the resting value and the minimum value of ADC. Different.
According to the 1 year after radiotherapy group, the average dose of the parotid gland was significantly lower than that of the dry mouth 2 (P0.001), but there was no significant difference between the two groups (P=0.100). For the parotid gland, 1 weeks after radiotherapy, the minimum value of ADC after the acid stimulation of the 1 stage of the dry mouth was lower than that of the 2 patients (P=0.012, P=0 respectively, respectively). .025, P=0.019), and the resting ADC value of the 2 class of dry mouth patients was lower than the ADC minimum value (P=0.037) after the acid stimulation; 1 years after radiotherapy, the increase of ADC in the dry mouth 1 patients was higher than that of the dry mouth 2 (P=0.048). For the submandibular gland, 1 weeks after radiotherapy, the ADC of the dry mouth 1 patients was higher than that of the stoma 2 (P=0.013); and 1 years after radiotherapy, ADC of the 1 level patients with dry mouth had ADC values. Decreased (P=0.017), while the ADC level of 2 patients with dry mouth did not decrease significantly (P=0.222).
Conclusion ADC is a sensitive index of functional injury of salivary glands, and it can reflect the change of the clinical dry mouth rating early..MRDWI may be a new objective examination method for the noninvasive monitoring of salivary gland function and the severity of dry mouth. The third part
Application of three-dimensional FRFSE sequence in MR sialduct imaging and comparative study before and after acid stimulation
Objective to evaluate the display of the salivary duct system by fast spin echo sequence (3D-FRFSE) in magnetic resonance imaging (MR) sialo imaging and to optimize the technique of MR sialo imaging by contrast before and after acid stimulation. Materials and methods used 3.0T magnetic resonance (3.0T) magnetic resonance (MRI) and eight channel head and neck coils for the first diagnosis of normal salivary glands. Patients with cancer of the pharynx underwent magnetic resonance imaging (MRI).MR sialorol imaging using the 3D-FRFSE sequence, which included bilateral parotid and submandibular glands, and the imaging time was about 8-9 minutes. All patients were scanned at resting state first, then the patients were given vitamin C100mg x 6, and repeated scans were repeated after acid stimulation. The display of salivary tube branches was observed. The salivary duct visibility was scored according to the salivary duct system score, and the difference was compared before and after acid stimulation.
Results MR sialo imaging can clearly display the duct system of the parotid and submandibular glands with 3D-FRFSE sequence. Part of the parotid gland can even display the three branches in the gland. The two branches of the parotid and submandibular glands in resting state were 61.1%, 20.4% respectively, and 85.2%, 31.5% (P0.001, P=0.031) were raised respectively after acid stimulation. The visibility score of the parotid and submandibular gland ducts was 3.57 + 0.63,1.83 + 0.38, respectively, and 4.85 + 0.66,2.46 + 0.69 respectively after acid stimulation, which were all higher than those of the resting state catheter score (P0.001).
Conclusion the 3D-FRFSE sequence in MR sialtube imaging can successfully display the salivary duct system, and the display of the catheter after acid stimulation is better.
The fourth part
MR salivary tube imaging for salivary duct injury following radiotherapy for head and neck cancer: a follow-up study
Objective to evaluate the feasibility and clinical value of magnetic resonance Sialon imaging in evaluating xerostomia after radiotherapy for head and neck cancer.
Materials and methods MR sialography was performed on 21 patients with nasopharyngeal carcinoma before radiotherapy, 1 weeks after radiotherapy and 1 years after radiotherapy, and the 3D-FRFSE sequence was used in the.MR sialol imaging of patients' clinical symptoms according to the RTOG/EORTC radiation damage classification standard at the same time point. The scan range included double. The imaging time of the parotid and submandibular glands was about 8-9 minutes. All the patients were scanned at resting state first, then the patients were given vitamin C100mg x 6 tablets and repeated scans after acid stimulation. The sialol visibility was graded according to the sialol system score standard, and the difference of the sialol score before and after the therapy was compared. Results the average dose of parotid gland in all patients (39.73 + 4.30Gy) was significantly lower than that in the submandibular gland (59.34 +).
3.24Gy, P0.001). 1 weeks after radiotherapy, the dry mouth rating of all patients rose from grade 0 to grade 2. 12 patients had a 1 grade of dry mouth rating in 1 years after radiotherapy. 9 cases were still 2. All patients' parotid and submandibular gland resting catheter score and acid irritation catheter score decreased at 1 weeks after radiotherapy (all P0.001). The parotid duct score was more than 1 years after radiotherapy. There was no significant improvement in the submandibular gland duct score (resting P=0.002, P=0.001 after acid stimulation) (resting P=0.070, P=0.698 after acid stimulation). The response to acid stimulation was the same as before radiotherapy. 1 weeks after radiotherapy, the parotid and submandibular gland score of the parotid gland and the submandibular gland were all higher than those in the resting state (P0.001) after 1 years of acid stimulation.
The average dose of parotid gland exposure in 1 years after radiotherapy was significantly lower than that of grade 2 (P=0.008), but there was no significant difference between the two groups (P=0.962). 1 years after radiotherapy, the parotid duct in the 1 stage of dry mouth was better than the dry mouth 2, but there was no significant difference in the display of the submandibular gland ducts between the two groups.
Conclusion MR sialialo imaging can demonstrate the changes in the sialol system before and after radiotherapy, and reflect the difference between dry mouth and dry mouth. It has the potential to be a new noninvasive method to evaluate salivary gland function and follow up after radiotherapy.

【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2013
【分類號】：R445.2;R739.91;R730.55

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