摘要
目的探讨MRI量化评估技术检测鼻咽癌(NPC)患者放疗后胸锁乳突肌纤维化的可行性及临床应用价值。方法收集2019年8月至2021年3月在浙江大学丽水医院复查的NPC放疗后的患者45例(病例组)和同期体检的健康志愿者30名(对照组),根据放射治疗肿瘤组/欧洲癌症研究和治疗组织(RTOG/EORTC)制定的晚期放射性损伤分级标准,病例组双侧胸锁乳突肌晚期放射性损伤Ⅰ、Ⅱ、Ⅲ级分别有8、32、5例。所有被试均行颈部T_(1) mapping和T_(2) mapping成像。采用西门子公司图像后处理工作站NUMARIS/4软件生成伪彩图,然后在轴面伪彩图的喉室水平沿胸锁乳突肌边缘手动勾画感兴趣区,分别测量左侧和右侧胸锁乳突肌T_(1)、T_(2)值及长径与短径。其次,由1名医师分析并比较两组间图像中胸锁乳突肌的直观影像表现。最后采用独立样本t检验进行组间分析,并采用Spearman秩相关分析病例组双侧胸锁乳突肌的平均T_(1)值、T_(2)值与晚期放射损伤分级的关系。结果病例组胸锁乳突肌较对照组形态缩小、边缘欠规整,T_(1) mapping伪彩图色阶不均匀升高,T_(2) mapping伪彩图示肌肉信号差异不明显;病例组左侧和右侧胸锁乳突肌的T_(1)值分别为(1524.7±97.6)、(1496.5±93.2)ms,对照组分别为(1231.5±85.3)、(1275.9±90.9)ms;病例组左侧和右侧胸锁乳突肌的T_(2)值分别为(28.4±4.8)、(28.4±3.6)ms,对照组的分别为(30.4±3.5)、(30.4±3.5)ms,双侧胸锁乳突肌的T_(1)、T_(2)值组间差异均有统计学意义(P均<0.05)。病例组双侧胸锁乳突肌的长径与短径均较对照组缩短(P均<0.05)。NPC患者放疗后双侧胸锁乳突肌平均T_(1)值和T_(2)值分别为(1510.6±95.4)、(28.4±4.2)ms,T_(1)值与晚期放射损伤分级呈正相关(r=0.78,P<0.001),T_(2)值与晚期放射损伤分级呈负相关(r=-0.87,P<0.001)。结论mapping量化评价技术可无创性客观检测和评价NPC放疗后胸锁乳突肌纤维化,具有潜在的临床应用价值。
Objective To investigate the feasibility and clinical value of MRI quantitative evaluation technique in detecting sternocleidomastoid muscle fibrosis in patients with nasopharyngeal carcinoma(NPC)after radiotherapy.Methods From August 2019 to March 2021,45 patients with clinically confirmed NPC after radiotherapy and 30 healthy controls who underwent physical examination in Lishui Hospital of Zhejiang University were enrolled in our study.According to the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer(RTOG/EORTC)classification criteria of late radiation reactions respectively,the sternocleidomastoid muscle injury in the NPC group was divided into gradeⅠ,ⅡandⅢ,which included 8,32 and 5 patients respectively.All patients underwent T_(1) mapping and T_(2) mapping imaging of the neck.Firstly,the mapping images of sternocleidomastoid muscle between the two groups were analyzed and compared.Using NUMARIS/4 software of Siemens image post-processing workstation,the region of interest was manually drawn along the edge of sternocleidomastoid muscle at the level of laryngeal chamber in axial mapping diagram.Then,T_(1) and T_(2) values and the long and short diameters of sternocleidomastoid muscle were measured respectively.Finally,the differences of the parameters between the two groups were compared by independent sample t-test,Spearman rank correlation was used to analyze the relationship between the average T_(1) and T_(2) values of bilateral sternocleidomastoid muscles and the grade of late radiation injury.Results Compared with the control group,the shape of sternocleidomastoid muscle in the NPC group was smaller in shape,with irregular edge and uneven increase of T_(1) mapping color scale.There was no significant difference in muscle signal in T_(2) mapping.The T_(1) values of left and right sternocleidomastoid muscles in the NPC group were(1524.7±97.6)and(1496.5±93.2)ms respectively,which were significantly higher than those in the normal control group[(1231.5±85.3)and(1275.9±90.9)ms](P<0.05),and the T_(2) values of left and right sternocleidomastoid muscles in the NPC group were(28.4±4.8)and(28.4±3.6)ms respectively,which were lower than those in the normal control group[(30.4±3.5)and(30.4±3.5)ms](P<0.05).The long and short diameters of bilateral sternocleidomastoid muscles in the NPC group were shorter than those in the control group(P<0.05).The average T_(1) and T_(2) values of bilateral sternocleidomastoid muscles in NPC patients after radiotherapy were(1510.6±95.4)and(28.4±4.2)ms respectively,The T_(1) value was positively correlated with the classification of advanced radiation injury(r=0.78,P<0.001),and T_(2) value was negatively correlated with the level of advanced radiation injury(r=-0.87,P<0.001).Conclusion Mapping quantitative evaluation technique can noninvasively and objectively detect and evaluate sternocleidomastoid muscle fibrosis after NPC radiotherapy,which has potential clinical application value.
作者
叶勇军
余日胜
陈家骏
周宝鹤
尚飞
章若梦
纪建松
Ye Yongjun;Yu Risheng;Chen Jiajun;Zhou Baohe;Shang Fei;Zhang Ruomeng;Ji Jiansong(Department of Radiology,Lishui Hospital of Zhejiang University,Lishui 323000,China;Department of Radiology,the Second Affiliated Hospital of Medical College of Zhejiang University,Hangzhou 310009,China)
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2022年第3期309-313,共5页
Chinese Journal of Radiology
基金
浙江省医药卫生科技计划项目(2020KY1077)。
关键词
磁共振成像
鼻咽肿瘤
纤维化
放疗并发症
胸锁乳突肌
Magnetic resonance imaging
Nasopharyngeal neoplasms
Fibrosis
Radiotherapy-related complications
Sternocleidomastoid
