宫颈癌中子刀(252锎)放射治疗前后MRI检查的临床价值

1、文档收集于互联网，已重新整理排版.word版本可编借，有帮助欢迎下载支持. 宫颈癌中子刀（252钿）放射治疗前后MRI检 查的临床价值 作者：张殿波 荣荥 王旭东徐兵宋万江 戴志学 【摘要】目的分析宫颈癌中子刀（252钢）放射治疗前后的MRI 表现，探讨MRI对宫颈癌中子刀（252 #8）放射治疗后的诊断价值。方 法 对100例经病理证实的宫颈癌患者在中子刀（252钿）放射治疗前及 放疗后不同时间段行MRI扫描。每次MRI扫描均用相同的扫描方法。 在MRI图像上观察肿瘤中子刀（252钢）放射治疗前后的大小、信号改 变及其周围结构的变化，进行对比分析。结果放疗结束时，局部控 制率100%;78例

2、肿瘤消失;22例肿瘤明显缩小，缩小率85%o肿瘤 信号改变：放疗结束后，78例肿瘤信号消失，T2WI及STIR无异常信 号改变，22例T2WI及STIR见有肿瘤信号;T1WI增强，78例无异常信 号改变或轻微强化，22例不均匀强化;放疗后2年内，97例无异常信 号改变;T1WI增强成像后，90例无异常信号改变，3例轻微强化。7 例T2WI及STIR仍见有不均匀肿瘤信号，但较前期信号明显降低,T1WI 增强，肿瘤呈不均匀强化。放疗后盆腔内脏器的表现：并发直肠炎性 改变5例，肠壁增厚（6mnT-9. 5mm）, T1WI呈等信号，T2WI及STIR呈 高信号;膀胱炎性改变3例，膀胱壁增厚（6. 2

3、mm）, T1WI呈等信号，T2WI 及STIR呈高信号;子宫颈限局性改变3例，T1WI呈低信号，T2WI及 STIR呈高信号。放疗后2年内，上述改变恢复正常或轻微纤维化。结 论MRI检查可反映中子刀（252 J）对肿瘤的疗效，是评价宫颈癌中子 刀（252钢）放射治疗疗效及预后的最佳检查手段。放疗结束后，肿瘤 缩小程度、T2WI上的信号改变及T1WI增强扫描瘤内有无强化区是预 测中子刀(252 tW)放射治疗效果的重要观测指标。 【关键词】子宫颈癌；中子刀(252钿)；放射治疗;磁共振成像 Clinical value in evaluating of cervical cancer to n

4、eutron-knife radiation therapyZHAXG Dianbo, RONG Xing, WAXG Xu-dong, et al. Department of MRI, the Hospital of Heilongjiang Farm , Harbin ChinaAbstract Objective To analysis the image of MR I and discuss Othe diagnostic value of MR I in evaluating of cervical cancer to neutron-knife radiation therap

5、y Methods lOOcases were checked by MR I before and after radiation therapy that were confirmed by pathology with cervical cancer Same scan methods were done We compared and discussed the changing of image in size , signal and surrounding of tumor befor and after neutron-knife radiation therapy . Res

6、ults At the end of radiation therapy , rate of partial control was 100% . Among them , tumors was disappear in 78 cases , tumors got smaller obviously in 22 cases , small rate was more than 85% Signal changing of tumors : At the end of radiation therapy , signal were disappear in 78 cases , no abnor

7、mal signal changing were seen at T2WI and STIR Tumors signal were seen in 22 cases . In T1WI enhancement , no signal changing or slight enhancement were in 78 cases , uneven enhancement were in 22 cases In two years after radiation therapy , no abnormal signal changing were in 97 cases . After T1WI

8、enhancement , no abnormal signal changing were in 90 cases , slight enhancement were in 3 cases Uneven tumors signal were seen in 7 cases at T2WI and STIR . Signals was lower than before In T1WI enhancement , uneven enhancement were seen in tumors Pelvis organs image after radiation therapy : inflam

9、mation and thickness of rectal were in 5 cases , T1WI was even signal , T2WI and STIR was high signal ; inflammation and thickness of bladder were 3 cases T1WI was even signal , T2WI and STIR weres high signal Changing of cervical were 3 cases , T1WI was low signal , T2WI and STIR were high signal I

10、n 2 years after radiation therapy , the changing was normal or slight fiber Conclusion Image of MR I can evalua te of cervical cancer of neutron-knife radiation therapy and is good method to do so . After radiation therapy , it is an important evaluating tool in size of tumors , changing of signals

11、and enhancement Key words uterus cervical cancer; neutron-nife (Cal ifornium-252); radiation therapy; magnetic resonance imaging 对中晚期(II b以上)的子宫颈癌(uterus cervical cancer , UCC),放射治疗(简称放疗)是首选的治疗方法。国内外多采 用192Ir或137Cs高剂量率Y射线腔内后装治疗。而中子刀（252钿） 近距离治疗妇科恶性肿瘤始于20世纪60年代后期1、2、3,己取得 了很好疗效。有关UCC放疗前后MRI的研究文献，国内己有

12、诸多报道, 表明MRI是UCC放疗后判断疗效及预后的最佳检查方法。但MRI对中 子刀（252钿）腔内放射治疗UCC后诊断的研究，国内外少有报道。笔 者搜集100例经病理证实UCC中子刀（252钿）放疗前后的MRI资料， 系统观察UCC经中子刀（252钢）治疗后的MRI表现，结合文献及临床 随访资料分析总结如下。 材料与方法 1、临床资料 选取2003年8月2008年12月，未接受过任 何治疗的100例原发性宫颈癌患者均经活检确诊，年龄21-76岁，平 均 Clinical value in evaluating of cervical cancer to neutron-knife radia

13、tion therapy ZHANG Dianbo, RONG Xing, WANG Xudong, et al. Department of MRI, the Hospital of Heilongjiang Farm , Harbin China Abstract Objective To analysis the image of MRI and discuss Othe diagnostic value of MRI in evaluating of cervical cancer to neutron-knife radiation therapy Methods lOOcases

14、were checked by MRI before and after radiation therapy that were confirmed by pathology with cervical cancer . Same scan methods were done We compared and discussed the changing of image in size , signal and surrounding of tumor befor and after neutron-knife radiation therapy . Results At the end of

15、 radiation therapy , rate of partial control was 100% . Among them , tumors was disappear in 78 cases , tumors got smaller obviously in 22 cases , small rate was more than 85% . Signal changing of tumors : At the end of radiation therapy , signal were disappear in 78 cases , no abnormal signal chang

16、ing were seen at T2WI and STIR Tumors signal were seen in 22 cases In T1WI enhancement , no signal changing or slight enhancement were in 78 cases , uneven enhancement were in 22 cases In two years after radiation therapy , no abnormal signal changing were in 97 cases . After T1WI enhancement , no a

17、bnormal signal changing were in 90 cases , slight enhancement were in 3 cases Uneven tumors signal were seen in 7 cases at T2WI and STIR Signals was lower than before In T1WI enhancement , uneven enhancement were seen in tumors Pelvis organs image after radiation therapy : inflammation and thickness

18、 of rectal were in 5 cases , T1WI was even signal , T2WI and STIR was high signal ; inflammation and thickness of bladder were 3 cases T1WI was even signal , T2WI and STIR weres high signal Changing of cervical were 3 cases , T1WI was low signal , T2WI and STIR were high signal In 2 years after radi

19、ation therapy , the changing was normal or slight fiber Conclusion Image of MR I can evaluate of cervical cancer of neutron-knife radiation therapy and is good method to do so . After radiation therapy , it is an important evaluating tool in size of tumors , changing of signals and enhancement Key w

20、ords uterus cervical cancer; neutron-nife （Californium-252） ; radiation therapy; magnetic resonance imaging 对中晚期（lib以上）的子宫颈癌（uterus cervical cancer , UCC）,放射治疗（简称放疗）是首选的治疗方法。国内外多采 用192Ir或137Cs高剂量率Y射线腔内后装治疗。而中子刀（252钿） 近距离治疗妇科恶性肿瘤始于20世纪60年代后期1、2、3,已取得 了很好疗效。有关UCC放疗前后MRI的研究文献，国内己有诸多报道, 表明MRI是UCC放疗后判断疗效

21、及预后的最佳检查方法。但MRI对中 子刀（252钿）腔内放射治疗UCC后诊断的研究，国内外少有报道。笔 者搜集100例经病理证实UCC中子刀（252钿）放疗前后的MRI资料， 系统观察UCC经中子刀（252钿）治疗后的MRI表现，结合文献及临床 随访资料分析总结如下。 材料与方法 Abstract Objective To analysis the image of MRI and discuss Othe diagnostic value of MRI in evaluating of cervical cancer to neutron-knife radiation therapy Me

22、thods lOOcases were checked by MRI before and after radiation therapy that were confirmed by pathology with cervical cancer Same scan methods were done We compared and discussed the changing of image in size , signal and surrounding of tumor befor and after neutron-knife radiation therapy . ResuIts

23、At the end of radiation therapy , rate of partial control was 100% Among them ,tumors was disappear in 78 cases , tumors got smaller obviously in 22 cases , small rate was more than 85% Signal changing of tumors : At the end of radiation therapy , signal were disappear in 78 cases , no abnormal sign

24、al changing were seen at T2WI and STIR Tumors signal were seen in 22 cases . In T1WI enhancement , no signal changing or slight enhancement were in 78 cases , uneven enhancement were in 22 cases In two years after radiation therapy , no abnormal signal changing were in 97 cases . After T1WI enhancem

25、ent , no abnormal signal changing were in 90 cases , slight enhancement were in 3 cases Uneven tumors signal were seen in 7 cases at T2WI and STIR . Signals was lower than before In T1WI enhancement , uneven enhancement were seen in tumors Pelvis organs image after radiation therapy : inflammation a

26、nd thickness of rectal were in 5 cases , T1WI was even signal , T2WI and STIR was high signal ; inflammation and thickness of bladder were 3 cases T1WI was even signal , T2WI and STIR weres high signal Changing of cervical were 3 cases , T1WI was low signal , T2WI and STIR were high signal In 2 year

27、s after radiation therapy , the changing was normal or slight fiber Conclusion Image of MR I can evaluate of cervical cancer of neutron-knife radiation therapy and is good method to do so . After radiation therapy , it is an important evaluating tool in size of tumors , changing of signals and enhan

28、cement Key words uterus cervical cancer; neutron-nife （Cal ifornium-252）; radiation therapy; magnetic resonance imaging 对中晚期（I【b以上）的子宫颈癌（uterus cervical cancer , UCC）,放射治疗（简称放疗）是首选的治疗方法。国内外多采 用192Ir或137Cs高剂量率Y射线腔内后装治疗。而中子刀（252钿） 近距离治疗妇科恶性肿瘤始于20世纪60年代后期1、2、3,己取得 了很好疗效。有关UCC放疗前后HRI的研究文献，国内己有诸多报道, 表明MR

29、I是UCC放疗后判断疗效及预后的最佳检查方法。但MRI对中 子刀（252钿）腔内放射治疗UCC后诊断的研究，国内外少有报道。笔 者搜集100例经病理证实UCC中子刀（252钿）放疗前后的MRI资料， 系统观察UCC经中子刀（252钿）治疗后的MRI表现，结合文献及临床 随访资料分析总结如下。 材料与方法 1、临床资料 选取2003年8月2008年12月，未接受过任 何治疗的100例原发性宫颈癌患者均经活检确诊，年龄21-76岁，平 均年龄48.5岁。治疗前分期采用国际妇产科协会(international federation of gynecology and obstetrics , FI

30、GO)分类法，结合 MRI 检查判定1、4K本组IIB28例,IIIA20例，IIIB46例，IVA6例；89例 为宫颈鳞癌，中分化52例，低分化26例，高分化12例;腺癌10例。 2、治疗方法 应用中子刀(252钿)腔内后装治疗配合8MVX或 10MVX直线加速器同时行全盆腔照射治疗。首先行252钿中子腔内治 疗，A点剂量810Gy/次，1次/W, 45次/疗程。参考A点的剂量达 3640Gy。中子治疗的第2周，全盆腔行8MVX或10MVX直线加速器采 用前后野对穿外照射,外照射总剂量为4050Gy,平均45Gy, 2Gy/ 次，4次/W,当剂量达到2030Gy时，盆腔中央扫4cm厚铅块。

31、3、MRI检查 采用GE Signa Profil/I 0. 2T永磁型开放式磁 共振成像仪。检查前适量饮水，带金属节育环者，取出节育环后进行 检查。所有病例放疗前后均行以下序列和方位的盆腔扫描：轴位SE T1WI序列,TR440ms, TE13ms,激励次数(NEX)5;轴位、矢状位和/ 或冠状位快速自旋回波(FSE)T2WI序列,TR33004000ms, TE 132ms, 回波链长度(ETL)IO11,激励次数6;轴位频带预饱和反转恢复法 脂肪抑制技术(spectral saturation inversion recovery , STIR); 轧喷酸葡胺(0. 2ml/kg体重)静

32、脉注射后行轴位、矢状位及冠状位化 学位移成像(out of phave )扫描。所有扫描序列视野(F0V)26,层厚 6mm,层间距2mm,扫描矩阵256 X 160。 100例患者，放疗前MRI检查1次，放疗后2年内不同时间 段做25次不等的MRI扫描。每次MRI检查后，对肿瘤消失者，均做 宫颈刮片或行组织活检。结果 1、宫颈癌放疗后肿瘤的MRI表现（1）肿瘤大小形态变化：中 子刀（252钿）放射治疗前肿瘤大小为7. 4cm316. 5cm3;规则形43例， 不规则形57例。放疗结束时，局部控制率100%, 78例肿瘤消失，12 例肿瘤明显缩小（图1）,缩小率85%（图2, 3） ; （2）

33、肿瘤信号变化：放 疗结束后，78例肿瘤信号消失，T2WI及STIR无异常信号改变，22例 T2WI及STIR见有肿瘤信号;T1WI增强，78例无异常信号改变或轻微 强化（图1）, 22例不均匀强化（图2, 3）;放疗后2年内，97例无异常 信号改变;T1WI增强成像后，90例无异常信号改变，3例轻微强化（图 1、2, 3）o 7例T2WI及STIR仍见有不均匀肿瘤信号，但较前期信号 明显降低，T1WI增强，肿瘤呈不均匀强化（图3）。 2、放疗后盆腔内脏器的MRI表现 放疗结束后，并发直肠炎 性改变5例，肠壁增厚（6mm9. 5mm）, T1WI呈等信号，T2WI及STIR 呈高信号（图2）;膀

34、胱炎性改变3例，膀胱壁增厚（6.2mm）, T1WI呈等 信号，T2WI及STIR呈高信号（图1）;子宫颈限局性改变3例，T1WI呈 低信号，T2WI及STIR呈高信号。放疗后2年内，上述改变恢复正常 或轻微纤维化。 讨论 宫颈腺癌特别是恶性程度较高的腺癌，对一般的低LETY射 线（如60钻、137艳、192铁等丫射线）不甚敏感，但中子射线属于高 LET射线，对高分化及低分化腺癌均较敏感，故应用中子刀（252钿） 放射治疗UCC,大大提高了局部控制率及生存率，文献研究报道，平 均肿块直径达52mm, 3年局部控制率达97. 4%, 3年总生存率达81. 8%;5 年存活率可达7080%2、5、

35、6、7、8。本组50例2年局部控制率 达100%, 2年总生存率100%o MRI具有高的组织分辨率和多方位、多序列成像方法及无损 伤的独特优势，能清晰显示子宫颈、子宫（可显示子宫浆膜层、肌层及 粘膜层，这是其他影像检查方法无法比拟的）及盆腔其他脏器、盆腔内 间隙及盆腔的解剖层次。 有关UCC放疗前后MRI的研究文献，国内己有诸多报道9、 10、11、12、13、14,表明MRI是UCC放疗后判断疗效及预后的最佳 检查方法。但中子刀（252 tW）治疗UCC后的MRI表现，国内外文献少 有报道。笔者对100例UCC患者经中子刀（252钿）治疗后的MRI表现 研究分析，得出以下结论：由于中子射线

36、独特的放射生物学特性， 无论是宫颈鳞癌或腺癌，中子刀（252钢）放射治疗UCC后肿块可消失 或明显缩小（缩小率达85%以上）至消失，且疗后并发症的发生率。 具有独特优势的MRI可直观地显示中子刀（252钿）放射治疗UCC后肿 瘤大小和信号的变化情况。尤其是T2WI及T1WI增强扫描信号变化不 仅可反应残留的肿瘤组织，亦可反映放疗4、15。放疗结束时肿瘤缩 小程度、T2WI上的信号改变及T1WI增强扫描瘤内有无强化区是预测 中子刀（252钿）放射治疗效果的重要观测指标。 【参考文献】 1.赵维勇,王科明，孙坚,等.252钿（Cf）中子腔内后装加外照 射治疗子宫颈癌的临床观察J.中国癌症杂志,20

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38、ky gyn carcinoma for futureJ. Strahlenther Oncol, 1994, 170(5): 253-263. 4. 王劲，张雪林，赵修义，等.HRI诊断放射治疗前后宫颈 癌的临床价值J.中国医学影像学杂志,2004, 12(5)： 355-357. 5. 单锦露，雷新，王东，等.252钿中子腔内后装治疗子宫 颈癌的3年临床观察J.中华妇产科杂志,2005, 44(5)： 442-444. 6. Maruyama Y, Pavlov AS, Kostromina KN. Clinical experience of neutron brachytherapy for patients with cervix carcinoma : califomium-252 , Is