【作者】 刘晓玉；

【导师】 王小宜；

【作者基本信息】 中南大学 ， 医学影像学与核医学， 2008， 硕士

【摘要】 目的:采用MRI-PWI评价靶向EBV-LMPl mRNA脱氧核酶辅助放疗鼻咽癌的疗效。方法:本院自2007年3月至2008年5月临床及病理诊断为鼻咽癌患者31例,完全双盲分组,其中17例为综合治疗组,14例为单纯放疗组。综合治疗组采用靶向EBV-LMPl mRNA的脱氧核酶+根治性放疗;单纯放疗组采用安慰剂+根治性放疗。分别在放疗前、放疗50Gy、放疗70Gy和放疗结束后3个月进行MRI以及PWI检查。通过MRI观察肿块消退的情况,以及放疗前、中、后PWI参数的改变来分析靶向EBV-LMP1 mRNA的脱氧核酶的疗效。PWI采用Turbo FLASH成像序列,肘前静脉团注Gd—DTPA(0.4mmol/kg),注射速率4ml/s。获得时间一信号强度曲线进行后处理,得到灌注参数E_R、Catake、EP、TTP。常规增强MRI横断位上勾画肿瘤边界,得到肿块体积,计算肿块缩小比率。结果:①三个时期的综合治疗组缩小率(平均秩和:15.33,14.92,16.5)与单纯放疗组肿块缩小率(平均秩和:9.67,10.08,8.5)之间的差异有统计学意义(P＜0.05)。②综合治疗组放疗50Gy时E_R(4.01±2.29/min)、Catake(287.41±101.54 ml/100cm~3)下降比单纯放疗组的E_R(8.08±4.23 enhancement)、Catake(384.91±42.36ml/100cm~3)明显,两组患者之间的差异有统计学意义(P＜0.05);③在放疗70Gy时,综合治疗组的E_R(2.70±1.48/min)、Catake(209.35±63.81 ml/100cm~3)和EP(2.59±0.70%)下降比单纯放疗组的E_R(6.06±3.21/min)、Catake(338.99±108.75 ml/100cm~3)、EP(3.41±0.65%)明显,与单纯放疗组之间的差异有统计学意义(P＜0.05);④在放疗结束后3个月时,综合治疗组的Catake(176.43±118.05 ml/100cm~3)仍低于单纯放疗组的Catake(347.09±153.15ml/100cm~3),两者之间的差异有统计学差异(P＜0.05)。结论:①运用PWI获得E_R、Catake、EP、TTP等参数评价肿瘤组织血管的渗漏性等,来判断放疗的疗效,转归及预后有重要的临床价值,可以有望成为临床判断肿块预后、疗效的备选指标。②MRI评价肿块的大小、形态、边界及淋巴结转移等用于明确病变范围、肿块分期及指导放疗定位等有重要的临床价值。③综合治疗较单纯放疗更有利于肿块的缩小、消退及降低病灶组织血管的渗漏性。更多还原

【Abstract】 Obieetive:Using MR perfusion imaging to evaluate targeting EBV-LMP1 mRNA deoxy ribozyme radiotherapy effect of the NPC.Methods:All these sections,which including 31 patients were all originated from Xiangya Hospital,Central South University from March 2007 to May 2008,were pathological diagnosised Nasopharyngeal cancer.They were divided into groups by double-blind,which including 17 patients in the testing group,14 patients un the contrasting group.The comprehensive treatment group use the EBV-LMP1 mRNA deoxyribozymes targeted therapy and radical radiotherapy,the radiotherapy alone group use placebo radical radiotherapy.All these patients were checked by MRI and PWI before radiotherapy,radiotherapy 50Gy,radiotherapy 70Gy and after 3 months of radiotherapy ending.The curative effect of EBV-LMP1 mRNA deoxyribozymes targeted therapy was analysis by observing the regression of tumor and changing the dabbling parameter,which before radiotherapy,in the radiotherapy and after radiotherapy.PWI using Turbo FLASH imaging sequence.Mission elbow intravenous injection Gd-DTPA(0.4mmol/kg),and the injection rate is 4 ml/s.TIC will be carried out after processing,and getting perfusion parameters,such as ER,Catake,EP,TTP.In conventional transverse- enhanced MRI,Sketched tumor borders and getted the mass volume,calculation of mass ratio.Results:During the three times,between the comprehensive treatment group masses reduced rate(the average rank:15.33,14.92,16.5) and the radiotherapy alone group masses reduced rate(the average rank: 9.67,10.08,8.5)had significant differences in the mass reduced rate.(P＜0.05).(?)In radiotherapy 50 Gy,the comprehensive treatment group’s E_R (4.01±2.29/min)and Catake(287.41±101.54ml/100cm~3)was significantly lower than the radiotherapy alone group’s E_R(8.08±4.23/min)、Catake(384.91±42.36 ml/100cm~3)(P＜0.05).(?)In radiotherapy 70 Gy,the comprehensive treatment group’s E_R(2.70±1.48/min)、Catake(209.35±63.81 ml/100cm~3)and EP(2.59±0.70%)was significantly lower than the radiotherapy alone group’s E_R(6.06±3.21/min)、Catake(338.99±108.75 ml/100cm~3)and EP(3.41±0.65%)(P＜0.05)(?)After 3 months of radiotherapy ending,the comprehensive treatment group’s Catake(176.43±118.05 ml/100cm~3) was significantly lower than the radiotherapy alone group’s Catake (347.09±153.15 ml/100cm~3)(P＜0.05).Conclusion:①Use PWI to get ER,Catake,EP and TTP,will help evaluation of tumor’s blood vessels leakage,judge radiation therapy,the outcome and prognosis has important clinical value,PWI is expected to become a mass prognosis of clinical judgement,by the effect of Election indicators.②Use MRI to evaluate the tumor size,shape,border and metastasis,will help to clear the masses border,staging mass and guiding radiotherapy has important clinical value.③The comprehensive treatment than the radiotherapy alone group may be more conducive to Reduce tumor size and vascular lesions of the leakage.更多还原