| PART 1 The analysis of the related factors of radiation encephalopathy of nasopharyngeal carcinoma[Objective]To analysis the related factors of radiation encephalopathy of nasopharyngeal carcinoma, to explore the dangerous factors and its clinical significance.[Material and method]1.Investigate objects707 cases of nasopharyngeal carcinoma patients after radiotherapy examed in Southern Hospital during December 2002 to December 2010 were included in this study, the people had conventional and enhanced CT or MRI scan. All patients selected are as follows:nasopharyngeal carcinoma were diagnosed by histopathology and radiotherapy; had the CT or MRI examination; the imaging no clear signs show invasion of the base of skull and brain metastasis, without brain tumors, no history fo cerebrovascular disease and instracranial surgery. All patiens have relatively intact clinical information.2.General information and group All patients were 707 cases,516 cases were male,191 cases were female, aged 13 to 77 years old, with average age of 45.87±11.114 years old. The group of radiation encephalopathy of nasopharyngeal carcinoma were 157 cases,122 cases were male,35 cases were female, aged 26～77 years old, with average age of 49.01±10.995 years; the group of no radiation encephalopathy were 550 cases,393 cases were male,156 cases were female, aged 13～76 years old, with average age of 44.98±10.994 years.3.Examination techniqueCT examination adopt the United States, GE Lightspeed 16 row helical CT, slice thick and distance 7mm, the dose were 1.5ml/Kg, velocity of flow were 2.5ml/s in the enhancement scan. MRI examination adopt the United States, GE signa excite 3.0T and the Germany, the Siemens Vision Plus 1.5T MRI superconductive scanners. Conventional and contrast enhanced MRI scan were used, receiving T1-weighted images (T1WI), T2-weighted images (T2WI) and water suppression image (FLAIR). T1WI:TR 450ms, TE 14ms, T2WI:TR 5000ms, TE 128ms, T2 FLAIR:TR 9000ms, TE 110ms, TI 1100ms, slice thick 6.0～8.0ms, distance 2mm. Position:Axial, coronal, part of patients added sagittal scan. Post administration of Gadopentetate Dimeglumine(O.lmmol/Kg).4.The related factors enactmentAccording to the subject request, we divided into two groups. To noted and analysis the related factors of the radiation encephalopathy of nasopharyngeal carcinoma, we can get detailed clinical information, including gender, age, pathological type, clinical stage, lymph node condition of neck, metastasis, method, dose, chemotherapy, hepertension, diabetes mellitus, arteriosclerosis of the cerebral and carotid arteries, other underlying diseases, relapse, the second course of radiation and so on. 5.Statistical analysisThe SPSS 13.0 software was applied in this study. All measurement data are indicate as the mean±standard deviation(x±s) and histogram, count data are indicate as percentage and bar diagram, using Pearson chi-square test the contrast of the count data, level data and the abnormal distribution used Wilcoxon test. Multiple logistic regression was uesd to analysis the related factors. The level of test a was 0.05, P<0.05 consider that the difference was statistically significant.[Results]1.124 cases were the first course of radiation of encephalopathy,33 cases were the second course. the first course of radiation latent period 48.27±39.974 months, the other one 46.18±35.243 months, it's earlier than the first course; which occurred in the left temporal lobe lesions were 32 cases,32 cases of right temporal lobe,79 case of bilateral temporal lobe,3 cases of bilateral cerebellar hemispheres,9 cases of brain stem and 2 cases of bilateral frontal, the predilection site was bilateral temporal lobe.2. The related factors of radiation encephalopathy after radiotherapy showed that gender, chemotherapy, lymph node conditions, diabetes mellitus, metastasis were no significant difference (P> 0.05). Age(χ2=15.466, P=0.000), pathological type(x2 =31.373, P=0.000), radiation methods(χ2=31.898, P=0.000), high blood pressure(x2 =25.372, P=0.000), courses (χ2=32.551, P=0.000)and relapse(χ2=13.064, P=0.000) were statistically significant, clinical stage(χ2=-2.755, P=0.006) and radiotherapy dose (χ2=12.336, P=0.002)and carotid/cerebral arteriosclerosis(χ2=6.692, P=0.010) were statistically significant.3. Multiple logistic regression of the radiation encephalopathy showed that clinical stage, age, treatment method, hypertension, carotid/cerebral arteriosclerosis and the second course after re-occurrence of nasopharyngeal carcinoma were risk factors. The exp(B) of hypertension was 3.6, the ratio carotid/cerebral arteriosclerosis leaded to radiation encephalopathy was 2.883, the second course was 3.94, the later clinical stage, the higher risk of radiation encephalopathy, and the elderly people, the greater risk of radiation encephalopathy. Conventional and three-dimensional conformal radiation therapy makes the risk of radiation encephalopathy of NPC increase 6.202 times and 2.384 times, therefore, intensity modulated radiation therapy can control the occurrence of radiation encephalopathy.[Conclusion]1. It's useful to find the radiation encephalopathy of nasopharyngeal carcinoma acorrding to medical imaing examination, it's better than clinical examinations, radiotherapy patients should follow up regularly, we can find the abnormal signal earlier to cure this disease. The predilection site was bilateral temporal lobe. the second course of radiation latent period is shorter than the first course.2. Age, pathological type, clinical stage, radiation methods, dose, high blood pressure, carotid/cerebral arteriosclerosis, courses and relapse were statistically significant.3. Age, clinical stage, radiation methods, hypertension, carotid/cerebral arteriosclerosis and courses after re-occurrence of nasopharyngeal carcinoma were risk factors to radiation encephalopathy of nasopharyngeal carcinoma, we should strengthen the follow-up and monitoring to the old people, the late clinical stage, the people who used conventional method, had hypertension, carotid/cerebral arteriosclerosis and several radiationtherapy, we should actively cure the underlying diseases, to pay attention to the first course of radiationtherapy, control the second course strictly.PART 2 The dynamic follow-up MRI study of radiation encephalopathy of nasopharyngeal carcinoma [Objective]To study and explore the MRI imaging of the nasopharyngeal carcinoma patients after radiotherapy on long-term follow-up, in order to correctly understand the performance of MRI radiation encephalopathy of nasopharyngeal carcinoma and its variation.[Material and method]1.Investigate objectsThe subjects were from the first part of the 157 cases who occurred radiation encephalopathy of nasopharyngeal carcinoma,98 cases of nasopharyngeal carcinoma patients after radiotherapy examed conventional and enhanced MRI scan in the imaging center of Nanfang Hospital,81 cases were male,17 cases were female, with average age 48.49±11.260 years old.98 patients underwented MRI examination 132 times, including 13 cases had 2 times,≥3 times in 16 cases, were found in 166 lesions. The selected standard as well as Part 1.2.Examination techniqueMRI examination adopt the United States, GE signa excite 3.0T and the Germany, the Siemens Vision Plus 1.5T MRI superconductive scanners. Conventional and contrast enhanced MRI scan were used, receiving T1-weighted images (T1WI), T2-weighted images (T2WI) and water suppression image (FLAIR). T1WI:TR 450ms, TE 14ms, T2WI:TR 5000ms, TE 128ms, T2 FLAIR:TR 9000ms, TE 110ms, TI 1100ms, slice thick 6.0～8.0ms, distance 2mm. Position:Axial, coronal, part of patients added sagittal scan. Post administration of Gadopentetate Dimeglumine(0.1mmol/Kg).3.1amge post-processing and data measurement2 experienced radiologists (each with 26 years and 8 years clinical diagnostic experience) independently reviewed the MRI images, including the lesion location, v number, shape, size, signal performance, edema, enhancement characteristics, repeatedly discussed the inconsistent results. And after radiation, we individed 8 groups:<6 months,6 months to 1 year,1 year to 2 years,2 years to 3 years,3 years to 4 years,4 years to 5 years,5 years to 6 years,> 6 years, reviewed several times each period to select only one of which MRI performance to records. We uesd the edema tumor ratio(ETR) to calculation the perifocal edema, the ratio of the maximum length of edema and the maximum diameter of the tumor, we divided into:0°no edema, I 0 ETR≤1,Ⅱ°1<ETR≤2,Ⅲ°ETR>2,Ⅳ°simple edema(it's especial for this abnormal signal intensity without enhanced necrosisi).4.Statistical analysisThe SPSS 13.0 software was applied in this study. the Pearson chi-square test was used to compare between count data, level data and the abnormal distribution used Wilcoxon rank sum test. The level of test awas 0.05, P<0.05 consider that the difference was statistically significant. MR imaging characteristics were statistical description.[Results]1.To note the MRI performance of 157 lesions in 89 patients who had necrotic lesions, comparing different sizes, the enhanced tumor diameter, number of lesions (χ2=6.395, P=0.011), enhancement characteristics (x2=83.831, P=0.000), necrosis (χ2=42.082, P=0.000) and hemorrhage (x2=8.348,P=0.015) were significantly different.with edema around lesions was no significant (χ2=1.818, P=0.178)。2. In an early stage, the location was one-sided, bilateral symmetry lesions were appeared following in time. pieces enhancement was seen in 3-4 years after radiotherapy, nodular, small ring and small patchy enhancement were seen 1-3 years, and rosette-like enhancement appeared the whole process of REP. In the follow up of 1 year, there was little or no edema around the lesion,Ⅰ°,Ⅱ°edema were main performance in 1-3 years,Ⅱ°,Ⅲ°edema in 3-4 years, with the further extension of time,Ⅰ°,Ⅱ°edema had become the major performance. There was little abnormal singal after radiotherapy within 6 months, over time, varying degrees of necrosis and edema appeared, the type of necrosis without edema and necrosis with edema become the major types, of edema, the longer survival patients, the necrosis lesion become cystic liquefaction.[Conclusion]1.The size of lesions of radiation encephalopathy of nasopharyngeal carcinoma, the number of lesions, enhancement characteristics, lesion types were significantly different. The small pieces could fuse a large sheet, the change of enhancement patten from small ring, nodular to rosette-like change, accompanied by necrosis and bleeding. The MR characteristic was necrosis composed of a variety of signals in temporal lobe tissue, around the large irregularly shaped edema, the enhancement characteristic was rosette-like change.2.MR performance of radiation encephalopathy can be divided into four types: abnormal signal without enhancement; necrosis lesion without edema; necrosis lesion with edema; completely cystic type. Early stage, abnormal signal become the major stype, with progression of disease, necrosis with limited or extensive edema, longer survival in patients, the lesions become soft and completely cystic liquefaction, peripheral edema could be absorbed.3.MR characteristic of radiation encephalopathy often not match with clinical manifestations. MRI is an advanced examination equipment, with good soft tissue resolution, in early stage, it can find the small lesions and abnormal signal change, regularly strengthen the MRI examination after radiotherapy can be early detection and treatment, it is very significative to the prognosis and quality of life of nasopharyngeal carcinoma patients after radiotherapy significantly. |
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