脑放射损伤的影像学研究进展

林曰增

脑放射损伤的影像学研究进展

林曰增

文章导航 > 国际放射医学核医学杂志 > 2000, 24 > 4: (148-151)

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脑放射损伤的影像学研究进展

林曰增

510515 广州, 第一军医大学南方医院影像中心

作者简介: 林曰增(1964-),男,山东潍坊人,第一军医大学南方医院影像中心博士研究生,主治医师。;

中图分类号: R818.04

Progress in imaging of brain radiation injury

LIN Yue-zeng

Imaging Diagnostic Center, Nanfang Hospital, the First Military Medical University, Guangzhou 510515, China
CLC number: R818.04

摘要: 脑放射损伤发病机制主要有三种学说即血管损伤、胶质损伤和免疫反应机制,最近多数学者的研究支持血管和胶质损伤机制,血管方面的改变在晚期放射效应中起主要作用。CT和MRI对局限性脑损伤和弥漫性脑白质损伤可明确诊断。MRI的T₂加权成像(T₂WI)显示水分变化敏感性高,又不受颅底线束硬化伪影的影响,MRI发现白质病变的敏感性是CT的2~3倍。如果是脑本身肿瘤放疗后,CT和MRI区别病灶复发或放射性坏死比较困难,PET和MRS(磁共振波谱成像)在两者鉴别诊断中则初步呈现出一定的优势。行PET检查时,如为肿瘤则代谢活跃,坏死则代谢低下,但敏感性和特异性欠理想。MRS测量感兴趣区内代谢产物的量或比率有助于两者的鉴别诊断。另外,PET功能成像和MRS还可预测放疗病人较早期无症状的可逆性放射损伤,以便及时应用激素等药物治疗,避免其进一步发展为临床症状明显的不可逆性损伤。
- 脑 /
- 放射损伤 /
- 体层摄影术,X线计算机 /
- 磁共振成像 /
- 磁共振波谱成像 /
- 正电子发射断层
Abstract: The mechanisms of brain radiation injury mainly include three hypotheses: vascular injury, glial cells damage and immune response. Most scholars' studies have recently supported the former two ones. Vascular in-jury plays a major role in the effect of delayed radiation injury. Focal brain injury and diffuse white matter injury can be definitely diagnosed by CT and MRI. T₂-weighted imaging (T₂WI) in MRI shows high sensitivity in water contents, and is not affected by the beamhardening arifacts from the cranial base. Compared with CT, the sensitivity of MR for detecting white matter lesions is two to threefold higher. When lesions occrs at the site of an irradiated cerebral tumor, tumor recurrence and focal cerebral necrosis cannot be differentiated by CT or MR, PET and MRS now present a certain advantage of differential diagnosis. Tumoror presents high metabolism and necrosis demonstrates low metabolism by utilizing PET scanning, however PET's sensitivity and specificity are far from satisfactory. The amount or ratio of metabolic products in the region of interest measured by MRS contributes to the deferential diagnosis. In addition, PET functmnal imaging and MRS can also predict the early asymptomatic reversible radiation injury so as to allow the early therapy of steroids andpossibly other drugs, prior to the development of irreversible changes.
- brain /
- radiation injury /
- tomography, X-ray computed /
- magnetic resonance imaging /
- magnetic resonance spectroscopy /
- positron emission tomography
本作品遵循Signature-Non-Commercial Use 4.0 International (CC BY-NC 4.0)协议

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脑放射损伤的影像学研究进展

林曰增

作者简介:林曰增(1964-),男,山东潍坊人,第一军医大学南方医院影像中心博士研究生,主治医师。

510515 广州, 第一军医大学南方医院影像中心

收稿日期: 1999-12-13

关键词:

摘要: 脑放射损伤发病机制主要有三种学说即血管损伤、胶质损伤和免疫反应机制,最近多数学者的研究支持血管和胶质损伤机制,血管方面的改变在晚期放射效应中起主要作用。CT和MRI对局限性脑损伤和弥漫性脑白质损伤可明确诊断。MRI的T₂加权成像(T₂WI)显示水分变化敏感性高,又不受颅底线束硬化伪影的影响,MRI发现白质病变的敏感性是CT的2~3倍。如果是脑本身肿瘤放疗后,CT和MRI区别病灶复发或放射性坏死比较困难,PET和MRS(磁共振波谱成像)在两者鉴别诊断中则初步呈现出一定的优势。行PET检查时,如为肿瘤则代谢活跃,坏死则代谢低下,但敏感性和特异性欠理想。MRS测量感兴趣区内代谢产物的量或比率有助于两者的鉴别诊断。另外,PET功能成像和MRS还可预测放疗病人较早期无症状的可逆性放射损伤,以便及时应用激素等药物治疗,避免其进一步发展为临床症状明显的不可逆性损伤。