Abstract:Objective To investigate the clinical value of blood oxygen level-dependent functional magnetic resonance imaging (BOLD-FMRI) in guiding the dose reduction and functional protection of the motor cortex during postoperative radiotherapy for brain astrocytoma. Methods This study included 27 brain astrocytoma patients with tumors near the motor cortex, who underwent routine MRI and BOLD-FMRI before postoperative radiotherapy. The location and scope of the motor cortex, which were acquired based on BOLD-FMRI results, were marked on positioning CT images, so that the motor cortex would be dealt with as organs at risk. The dose to the motor cortex was reduced as much as possible while ensuring the therapeutic dose to the target area. Finally, the radiotherapy plan that would reduce the mean received dose of the motorcortex was formulated and compared with the routine plan that could not reduce the received dose. Results With the protective radiotherapy plan, the mean received dose of the motor cortex decreased 0.76%—59.20%(mean 30.78%) on the affected side and 23.33%—68.30%(mean 48.07%) on the unaffected side;the coefficients of variation were 71.41% on the affected side and 36.71% on the unaffected side. Conclusions BOLD-FMRI can help to reduce the received dose of the motorcortex while ensuring the therapeutic dose to the target area when formulating the postoperative radiotherapy plan for brain astrocytoma, thus protecting the motor function and improving patients′ quality of life.
He Hong*,Guo Yanhong,Wang Minglei et al. Clinical application of BOLD-FMRI in guiding protection of the motor cortex during postoperative radiotherapy for brain astrocytoma[J]. Chinese Journal of Radiation Oncology, 2014, 23(3): 248-251.
[1] 李玉,田启和,安兵,等.放射治疗68例脑星形细胞瘤[J].中华放射肿瘤学杂志,2000,9:57. [2] Kurita H, Kawahara N, Asai A, et al. Radiation-induced apoptosis of oligodendrocytes in the adult rat brain[J]. Neurol Res,2001,23:869-874. [3] 朱妍,回树新,郝继山,等.放射性脑损伤的诊断[J].中华神经医学杂志,2005,4:391-393. [4] Kauczor HU, Zechmann C, Stieltjes B, et al. Functional magnetic resonance imaging for defining the biological target volume[J]. Cancer Imaging,2006,6:51-55. [5] Aoyama H, Kamada K, Shirato H, et al. Integration of functional brain information into stereotactic irradiation treatment planning using magnetoencephalography and magnetic resonance axonography[J].Int J Radiat Oncol Biol Phys,2004,58:1177-1183. [6] Dhermain F, Ducreux D, Bidault F, et al. Use of the functional imaging modalities in radiation therapy treatment planning in patients with glioblastoma[J].Bull Cancer,2005,92:333-342. [7] Thulborn KR, Waterton JC, Matthews PM, et al. Oxygenation dependence of the transverse relaxation time of water protons in whole blood at high field[J].Biochim Biophys Acta,1982,714:265-270. [8] Roessler K, Donat M, Lanzenberger R, et al. Evaluation of preoperative high magnetic field motor functional MRI (3 Tesla) in glioma patients by navigated electrocortical stimulation and postoperative outcome[J].J Neurol Neurosurg Psychiatry,2005,76:1152-1157. [9] Yetkin FZ,Mueller WM, Morris GL, et al. Functional MR activation correlated with intraoperative cortical mapping[J].Am J Neuroradiol,1997,18:1311-1315. [10] Kober H,Nimsk C,Mller M, et al. Correlation of sensorimotor activation with functional magnetic resonance imaging and magnetoencephalography in presurgical functional imaging:a spatial analysis[J].Neuroimage,2001, 14:1214-1228. [11] 刘原照,吴钦宏.脑功能磁共振在脑瘤立体定向放疗中的应用[J].中国微创外科杂志,2004,4:241-242. [12] Liu WC, Schulder M, Narra V, et al. Functional magnetic resonance imaging aided radiation treatment planning[J]. Med Phys,2000,27:1563-1572. [13] 王玉林,刘梦雨,李金锋,等.表观弥散系数值在鉴别胶质瘤复发与放射性脑损伤中的价值[J].中国医学科学院学报,2012, 34:396-400. [14] 谭国强,马雁秀,谭洁媚,等.磁共振单体素波谱成像对脑肿瘤治疗后反应的评价[J].中国CT和MR杂志,2012,10:14-16. [15] 李玉锋,尹强,牟玲,等.MR灌注成像与CT融合在脑胶质瘤术后临床靶区勾画中的应用[J].山东医药,2011,51:88-89. [16] 邹喜,张纬建,洪金省,等.脑转移瘤三维适形放疗与调强放疗的剂量学比较研究[J].肿瘤基础与临床,2011,24:402-405. [17] 王靖.脑转移调强放疗、三维适形或立体定向推量放疗瘤旁正常组织剂量学变化[J].内蒙古中医药,2012,31:94-95.