PURPOSE:To determine whether the combined magnetic resonance imaging (MRI) and magnetic resonance spectroscopy imaging (MRSI) before radiation therapy (RT) is valuable for RT target definition, and to evaluate the feasibility of replacing the current definition of uniform margins by custom-shaped margins based on the information from MRI and MRSI. METHODS AND MATERIALS:A total of 23 glioblastoma multiforme (GBM) patients underwent MRI and MRSI within 4 weeks after surgery but before the initiation of RT and at 2-month follow-up intervals thereafter. The MRSI data were quantified on the basis of a Choline-to-NAA Index (CNI) as a measure of spectroscopic abnormality. A combined anatomic and metabolic region of interest (MRI/S) consisting of T2-weighted hyperintensity, contrast enhancement (CE), resection cavity, and CNI2 (CNI >or= 2) based on the pre-RT imaging was compared to the extent of CNI2 and the RT dose distribution. The spatial relationship of the pre-RT MRI/S and the RT dose volume was compared with the extent of CE at each follow-up. RESULTS:Nine patients showed new or increased CE during follow-up, and 14 patients were either stable or had decreased CE. New or increased areas of CE occurred within CNI2 that was covered by 60 Gy in 6 patients and within the CNI2 that was not entirely covered by 60 Gy in 3 patients. New or increased CE resided within the pre-RT MRI/S lesion in 89% (8/9) of the patients with new or increased CE. CONCLUSION:These data indicate that the definition of RT target volumes according to the combined morphologic and metabolic abnormality may be sufficient for RT targeting.

译文

目的:确定放射治疗(RT)之前的磁共振成像(MRI)和磁共振波谱成像(MRSI)的组合对于RT目标定义是否有价值,并评估用定制的方法代替当前定义的均匀余量的可行性-根据MRI和MRSI的信息对边缘进行整形。
方法和材料:总共23例多形性胶质母细胞瘤(GBM)患者在手术后4周内,开始RT之前以及随后的2个月随访期间接受了MRI和MRSI。 MRSI数据基于胆碱到NAA指数(CNI)进行量化,以衡量光谱异常。比较基于T2加权的高强度,造影剂增强(CE),切除腔和CNI2(CNI>或= 2)组成的感兴趣的解剖和代谢组合区域(MRI / S),在一定程度上CNI2和RT剂量分布的关系。在每次随访时,将RT前MRI / S与RT剂量的空间关系与CE的程度进行比较。
结果:9例患者在随访期间显示出新的或增加的CE,14例病情稳定或CE降低。 6例患者的CNG2内出现新的或增加的CE区域,被60 Gy覆盖; 3例患者的CNI2内未完全被60 Gy覆盖。在新的或增加的CE患者中,有89%(8/9)的患者在RT之前的MRI / S病变中存在新的或增加的CE。
结论:这些数据表明,根据形态和代谢异常的结合来确定RT靶标的量可能足以作为RT靶标。

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