Ciszkowska-Łysoń Beata, Królicki Leszek, Teska Anna, Janowicz-Zebrowska Anna, Krzakowski Maciej, Tacikowska Małgorzata
Zakładu Medycyny Nuklearnej i Rezonansu Magnetycznego Wojewódzkiego Szpitala Bródnowskiego w Warszawie.
Neurol Neurochir Pol. 2003;37(4):783-98.
The purpose of our study was to evaluate CNS pathology due to chemotherapy neurotoxicity, using MRI and localized proton MRS in patients with lung cancer treated with cisplatine, Vinca alkaloids and etoposide. A reduction in N-acetylaspartate was expected as a result of chemotherapy neurotoxicity.
31 patients aged 42 to 73 years underwent the following procedures before and after chemotherapy: clinical examination; MRI of the brain (Elscint Prestige 2T), MRS (PRESS sequence, TR 1500 ms, TE 80 ms) with volumes of interest (VOI) of 8 ml localized in the semi-oval center and a cerebellar hemisphere. The analysis of each patient's NAA/Cr and Cho/Cr ratios was carried out separately for the semi-oval center and cerebellum measurements.
None of the patients demonstrated any clinical manifestations of the CNS neuropathy. MRI of the brain did not reveal any abnormalities caused by chemotherapy. Pre-treatment NAA/Cr and Cho/Cr ratios in the semi-oval center did not differ significantly from these measured after chemotherapy. However, the analysis of the cerebellar spectra showed a significant decrease in the NAA/Cr ratio (p < 0.05) and a time-related decrease in the Cho/Cr ratio (p < 0.05) after chemotherapy. An analysis of Pearson's correlations showed a very strong linear relationship between NAA/Cr and Cho/Cr ratios (p < 0.001), both in the semi-oval center and cerebellum.
The decreased NAA/Cr ratio can indicate some neuronal loss caused by chemotherapy. The decrease in the Cho/Cr ratio could be associated with some myelin damage. The MRS results suggest the presence of a sub-clinical selective cerebellar neuropathy caused by chemotherapy. The MRS revealed that reaction to chemotherapy was different at the semi-oval center than that in the cerebellum. The results allow theorizing about an alternative or two-stage brain response to the neurotoxic factor found both in the cerebrum (the semi-oval center) and cerebellum. These initial results indicate that proton MR spectroscopy is a potentially useful modality for detecting an early stage of the CNS pathology caused by neurotoxicity of chemotherapy.
我们研究的目的是，利用磁共振成像（MRI）和局部质子磁共振波谱（MRS），评估接受顺铂、长春花生物碱和依托泊苷治疗的肺癌患者因化疗神经毒性所致的中枢神经系统（CNS）病理学变化。化疗神经毒性预计会导致N - 乙酰天门冬氨酸减少。
31名年龄在42至73岁之间的患者在化疗前后接受了以下检查：临床检查；脑部MRI（Elscint Prestige 2T）、MRS（PRESS序列，重复时间1500毫秒，回波时间80毫秒），感兴趣区（VOI）为8毫升，位于半卵圆中心和一个小脑半球。分别对每位患者半卵圆中心和小脑测量的NAA/Cr及Cho/Cr比值进行分析。
所有患者均未表现出CNS神经病变的任何临床表现。脑部MRI未发现化疗引起的任何异常。化疗前半卵圆中心的NAA/Cr及Cho/Cr比值与化疗后测量值相比，差异无统计学意义。然而，小脑波谱分析显示化疗后NAA/Cr比值显著降低（p < 0.05），且Cho/Cr比值呈时间相关降低（p < 0.05）。Pearson相关性分析显示，半卵圆中心和小脑的NAA/Cr与Cho/Cr比值之间均存在非常强的线性关系（p < 0.001）。
NAA/Cr比值降低可能表明化疗导致了一些神经元损失。Cho/Cr比值降低可能与一些髓鞘损伤有关。MRS结果提示存在化疗引起的亚临床选择性小脑神经病变。MRS显示，半卵圆中心对化疗的反应与小脑不同。这些结果使人们能够推测大脑（半卵圆中心）和小脑对神经毒性因子的另一种或两阶段反应。这些初步结果表明，质子磁共振波谱是检测化疗神经毒性所致CNS病理学早期阶段的一种潜在有用方法。
