Rubin P, Whitaker J N, Ceckler T L, Nelson D, Gregory P K, Baggs R B, Constine L S, Herman P K
Department of Radiation Oncology, University of Rochester Cancer Center, NY 14642.
Int J Radiat Oncol Biol Phys. 1988 Dec;15(6):1371-81. doi: 10.1016/0360-3016(88)90233-7.
The identification of radiation myelopathy using biochemical assays and imaging techniques has not previously been accomplished but has clear clinical application. Measurement of myelin basic protein (MBP) in the cerebrospinal fluid (CSF) and visualization of the spinal cord using magnetic resonance imaging (MRI) gives a potentially accurate diagnosis of radiation myelopathy. Female New Zealand white rabbits were irradiated to the thoracic spinal cord with single doses of 15-45 Gy. Animals receiving higher doses (greater than or equal to 22 Gy) generally demonstrated an early paresis (4-8 weeks) that temporarily improved, and then progressed to complete paralysis by 14-18 weeks. MBP levels in the CSF became strikingly elevated to 100-1000 times the normal value. Subsequent, experiments in which rabbits were serially assessed for MBP levels demonstrated a transient elevation, which corresponded to the transient paresis, followed by dramatic elevations concurrent with the onset of paralysis. Magnetic resonance imaging (MRI) of the irradiated spinal cord showed a geographically distinct region of abnormality that corresponded to the radiation field. Histopathology demonstrated demyelination, focal astrocytosis, erythrodiapedesis, and perineuronal edema in the irradiated sections. It appears that MBP levels in the CSF reflect not only radiation-induced myelopathy but also transient demyelination, and that MRI may have the potential to indicate the region of damage.
此前尚未通过生化检测和成像技术来识别放射性脊髓病，但它具有明确的临床应用价值。检测脑脊液（CSF）中的髓鞘碱性蛋白（MBP）以及使用磁共振成像（MRI）对脊髓进行成像，有可能准确诊断放射性脊髓病。对雌性新西兰白兔的胸段脊髓进行单次15 - 45戈瑞的照射。接受较高剂量（大于或等于22戈瑞）的动物通常在早期（4 - 8周）出现轻瘫，随后症状暂时改善，然后在14 - 18周时进展为完全瘫痪。脑脊液中的MBP水平显著升高至正常值的100 - 1000倍。随后，对兔子的MBP水平进行系列评估的实验表明，MBP水平先出现短暂升高，这与短暂性轻瘫相对应，随后在瘫痪开始时显著升高。对受照射脊髓进行磁共振成像（MRI）显示，在与放射野相对应的区域有一个明显的异常区域。组织病理学显示，受照射切片出现脱髓鞘、局灶性星形细胞增生、红细胞渗出和神经元周围水肿。脑脊液中的MBP水平似乎不仅反映放射性脊髓病，还反映短暂性脱髓鞘，而且MRI可能有潜力指示损伤区域。
