非小细胞肺癌脑转移全脑放疗后迟发性脑白质病的MRI研究

MRI Study of Delayed Leukoencephalopathy in Non- Small Cell Lung Cancer Patients with Brain Metastases After Whole Brain Radiation Therapy

目的探究非小细胞肺癌(NSCLC)脑转移全脑放疗(WBRT)后迟发性脑白质病(DLE)的发生率、认知功能变化、MRI影像表现及动态发展过程。方法回顾性分析44例NSCLC脑转移患者WBRT后定期随访MRI及临床资料。结果 NSCLC脑转移WBRT后DLE的MRI表现为弥漫对称性双侧侧脑室旁脑白质长T1、长T2信号,无强化,不累及U型纤维、胼胝体及灰质结构;随访3、6、9、12、18、24、30个月发生率分别为6.82%(3/44)、42.11%(16/38)、68.97%(20/29)、76.19%(16/21)、90%(9/10)、85.71%(6/7)、100%(3/3)。随着DLE的进展,患者的认知功能进一步损伤。结论 WBRT后DLE发生率高,MRI表现为弥漫性脑白质病变,呈进行性发展,且认知功能也随之损伤。

Objective To explore the incidence, neurocognitive function, MR imaging, dynamic developing process of delayed leukoencephalopathy （DLE） in non - small cell lung cancer patients with brain metastases who had undergone whole brain radiation therapy. Methods MRI and clinical data of 44 non - small cell lung cancer patients with brain metastases who bad undergone whole brain radiation therapy were retrospectively reviewed. Results The characteristic MR imaging of DLE in those patients was bilaterally diffuse white matter T2 hyperintensity around the periventricular areas with- out contrast enhancement, sparing from U fiber, callosum and gray matter structure. The incidence of DLE developed 6.82% （3/44）, 42.11% （16/38）, 68.97% （20/29）, 76.19% （16/21）, 90% （9/10）, 85.71% （6/7）, 100% （3/3） in those patients who were followed up for 3,6,9,12,18,24,30 months, respectively. Conclusion The incidence of DLE in those patients was high. MR imaging of DLE was bilaterally diffuse white matter changes, and it was progressive development. Neurocognitive function was damaged.