超声弹性成像技术用于头颈部放射治疗前后血管弹性检测的相关研究

The correlation research of ultrasound elastography in the detection of vascular elasticity of the head and neck before and after radiotherapy

目的:探讨超声弹性成像技术对评价头颈部放射治疗前后血管弹性变化的价值。方法:选取接受放射治疗的42例头颈部恶性肿瘤患者,分别于放射治疗前1～3 d、治疗2.5～3周(剂量26～30 Gy)、治疗结束时(剂量50～60 Gy)及治疗后1个月和3个月接受颈动脉常规超声检测及超声弹性成像检测,统计颈动脉内中膜厚度(IMT)、颈总动脉内径变化率(ΔD)以及血液与颈动脉壁应变率比值(A/B),并分析其变化情况。结果:患者的A/B值在放射治疗期间随放射治疗剂量的增加而增加,治疗后1个月和3个月则保持与治疗结束时相对稳定;ΔD在放射治疗期间随放射剂量的增加而减少,治疗后1个月和3个月则保持与治疗结束时相对稳定。A/B值和ΔD变化趋势放射治疗前后比较,差异均有统计学意义(F=62.058,F=71.658;P<0.001);A/B值与ΔD呈高度负相关(r=-0.764,P<0.05)。结论:头颈部肿瘤放射治疗患者颈动脉弹性在早期即下降,随放射剂量的增加下降程度越明显,且该变化至术后3个月仍不会出现明显的改善,故超声弹性成像技术能够有效检测患者颈动脉弹性。

Objective: To investigate the value of ultrasound elastography in evaluating the changes of vascular elasticity of head and neck before and after radiotherapy. Methods: 42 patients with malignant tumor at head and neck who were treated by radiotherapy were selected. Conventional carotid ultrasound and ultrasound elastography were applied at 1~3 days before radiotherapy, 2.5 to 3 weeks during radiotherapy (radiation dose was 26~30 Gy), just after radiotherapy (radiation dose was 50~60 Gy), 1 month after radiotherapy and 3 months after radiotherapy, respectively. The carotid intima-media thickness (IMT), variance ratio of inner diameter of arteria carotis communis (?D), the strain rate ratio of blood and carotid artery wall (A/B) were counted as statistic method and the change situation of them were analyzed. Results: During radiotherapy, A/B value of patients increased with the increasing of radiation dose, and A/B value at 1 and 3 months after radiotherapy remained relatively stable compared with just after radiotherapy. During radiotherapy,?D decreased with the increasing of radiation dose, and ?D value at 1 and 3 months after radiotherapy remained relatively stable compared with just after radiotherapy. The differences of change trends of A/B value and ?D between pre and post radiotherapy were statistically significant (F=62.058, F=71.658, P<0.001), respectively. There was a significantly negative correlation between A/B and ?D(r=-0.764, P<0.05). Conclusion: Carotid vascular elasticity of patients with head and neck neoplasm who received radiotherapy decreases at early stage of radiotherapy. With the increase of radiation dose, the decreasing degree of vascular elasticity is more obvious, and the change would not be improved within 3 months post radiotherapy. Therefore, ultrasonic elastography can effectively detect the carotid vascular elasticity.