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顱內惡性腫瘤放射線治療後之CT追蹤
CT Findings of Radiation Injury to the Brain
摘要
多數顱內惡性瘤於切除手術後輔以放射線治療，也有些根本無法手術只能直接採放射線治療，而此種輔助性放射治療有時會對腦組織產生立即或延遲副作用，如白質水腫，腦組織壞死等，在臨床上造成與復發性腫瘤相似的症狀。本文報告我們所追蹤的顱內惡性細胞瘤於接受放射線治療後在CT上顯示的異常徵象，以供鑑別診斷的參考。總共有33例顱內惡性瘤，包括惡性星狀細胞瘤(malign. astrocytoma)，21例，寡樹突膠質瘤(oligodendroglioma)3例，神經管胚細月包瘤(medulloblastoma)5例，germinoma 4例，在放射線照射後四年間以CT追蹤結果顯示如下：1.無放射線副作用者16例。2.有放射線副作用者17例，包括：(1)白質病變13例，(2)放射性壞死9例，(3)腦脊液腔擴大3例，(4)鈣化2例。放射性壞死9例中有7例在CT上發現環狀對此劑強化現象及週圍白質水腫，與復發性腫瘤最難區別，但多數使用類固醇藥物治療之後可使其消失。病患接受放射線照射的劑量在1600-17000rad之間，有放射治療副作用者與無副作用者其所接受的劑量並無明顯差別。CT影像發現腦部有放射線副作用者，自放射線治療完全至做CT時間為1個月至5年，平均約6個月，只有1例在治療中即顯示有白質水腫及放射性壞死。
並列摘要
The incidence of post-irradiation CNS adverse effects is about 49-52%. It is not difficult to demonstrate these adverse effects which include post-irradiation white matter abnormality, radionecrosis, CSF space widening and calcification by CT scan. In the past 4 years, we used CT to follow up 33 cases of intracranial malignant tumor who received radiation therapy. These included 21 cases of malignant astrocytoma, 3 cases of oligodendroglioma, 5 cases of medulloblastoma. Seventeen cases (52%) showed post-irradiation side effect on CT, including: (1) post-irradiation white matter edema in 13 cases. CT showed decreased density with mass effect. (2) radionecrosis in 9 cases. CT revealed ring enhancement with central lucency and peripheral white matter edema, which was very difficult ot differentiate from recurrent tumor, but most cases of radionecrosis had good response to steroid treatment. Radionecrosis usually occured in the original site of tumor, but in 1 case of this series, it occurred on the opposite site. (3) CSF space widening in 3 cases, which disclosed dilatation of ventricles, widening of sulci and cistern, and was similar to brain atrophy. (4) post-irradiation calcification, which has been seen in children only. We had 2 such cases and 1 was considered to be mineralized leukoencephalopathy. The radiation doses of 1600-7000 rad were received by the patients, which had no bearing on the post-irradiation adverse effects.
延伸閱讀
- 林胤均、張瑋莉、曾漢民、成佳憲、蕭輔仁、陳敞牧、張璞曾、王駿瑋（2010）。顱內放射手術治療時間長短與治療位移誤差之探討。中華放射線技術學雜誌，34(3)，161-168。https://doi.org/10.30045/CJRT.201009.0002
- 蕭昌樺、李三剛、余昌遺、邱文達、施純仁（1981）。顱內轉移性腫瘤－病例分析與放射線學徵象。中華放射線醫學雜誌，6(3)，194-203。https://www.airitilibrary.com/Article/Detail?DocID=10188940-198109-6-3-194-203-a
- Hsu, W. C., Tai, P. A., Chang, C. S., Chen, H. J., & Chang, Y. K. (2015). 以立體定位放射手術治療顱內腦膜動靜脈瘻管：病例報告及文獻回顧. 放射治療與腫瘤學, 22(1), 71-81. https://doi.org/10.6316/TRO/201522(1)71
- 梁基安、林芳仁、湯國政（1993）。Radiation Therapy for Craniopharyngioma。中華放射線醫學雜誌，18(1)，51-57。https://www.airitilibrary.com/Article/Detail?DocID=10188940-199303-18-1-51-57-a
- 廖漢弘、楊仁宗、楊博堯、翁旭惠（2012）。Monitoring and Reduction in Routine Brain CT Scans。中華放射線技術學雜誌，36(1)，15-20。https://doi.org/10.30045/CJRT.201203.0003