RESUMO
Objective:To investigate the feasibility and clinical value of MRI quantitative evaluation technique in detecting sternocleidomastoid muscle fibrosis in patients with nasopharyngeal carcinoma (NPC) after radiotherapy.Methods:From August 2019 to March 2021, 45 patients with clinically confirmed NPC after radiotherapy and 30 healthy controls who underwent physical examination in Lishui Hospital of Zhejiang University were enrolled in our study. According to the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer (RTOG/EORTC) classification criteria of late radiation reactions respectively, the sternocleidomastoid muscle injury in the NPC group was divided into grade Ⅰ, Ⅱ and Ⅲ, which included 8, 32 and 5 patients respectively. All patients underwent T 1 mapping and T 2 mapping imaging of the neck. Firstly, the mapping images of sternocleidomastoid muscle between the two groups were analyzed and compared. Using NUMARIS/4 software of Siemens image post-processing workstation, the region of interest was manually drawn along the edge of sternocleidomastoid muscle at the level of laryngeal chamber in axial mapping diagram. Then, T 1 and T 2 values and the long and short diameters of sternocleidomastoid muscle were measured respectively. Finally, the differences of the parameters between the two groups were compared by independent sample t-test, Spearman rank correlation was used to analyze the relationship between the average T 1 and T 2 values of bilateral sternocleidomastoid muscles and the grade of late radiation injury. Results:Compared with the control group, the shape of sternocleidomastoid muscle in the NPC group was smaller in shape, with irregular edge and uneven increase of T 1 mapping color scale. There was no significant difference in muscle signal in T 2 mapping. The T 1 values of left and right sternocleidomastoid muscles in the NPC group were (1 524.7±97.6) and (1 496.5±93.2) ms respectively, which were significantly higher than those in the normal control group [(1 231.5±85.3) and (1 275.9±90.9) ms] ( P<0.05), and the T 2 values of left and right sternocleidomastoid muscles in the NPC group were (28.4±4.8) and (28.4±3.6) ms respectively, which were lower than those in the normal control group [(30.4±3.5) and (30.4±3.5) ms] ( P<0.05). The long and short diameters of bilateral sternocleidomastoid muscles in the NPC group were shorter than those in the control group ( P<0.05). The average T 1 and T 2 values of bilateral sternocleidomastoid muscles in NPC patients after radiotherapy were (1 510.6±95.4) and (28.4±4.2) ms respectively, The T 1 value was positively correlated with the classification of advanced radiation injury ( r=0.78, P<0.001), and T 2 value was negatively correlated with the level of advanced radiation injury ( r=-0.87, P<0.001). Conclusion:Mapping quantitative evaluation technique can noninvasively and objectively detect and evaluate sternocleidomastoid muscle fibrosis after NPC radiotherapy, which has potential clinical application value.
RESUMO
Objective:To explore the long-term effect of hip replacement and vitamin D in treatment of elderly osteoporotic femoral neck fractures and the transfection of bone morphogenetic protein-7 (BMP-7) /25 hydroxy vitamin D3[ (25- (OH) ) -D3] level.Method:Data of 108 elderly osteoporotic femoral neck fracture patients admitted from Jan. 2018 to Jan. 2020 were selected, and they were divided them into the observation group (hip replacement adjuvant vitamin D treatment) and control group (hip replacement treatment) , 54 cases in each group. All subjects were followed up for 1 year to observe the long-term treatment efficacy and SF-36 scores of the two groups of patients. Before treatment and 1, 3, 6, and 12 months after treatment, the differences in the changes in lumbar and hip bone mineral density, hip joint Harris score, BMP-7, and 25- (OH) -D3 levels were compared between the two groups.Results:12 months after treatment, the long-term treatment effect of the observation group was significantly higher than that of the control group ( P<0.05) ; 1, 3, 6, 12 months after treatment, for the lumbar and hip bone mineral density, SF-36 score, hip Harris score, BMP-7, 25- (OH) -D3 levels of the two groups of patients over time, the degree of increase was not equal, but the treatment group had the greater degree of improvement ( P<0.01) . Conclusion:Hip joint replacement and vitamin D have a good long-term effect in treatment of elderly osteoporotic femoral neck fractures, which can significantly increase bone density and improve BMP-7 and 25- (OH) -D3 levels.
