作者：寵物醫(yī)師網(wǎng)編委會(huì)

點(diǎn)擊閱讀作者更多臨床文獻(xiàn)

文章來(lái)源：https://onlinelibrary.wiley.com/doi/10.1111/jvim.17213

小編導(dǎo)語(yǔ)

人類腦腫瘤患者放療后常出現(xiàn)腦微出血（CMBs），這種磁共振才能捕捉的微小血管損傷可能引發(fā)認(rèn)知障礙。但你知道嗎？接受放療的狗狗也可能面臨同樣風(fēng)險(xiǎn)！

點(diǎn)贊收藏不迷路，隨時(shí)回顧超實(shí)用！??

摘要

在醫(yī)學(xué)研究的廣闊領(lǐng)域中，科學(xué)家們不斷探索著各種治療方法和其潛在的后遺癥。近期，一項(xiàng)針對(duì)犬類腦腫瘤放射治療后的研究揭示了令人關(guān)注的新發(fā)現(xiàn)：放射治療可能導(dǎo)致犬類出現(xiàn)腦微出血（CMBs）。

一、研究背景

腦微出血是指微小的腦血管破裂導(dǎo)致的血液滲漏，這種情況在人類接受腦部放射治療的患者中已有報(bào)道。然而，對(duì)于犬類是否存在類似的放射治療后遺癥，此前并無(wú)確切證據(jù)。

二、研究目的

為了填補(bǔ)這一知識(shí)空白，研究人員開展了一項(xiàng)專門的研究，旨在探討犬類在接受放射治療后是否會(huì)發(fā)生腦微出血，以及這些微出血的數(shù)量是否與放射劑量相關(guān)，并隨時(shí)間推移而增加。

圖1.一只接受放射治療的犬的矢狀面重建圖，CT掃描是在靜脈注射對(duì)比劑后的平衡階段獲取的，顯示了位于右側(cè)額區(qū)、沿大腦鐮部的（推測(cè)）腦膜瘤。圖中顯示了3個(gè)等劑量體積（綠色輪廓：低劑量區(qū)，<20?Gy；黃色輪廓：中劑量區(qū)，20-30?Gy；橙色輪廓：高劑量區(qū)，>30?Gy），以及腫瘤體積（GTV，粉色輪廓）。

三、研究對(duì)象與方法

研究人員選擇了34只患有顱內(nèi)原發(fā)性腫瘤并接受放射治療的犬作為研究對(duì)象。這些犬均接受了至少兩次磁共振成像（MRI）掃描，特別是敏感加權(quán)成像（SWI），以精確識(shí)別腦微出血。

通過(guò)回顧性、觀察性和單中心的研究設(shè)計(jì)，研究人員詳細(xì)記錄了每只犬的腦微出血情況 ，并分析了腦微出血數(shù)量與放射劑量以及治療后時(shí)間的關(guān)系。

圖2 放射治療后，研究隊(duì)列中檢測(cè)到的腦微出血（CMBs）累積數(shù)量，按劑量水平和時(shí)間段進(jìn)行分層。mo，月。

觸目驚心的數(shù)字

?62%中招率：21/34只放療犬出現(xiàn)≥1處腦微出血

? 時(shí)間累積效應(yīng)：每過(guò)1個(gè)月，出血灶數(shù)量暴增14%

? 劑量致命關(guān)聯(lián)：高劑量區(qū)（>30Gy）出血風(fēng)險(xiǎn)飆升4.7倍

四、研究結(jié)果

研究結(jié)果顯示，在接受放射治療后，有62%的犬至少出現(xiàn)了一處腦微出血。這一比例遠(yuǎn)高于基線掃描時(shí)的27%。此外，研究人員還發(fā)現(xiàn)，腦微出血的數(shù)量隨時(shí)間推移而顯著增加，每增加一個(gè)月，腦微出血的數(shù)量就增加14%。

更令人矚目的是，腦微出血最有可能出現(xiàn)在腫瘤周圍接受高劑量放射治療的區(qū)域。與高劑量區(qū)相比，低劑量區(qū)發(fā)生腦微出血的可能性顯著降低。

圖3 放射治療（RT）后，單只犬只腦微出血（CMBs）數(shù)量增加的示例（與圖1中的犬只相同）。如在放射敏感加權(quán)成像（SWI）序列中所見，治療后2個(gè)月、8個(gè)月、14個(gè)月和18個(gè)月，信號(hào)空洞/CMBs的數(shù)量隨時(shí)間增加。該犬還表現(xiàn)出腦部更尾側(cè)區(qū)域CMBs的增加。部分信號(hào)空洞為腫瘤內(nèi)的，這些不被計(jì)入為CMBs。

臨床警示：這些癥狀需警惕！

雖然目前腦微出血的直接臨床癥狀尚未明確，但研究者提示：

?? 放療后出現(xiàn)異常行為改變（如定向障礙、反應(yīng)遲鈍）

?? 突發(fā)癲癇發(fā)作頻率增加

?? 運(yùn)動(dòng)協(xié)調(diào)性下降

五、結(jié)論與臨床重要性

這項(xiàng)研究的重要發(fā)現(xiàn)表明，放射治療可能是導(dǎo)致犬類腦微出血形成的原因之一。腦微出血在腫瘤周圍的高劑量區(qū)最為常見，且隨時(shí)間推移數(shù)量逐漸增加。

然而，盡管這一發(fā)現(xiàn)揭示了放射治療與腦微出血之間的潛在聯(lián)系，但腦微出血的臨床相關(guān)性尚不明確。這意味著，盡管我們知道了腦微出血的存在和分布，但還需要進(jìn)一步的研究來(lái)探索其對(duì)犬類健康的具體影響。

總的來(lái)說(shuō)，這項(xiàng)研究為理解放射治療對(duì)犬類腦部的影響提供了新的視角，也為未來(lái)的研究指明了方向。隨著研究的深入，我們有望更全面地了解放射治療對(duì)犬類健康的影響，從而為寵物醫(yī)療提供更加精準(zhǔn)和有效的治療方案。

給主人的建議

放療前全面評(píng)估：建議進(jìn)行基線SWI掃描排除原有微出血

劑量精細(xì)化管理：與腫瘤專科醫(yī)生討論精準(zhǔn)技術(shù)應(yīng)用

長(zhǎng)期影像隨訪：治療后每6個(gè)月復(fù)查MRI，監(jiān)測(cè)CMBs演變

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點(diǎn)擊犬顱內(nèi)腫瘤放射治療劑量與腦微出血（CMBs）的關(guān)系，解鎖完整版

答題互動(dòng)：讀完文章在評(píng)論區(qū)留下你的答案吧

1. CMBs的數(shù)量與放射劑量相關(guān)？

2. CMBs數(shù)量是否隨時(shí)間增加？

來(lái)源|Online Library

翻譯|張帆

編輯|張秋雁

審核|郭羽麗