Imaging manifestations and research progress of radiotherapy-related cardiovascular injury
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摘要: 放疗作为肿瘤的重要治疗手段，在控制肿瘤进展的同时，也可造成心血管损伤，增加患者远期预后不良的风险。放疗相关心血管损伤表现多样，包括冠心病、心包炎、心瓣膜疾病、心肌病、胸颈部大血管粥样硬化等。影像学检查在放疗相关心血管损伤的诊疗中占有重要地位，可为疾病诊断、病情随访、预后判断提供关键信息。本文针对放疗相关不同类型心血管损伤的影像特征及研究进展进行综述。Abstract: As a vital therapy for tumors, radiotherapy effectively controls the progression of cancer; however, radiotherapy also leads cardiovascular injury and increases the risk of poor long-term prognosis. There are various manifestations of radiotherapy-related cardiovascular injury, including coronary heart disease, pericarditis, valvular heart disease, cardiomyopathy, chest and neck vascular atherosclerosis. Imaging examination plays an important role in the diagnosis and treatment of radiotherapy-related cardiovascular diseases, which provides key information for clinical diagnosis, routine follow-up and prognosis prediction. Therefore, this article reviews the imaging characteristics and research progress according to the types of radiotherapy-related cardiovascular diseases.
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图 1 放疗相关心血管损伤的分子机制示意图
Figure 1. Molecular mechanism of radiation-related cardiovascular injury
图 4 47岁左侧乳腺癌女性患者接受50 Gy胸部放疗
Figure 4. A 47-year-old woman with left side breast cancer received 50 Gy chest radiotherapy
图 5 健康志愿者以及乳腺癌放疗患者心脏影像
Figure 5. Heart imaging of healthy volunteers and patients with breast cancer radiation therapy
表 1 放疗相关心血管损伤急慢性反应
Table 1. Acute and chronic reactions of radiation-related cardiovascular injuries
疾病类型 急性反应 慢性反应 冠心病 ·作用不明显(放疗6个月后可能出现心肌灌注缺损或心肌运动障碍) ·促进冠心病更早发病
·加重冠心病的严重程度
·放疗后10年以上才出现临床症状(年龄小于50岁的患者多于10年后发病，年龄更大的患者潜伏期更长)
·好发部位为冠脉开口和近段心包炎 ·急性渗出性心包炎相对罕见(多由于接受放疗的肿瘤靠近心脏)
·迟发性急性心包炎发生于放疗后数周内，可表现为有症状的心包炎或无症状的心包积液，心脏填塞较为罕见·慢性心包炎多发生于放疗后数周或者数年后，表现为心包泛增厚、粘连，以及心包积液
·缩窄性心包炎发生率4%~20%，与放疗剂量相关心脏瓣膜疾病 ·作用不明显 ·表现为瓣膜的增厚、纤维化、缩短和钙化
·瓣膜反流比瓣膜狭窄更为常见，好发于二尖瓣与主动脉瓣
·瓣膜狭窄好发于主动脉瓣
·发病率与辐射剂量呈正相关心肌病 ·急性心肌炎可导致心脏运动功能轻度减低或心电图异常 ·心肌纤维化可导致心脏舒张与收缩功能障碍、心律失常
·严重者可发展为限制心肌病甚至心力衰竭颈动脉、主动脉粥样硬化 ·作用不明显 ·血管壁粥样硬化斑块形成，多位于照射范围内
·相比原发性血管粥样硬化，放疗导致的粥样硬化病变长度更长、累及范围更广
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