中华肿瘤杂志
中華腫瘤雜誌
중화종류잡지
CHINESE JOURNAL OF ONCOLOGY
2012年
2期
122-128
,共7页
邢军%李建彬%张英杰%李凤祥%范延勇%徐敏%尚东平%韩建军
邢軍%李建彬%張英傑%李鳳祥%範延勇%徐敏%尚東平%韓建軍
형군%리건빈%장영걸%리봉상%범연용%서민%상동평%한건군
肝肿瘤%四维CT模拟定位%内大体靶体积%呼吸时相
肝腫瘤%四維CT模擬定位%內大體靶體積%呼吸時相
간종류%사유CT모의정위%내대체파체적%호흡시상
Liver neoplasms%Four-dimensional CT simulation%Internal gross target volume%Respiratory phase
目的 比较基于四维CT(4D-CT)的3种不同勾画方法勾画原发性肝癌内大体靶体积( IGTV)位置和大小的差异及其相关的影响因素.方法 20例原发性肝癌患者介入治疗后行胸腹部4D-CT模拟定位,获得10个呼吸时相的CT图像和最大密度投影(MIP)图像.在Varian Eclipse治疗计划系统中,采用3种不同方法,依据碘油沉积范围分别勾画原发肿瘤的IGTV,即(1)在10个呼吸时相CT图像上分别勾画大体肿瘤体积(GTV),并将其融合得到IGTV10；(2)0％时相和50％时相GTV融合得到IGTVIN+EX；(3)在MIP图像上勾画可见肿瘤,得到包含呼吸运动信息的IGTVMIP.依据CT图像上肿瘤中心位置与肝脏的关系将患者分为A组(肿瘤中心位于肝脏上半部)和B组(肿瘤中心位于肝脏下半部),依据肿瘤最大截面长径的大小将患者分为C组(长径≤5 cm)和D组(长径＞5 cm),依据肿瘤中心三维运动矢量的大小将患者分为E组(运动矢量≤0.9 cm)和F组(运动矢量＞0.9cm).对比3种不同勾画方法所得IGTV10、IGTVIN+EX、IGTVMIP的位置、体积、包含度和匹配指数,并分别进行A组与B组、C组与D组、E组与F组的组间比较.结果 IGTV10 、IGTVIN+EX、IGTVMIP的靶区中心在X、Y、Z轴上的平均差异＜1.5 mm,且差异无统计学意义(P＞0.05).IGTV10、IGTVIN+EX和IGTVMIP的体积分别为(160.53±265.20) cm3、( 132.50±234.93) cm3和(130.02±225.73 )cm3,IGTV10＞ IGTVIN+EX,差异无统计学意义(t=0.354,P=0.725),IGTV10＞ IGTVMIP,差异无统计学意义(t=-0.392,P=0.697).IGTVIN+ EX/IGTV10、IGTVMIP/IGTV10分别为0.75±0.15和0.78±0.14.IGTV10对IGTVIN+EX和IGTVMIP的包含度分别为(74.85±15.09)％和(68.87±13.69)％.IGTV10与IGTVIN+EX、IGTV10与IGTVMIP的匹配指数分别为0.75±0.15和0.67±0.13.A组和B组中IGTVIN+EX/IGTV10的中位数分别为0.57和0.87,差异有统计学意义(Z=-3.300,P=0.001)；IGTVMIP/IGTV10的中位数分别为0.51和0.72,差异有统计学意义(Z=-3.413,P=0.001).C组和D组中IGTVIN+ EX/IGTV10的中位数分别为0.79和0.74,差异无统计学意义(Z=-0.920,P=0.358)；IGTVMIP/IGTV10的中位数分别为0.85和0.80,差异无统计学意义(Z=-0.568,P=0.570).E组和F组中IGTVIN+ EX/IGTV10的中位数分别为0.87和0.68,差异有统计学意义(Z=-2.897,P=0.004)；IGTVMIP/IGTV10的中位数分别为0.85和0.81,差异无统计学意义(Z=-1.522,P=0.128).结论 基于4D-CT不同方法所勾画的IGTV靶区中心位置变化不明显；IGTVIN+EX和IGTVMIP均不能完全替代IGTV10,但IGTVIN+EX与IGTV10大小更接近；IGTV10/IGTVIN+EX与肿瘤运动矢量相关.当肿瘤运动矢量≤0.9cm且位于肝脏下半部分时,可采用吸气末和呼气末融合图像勾画靶区；当肿瘤位于肝脏上半部分或运动矢量＞0.9 cm时,理想的IGTV应该由所有呼吸时相勾画靶区后融合得到.
目的 比較基于四維CT(4D-CT)的3種不同勾畫方法勾畫原髮性肝癌內大體靶體積( IGTV)位置和大小的差異及其相關的影響因素.方法 20例原髮性肝癌患者介入治療後行胸腹部4D-CT模擬定位,穫得10箇呼吸時相的CT圖像和最大密度投影(MIP)圖像.在Varian Eclipse治療計劃繫統中,採用3種不同方法,依據碘油沉積範圍分彆勾畫原髮腫瘤的IGTV,即(1)在10箇呼吸時相CT圖像上分彆勾畫大體腫瘤體積(GTV),併將其融閤得到IGTV10；(2)0％時相和50％時相GTV融閤得到IGTVIN+EX；(3)在MIP圖像上勾畫可見腫瘤,得到包含呼吸運動信息的IGTVMIP.依據CT圖像上腫瘤中心位置與肝髒的關繫將患者分為A組(腫瘤中心位于肝髒上半部)和B組(腫瘤中心位于肝髒下半部),依據腫瘤最大截麵長徑的大小將患者分為C組(長徑≤5 cm)和D組(長徑＞5 cm),依據腫瘤中心三維運動矢量的大小將患者分為E組(運動矢量≤0.9 cm)和F組(運動矢量＞0.9cm).對比3種不同勾畫方法所得IGTV10、IGTVIN+EX、IGTVMIP的位置、體積、包含度和匹配指數,併分彆進行A組與B組、C組與D組、E組與F組的組間比較.結果 IGTV10 、IGTVIN+EX、IGTVMIP的靶區中心在X、Y、Z軸上的平均差異＜1.5 mm,且差異無統計學意義(P＞0.05).IGTV10、IGTVIN+EX和IGTVMIP的體積分彆為(160.53±265.20) cm3、( 132.50±234.93) cm3和(130.02±225.73 )cm3,IGTV10＞ IGTVIN+EX,差異無統計學意義(t=0.354,P=0.725),IGTV10＞ IGTVMIP,差異無統計學意義(t=-0.392,P=0.697).IGTVIN+ EX/IGTV10、IGTVMIP/IGTV10分彆為0.75±0.15和0.78±0.14.IGTV10對IGTVIN+EX和IGTVMIP的包含度分彆為(74.85±15.09)％和(68.87±13.69)％.IGTV10與IGTVIN+EX、IGTV10與IGTVMIP的匹配指數分彆為0.75±0.15和0.67±0.13.A組和B組中IGTVIN+EX/IGTV10的中位數分彆為0.57和0.87,差異有統計學意義(Z=-3.300,P=0.001)；IGTVMIP/IGTV10的中位數分彆為0.51和0.72,差異有統計學意義(Z=-3.413,P=0.001).C組和D組中IGTVIN+ EX/IGTV10的中位數分彆為0.79和0.74,差異無統計學意義(Z=-0.920,P=0.358)；IGTVMIP/IGTV10的中位數分彆為0.85和0.80,差異無統計學意義(Z=-0.568,P=0.570).E組和F組中IGTVIN+ EX/IGTV10的中位數分彆為0.87和0.68,差異有統計學意義(Z=-2.897,P=0.004)；IGTVMIP/IGTV10的中位數分彆為0.85和0.81,差異無統計學意義(Z=-1.522,P=0.128).結論 基于4D-CT不同方法所勾畫的IGTV靶區中心位置變化不明顯；IGTVIN+EX和IGTVMIP均不能完全替代IGTV10,但IGTVIN+EX與IGTV10大小更接近；IGTV10/IGTVIN+EX與腫瘤運動矢量相關.噹腫瘤運動矢量≤0.9cm且位于肝髒下半部分時,可採用吸氣末和呼氣末融閤圖像勾畫靶區；噹腫瘤位于肝髒上半部分或運動矢量＞0.9 cm時,理想的IGTV應該由所有呼吸時相勾畫靶區後融閤得到.
목적 비교기우사유CT(4D-CT)적3충불동구화방법구화원발성간암내대체파체적( IGTV)위치화대소적차이급기상관적영향인소.방법 20례원발성간암환자개입치료후행흉복부4D-CT모의정위,획득10개호흡시상적CT도상화최대밀도투영(MIP)도상.재Varian Eclipse치료계화계통중,채용3충불동방법,의거전유침적범위분별구화원발종류적IGTV,즉(1)재10개호흡시상CT도상상분별구화대체종류체적(GTV),병장기융합득도IGTV10；(2)0％시상화50％시상GTV융합득도IGTVIN+EX；(3)재MIP도상상구화가견종류,득도포함호흡운동신식적IGTVMIP.의거CT도상상종류중심위치여간장적관계장환자분위A조(종류중심위우간장상반부)화B조(종류중심위우간장하반부),의거종류최대절면장경적대소장환자분위C조(장경≤5 cm)화D조(장경＞5 cm),의거종류중심삼유운동시량적대소장환자분위E조(운동시량≤0.9 cm)화F조(운동시량＞0.9cm).대비3충불동구화방법소득IGTV10、IGTVIN+EX、IGTVMIP적위치、체적、포함도화필배지수,병분별진행A조여B조、C조여D조、E조여F조적조간비교.결과 IGTV10 、IGTVIN+EX、IGTVMIP적파구중심재X、Y、Z축상적평균차이＜1.5 mm,차차이무통계학의의(P＞0.05).IGTV10、IGTVIN+EX화IGTVMIP적체적분별위(160.53±265.20) cm3、( 132.50±234.93) cm3화(130.02±225.73 )cm3,IGTV10＞ IGTVIN+EX,차이무통계학의의(t=0.354,P=0.725),IGTV10＞ IGTVMIP,차이무통계학의의(t=-0.392,P=0.697).IGTVIN+ EX/IGTV10、IGTVMIP/IGTV10분별위0.75±0.15화0.78±0.14.IGTV10대IGTVIN+EX화IGTVMIP적포함도분별위(74.85±15.09)％화(68.87±13.69)％.IGTV10여IGTVIN+EX、IGTV10여IGTVMIP적필배지수분별위0.75±0.15화0.67±0.13.A조화B조중IGTVIN+EX/IGTV10적중위수분별위0.57화0.87,차이유통계학의의(Z=-3.300,P=0.001)；IGTVMIP/IGTV10적중위수분별위0.51화0.72,차이유통계학의의(Z=-3.413,P=0.001).C조화D조중IGTVIN+ EX/IGTV10적중위수분별위0.79화0.74,차이무통계학의의(Z=-0.920,P=0.358)；IGTVMIP/IGTV10적중위수분별위0.85화0.80,차이무통계학의의(Z=-0.568,P=0.570).E조화F조중IGTVIN+ EX/IGTV10적중위수분별위0.87화0.68,차이유통계학의의(Z=-2.897,P=0.004)；IGTVMIP/IGTV10적중위수분별위0.85화0.81,차이무통계학의의(Z=-1.522,P=0.128).결론 기우4D-CT불동방법소구화적IGTV파구중심위치변화불명현；IGTVIN+EX화IGTVMIP균불능완전체대IGTV10,단IGTVIN+EX여IGTV10대소경접근；IGTV10/IGTVIN+EX여종류운동시량상관.당종류운동시량≤0.9cm차위우간장하반부분시,가채용흡기말화호기말융합도상구화파구；당종류위우간장상반부분혹운동시량＞0.9 cm시,이상적IGTV응해유소유호흡시상구화파구후융합득도.
Objective To compare the position and magnitude of internal target gross volume ( IGTV )of primary hepatocarcinoma delineated by three methods based on four-dimensional computed tomography (4D-CT) and to investigate the relevant factors affecting the position and magnitude.Methods Twenty patients with primary hepatocarcinoma after transcatheter arterial chemoembolization (TACE) underwent big bore 4D-CT simulation scan of the thorax and abdomen using a real-time position management ( RPM )system for simultaneous record of the respiratory signals.The CT images with respiratory signal data were reconstructed and sorted into 10 phase groups in a respiratory cycle,with 0％ phase corresponding to endinhale and 50％ corresponding to end-exhale. The maximum intensity projection (MIP) image was generated.IGTVs of the tumor were delineated using the following three methods:( 1 ) The gross tumor volume (GTV) on each of the ten respiratory phases of the 4D-CT image set was delineated and fused ten GTV to produce IGTV10; (2) The GrTNs delineated separately based on 0％ and 50％ phase were fused to produce IGTVIN+EX ; (3) The visible tumor on the MIP image was delineated to produce IGTVMIP.Twenty patients were divided into groups A and B based on the location of the target center,and were divided into groups C and D based on the tumor maximum diameter.The patients were divided into groups E and F based on the three-dimensional (3D) motion vector of the target center.The position of the target center,the volume of target,the degree of inclusion (DI) and the matching index (MI) were compared reciprocally between IGTV10,IGTVIN + EX and IGTV MIP,and the influence of the tumor position and 3D motion vector on the related parameters were compared based on the grouping.Results The average differences between the position of the center of IGTVs on direction of X,Y and Z axes were less than 1.5 nun,and the difference was statistically not significant.The volume of IGTV10 was larger than that of IGTVIN+EX,but the difference was not significant (t =0.354,P =0.725 ).The volume of IGTV10 was larger than that of IGTVMIP,but the difference was not significant (t =-0.392,P =0.697).The ratio of IGTVIN+EX to IGTV10 was 0.75 ±0.15 and the ratio of IGTVMIP to IGTV10 was 0.78 ±0.14.The DI of IGTVIN+Ex in IGTV10 was (74.85 ±15.09 ) ％ and that of IGTVMIP in IGTV10 was (68.87 ± 13.69) ％.The MI between IGTV10 and IGTVIN +EX,IGTV10 and IGTVMIP were 0.75 ±0.15 and 0.67 ±0.13,respectively.The median of ratio of IGTVIN+EX/IGTV10 was 0.57 in group A versus 0.87 in group B,statistically with a significant difference between the groups A and B ( Z =- 3.300,P =0.001 ).The median of ratio of IGTVMIp/IGTV10 was 0.51 in the group A and 0.72 in group B,with a significant difference between the groups A and B (Z =-3.413,P =0.001 ).The median of ratio of IGTVIN +EX/IGTV10 was 0.79 in group C versus 0.74 in group D,with a difference not significant (Z =-0.920,P =0.358).The median of ratio of IGTVMIP/IGTV10 was 0.85 in group C versus 0.80 in group D,with a non-significant difference (Z =- 0.568,P =0.570).The median of ratio of IGTVIN+EX/IGTV10 was 0.87 in group E versus 0.68 in group F,with a significant difference between the two groups ( Z =- 2.897,P =0.004 ).The median of ratio of IGTVMIP/IGTV10 was 0.85 in the group E versus 0.81 in the group F,with a non-significant difference ( Z =- 0.568,P =0.570).Conclusions The center displacement of the IGTVs delineated separately by the three techniques based on 4D-CT images is not obvious.IGTVIN+Ex and IGTVMIP can not replace IGTV10,however,IGTVIN+EX is more close to IGTV10 comparing with IGTVMIP.The ratio of IGTV10 and IGTVMIP is correlated to the 3D motion vector of the tumor.When the tumor is situated in the upper part of the liver and with a 3D motion vector less than 9 mm,IGTV10 should be the best IGTV.
