CAJ | 학술논문

目的探讨PET-CT在食管癌临床分期诊断和三维适形放疗靶区勾画及治疗计划制定中的应用价值.方法 2007-2008年经病理证实的食管癌患者20例人组,其中2例接受手术治疗,18例行三维适形放疗.患者疗前行PET-CT模拟定位,比较食管镜、食管钡餐造影、CT、PET-CT_(SUV2.5)、PET-CT_(40%SUVmax)图像上的病变长度及最大横径,观察CT与PET-CT对临床分期诊断的差异.依据CT、PET-CT_(SUV2.5)和PET-CT<40%SUVmax>勾画靶区并制定治疗计划,评价3套计划受量情况.结果食管镜、食管钡餐造影、CT、PET-CTS_(SUV2.5、PET-CT_(40%SUVmax))所示病变长度分别为4.93、5.06、6.67、5.89、4.84 cm,CT、PET-CT_(SUV2.5)、PET-CT_(40%SUV)所示病变最大横径分别为4.05、3.38、2.95 cm.CT图像诊断31个淋巴结转移,PET-CT图像诊断21个淋巴结转移,共同诊断14个,17个淋巴结CT诊断阳性而PET-CT为阴性,7个淋巴结CT诊断阴性而PET-CT为高代谢.5例患者经PET-CT模拟定位后M分期由Mn期改为_1期,1例经PET-CT模拟定位后由M_0期改为M_1期,1例CT和PET-CT M分期一致.依据CT和PET-CT_(SUV2.5)勾画的GTV基本相等2例,CTV_(CT)<GTV_(SUV2.5)者5例,>GT_(SUV2.5)者13例,GTV_(SUV2.5),<GTV_(CT)组患者正常组织受量较低.结论以SUV2.5为阈值勾画的GTV长度可能与实际病变长度最为接近,其次是食管钡餐造影;以40%SUV_(max)为阈值勾画GTV有可能会较低估计实际病变长度.PET-CT使部分患者临床分期及治疗目的发生改变,部分患者靶区范围或体积减少,正常组织受量降低.
목적 탐토PET-CT재식관암림상분기진단화삼유괄형방료파구구화급치료계화제정중적응용개치.방법 2007-2008년경병리증실적식관암환자20례인조,기중2례접수수술치료,18례행삼유괄형방료.환자료전행PET-CT모의정위,비교식관경、식관패찬조영、CT、PET-CT_(SUV2.5)、PET-CT_(40%SUVmax)도상상적병변장도급최대횡경,관찰CT여PET-CT대림상분기진단적차이.의거CT、PET-CT_(SUV2.5)화PET-CT<40%SUVmax>구화파구병제정치료계화,평개3투계화수량정황.결과 식관경、식관패찬조영、CT、PET-CTS_(SUV2.5、PET-CT_(40%SUVmax))소시병변장도분별위4.93、5.06、6.67、5.89、4.84 cm,CT、PET-CT_(SUV2.5)、PET-CT_(40%SUV)소시병변최대횡경분별위4.05、3.38、2.95 cm.CT도상진단31개림파결전이,PET-CT도상진단21개림파결전이,공동진단14개,17개림파결CT진단양성이PET-CT위음성,7개림파결CT진단음성이PET-CT위고대사.5례환자경PET-CT모의정위후M분기유Mn기개위_1기,1례경PET-CT모의정위후유M_0기개위M_1기,1례CT화PET-CT M분기일치.의거CT화PET-CT_(SUV2.5)구화적GTV기본상등2례,CTV_(CT)<GTV_(SUV2.5)자5례,>GT_(SUV2.5)자13례,GTV_(SUV2.5),<GTV_(CT)조환자정상조직수량교저.결론 이SUV2.5위역치구화적GTV장도가능여실제병변장도최위접근,기차시식관패찬조영;이40%SUV_(max)위역치구화GTV유가능회교저고계실제병변장도.PET-CT사부분환자림상분기급치료목적 발생개변,부분환자파구범위혹체적감소,정상조직수량강저.
Objective To investigate the value of PET-CT in TNM staging and three-conformal radiotherapy (3DCRT) in esophageal carcinoma. Methods From September 2007 to November 2008, 20 patients with pathologically confirmed esophageal carcinoma were enrolled, including 2 treated with surgery and 18 with 3DCRT. All the patients received PET-CT simulation before the treatment. The length and maximum transverse diameter of Grit based on esophagoscope, esophagography, CT, PET-CT_(SUV2.5) and PET-CT_(40%SUVmax) were compared. The TNM stages were compared based on CT and PET-CT images. Three treatment plans were produced and analyzed based on images of CT, PET-CT_(SUV2.5) and PET-CT_(40%SUVmax),respectively. Results The length of lesion on esophagoscope, esophagography, CT, PET-CT_(SUV2.5) and PET-CT_(40%SUVmax) was 4. 93 cm, 5.06 cm, 6. 67 cm, 5. 89 cm and 4. 84 cm, respectively. The corresponding maximum transverse diameter on the last 3 images was 4. 05 cm, 3.38 cm and 2. 95 cm, respectively. In all, 31, 21 and 14 positive lymph nodes were identified according to CT images, PET-CT images and the both. Five patients with CT diagnosed stage M_0 were found to have distant metastasis by PET-CT images, and 1 patient with CT diagnosed stage M_1 was excluded by PET-CT. The volumes of GTV_(CT) were similar with GTV_(SUV2.5) in 2 patients, smaller in 5 patients, and larger for the remaining 13 patients. For these 13 patients, the radiation dose of normal tissues based on GTV_(SUV2.5) was relatively lower. Conclusions The length of lesion based on PET -CT_(SUV2.5) matches the pathological length best , followed by esophagography. With PET-CT_(40%SUVmax) the actual lesion length may be underestimated. TNM stage might be changed by PET-CT, and then the target volumes and radiation doses of normal tissues might be reduced.