CAJ | 학술논문

目的探讨自由呼吸状态下基于四维CT的肺癌原发灶位移及其与感兴趣器官和体表标记位移相关性,以及各呼吸时相肿瘤体积与肺脏体积变化相关性.方法 16例肺癌患者进行自由呼吸状态下四维CT模拟定位扫描.以四维CT吸气末图像为基准图像,分别勾画肿瘤、感兴趣解剖结构和体表标志,记录配准后10套图像中的三维坐标.测量和比较各时相大体肿瘤体积( GTV)和肺脏体积以及相关性,测量肿瘤、感兴趣结构及体表标记的三维方向位移并计算三维运动矢量及其相关性.结果不同肺叶肿瘤运动范围相差较大,肺上叶为0.8～5.0 mm,肺中叶为5.7～5.9 mm,肺下叶为10.2～13.7 mm.肿瘤位移上下方向为(4.3+4.3) mm,大于前后方向(2.2±1.0) mm和左右方向(1.7+1.5) mm (x2=16.22,P=0.000).肿瘤GTV与各感兴趣结构三维运动矢量间均无相关性(r=-0.50～-0.01,P=0.058～-0.961),不同呼吸时相GTV变化与肺脏体积变化也无相关性(r=0.23,P=0.520).结论不同肺叶肿瘤位移和肿瘤三维方向上位移差异显著,肺癌放疗时内在靶体积外扩边界应基于四维CT测定个体化确定.
목적 탐토자유호흡상태하기우사유CT적폐암원발조위이급기여감흥취기관화체표표기위이상관성,이급각호흡시상종류체적여폐장체적변화상관성.방법 16례폐암환자진행자유호흡상태하사유CT모의정위소묘.이사유CT흡기말도상위기준도상,분별구화종류、감흥취해부결구화체표표지,기록배준후10투도상중적삼유좌표.측량화비교각시상대체종류체적( GTV)화폐장체적이급상관성,측량종류、감흥취결구급체표표기적삼유방향위이병계산삼유운동시량급기상관성.결과 불동폐협종류운동범위상차교대,폐상협위0.8～5.0 mm,폐중협위5.7～5.9 mm,폐하협위10.2～13.7 mm.종류위이상하방향위(4.3+4.3) mm,대우전후방향(2.2±1.0) mm화좌우방향(1.7+1.5) mm (x2=16.22,P=0.000).종류GTV여각감흥취결구삼유운동시량간균무상관성(r=-0.50～-0.01,P=0.058～-0.961),불동호흡시상GTV변화여폐장체적변화야무상관성(r=0.23,P=0.520).결론 불동폐협종류위이화종류삼유방향상위이차이현저,폐암방료시내재파체적외확변계응기우사유CT측정개체화학정.
Objective To investigate the correlation of position movement of primary tumor with interested organs and skin markers,and to investigate the correlation of volume variation of primary tumors and lungs during different respiration phases for patients with lung cancer at free breath condition scanned by four-dimensional CT (4DCT) simulation.Methods 16 patients with lung cancer were scanned at free breath condition by simulation 4DCT which connected to a respiration-monitoring system.A coordinate system was created based on image of T5 phase,gross tumor volume (GTV) and normal tissue structures of 10 phases were contoured.The three dimensional position variation of them were measured and their correlation were analyzed,and the same for the volume variation of GTV and lungs of 10 respiratory phases.Results Movement range of lung cancer in different lobe differed extinct:0.8 - 5.0 mm in upper lobe,5.7 -5.9 mm in middle lobe and 10.2 - 13.7 mm in lower lobe,respectively.Movement range of lung cancer in three dimensional direction was different:z-axis 4.3 mm ± 4.3 mm＞ y-axis 2.2 mm ± 1.0 mm ＞ x-axis 1.7 mm ± 1.5 mm ( x2 =16.22,P =0.000),respectively.There was no statistical significant correlation for movement vector of GTV and interested structures (r =-0.50 - -0.01,P =0.058 - -0.961 ),nor for volume variation of tumor and lung ( r =0.23,P =0.520 ).Conclusions Based on 4DCT,statistically significant differences of GTV centroid movement are observed at different pulmonary lobes and in three dimensional directions.So individual 4DCT measurement is necessary for definition of internal target volume margin for lung cancer.