CAJ | 학술논문

目的探讨调强放射治疗(IMRT)时应用CT-MRI图像融合技术准确设定高分级胶质瘤(HGG)肿瘤靶区体积(GTV)的方法.方法 19例HGG患者均采集CT、MRI图像,将两种影像融合.每位患者均由一位主任医师和一位住院医师分别独立依据增强CT、MRIT1增强序列勾画GTV,并叠加得到融合的GTV.计算各个GTV:GTVCT、GTVMRI、GTVCT+MR1,详细比较各GTV之间的差异.结果经主任医师和住院医师勾画,均GTVMRI＞GTVCT(均P＜0.050).GTVMRI/GTVCT+MRI:主任医师勾画为(98.57±7.00)%,住院医师勾画为(97.84±10.00)%.术后放疗患者与单纯放疗者GTVCT与GTVMRI间差异有统计学意义(P=0.046).依据CT图像,主任医师勾画的GTV大于住院医师所勾画(P= 0.020);依据MRI或融合图像,两级医师勾画的GTV间差异无统计学意义(均P＞0.050).结论对于HGG患者,GTV的准确设定必须综合CT与MRI的影像信息,包括应用CT-MRI融合技术,术后放疗的HGG患者更应如此.融合GTV应为依据增强CT及MRIT1增强序列勾画的GTV的叠加,并且,GTV必须由经验丰富的医师勾画或审核.
목적 탐토조강방사치료(IMRT)시응용CT-MRI도상융합기술준학설정고분급효질류(HGG)종류파구체적(GTV)적방법.방법 19례HGG환자균채집CT、MRI도상,장량충영상융합.매위환자균유일위주임의사화일위주원의사분별독립의거증강CT、MRIT1증강서렬구화GTV,병첩가득도융합적GTV.계산각개GTV:GTVCT、GTVMRI、GTVCT+MR1,상세비교각GTV지간적차이.결과 경주임의사화주원의사구화,균GTVMRI＞GTVCT(균P＜0.050).GTVMRI/GTVCT+MRI:주임의사구화위(98.57±7.00)%,주원의사구화위(97.84±10.00)%.술후방료환자여단순방료자GTVCT여GTVMRI간차이유통계학의의(P=0.046).의거CT도상,주임의사구화적GTV대우주원의사소구화(P= 0.020);의거MRI혹융합도상,량급의사구화적GTV간차이무통계학의의(균P＞0.050).결론 대우HGG환자,GTV적준학설정필수종합CT여MRI적영상신식,포괄응용CT-MRI융합기술,술후방료적HGG환자경응여차.융합GTV응위의거증강CT급MRIT1증강서렬구화적GTV적첩가,병차,GTV필수유경험봉부적의사구화혹심핵.
Objective To investigate the way to accurately delineate gross tumor volume (GTV) of high grade gliomas(HGG) for intensity modulated radiation therapy (IMRT) by using computed tomography (CT) and magnetic resonance imaging (MRI) image fusion technique. Methods CT and MRI images were fused from 19 patients. The GTV of each patient were independently delineated by one chief doctor and one resident doctor on CT and MRI image. The GTV contoured on CT (GTVCT), MRI (GTVMRI) were measured, and composite volumes (GTVCT+MRI) were the sum of CT-defined GTV and MRI-defined GTV. The differences of these volumes were compared. Results Whether chief or resident doctors delineated, all were GTVMRI ＞GTVCT(P ＜0.050). The percentages of GTVMRI on GTVCT+MRI were (98.57±7.00)% by chief doctors, and (97.84±10.00)% by resident doctors. Compared the difference between GTVCT and GTVMRI in postoperative patients and preoperative patients, P =0.046, and the difference between chief doctors and resident doctors was statistically significant for GTV defined by CT (P =0.020), but not by MRI and composite image (P ＞0.050).Conclusion The GTV of HGG patients must be delineated on both CT image and MRI image, including using CT and MRI image fusion. But the composite volumes(GTVCT+MRI) should be the sum of CT-defined GTV and MRI-defined GTV. Especially for the postoperative patients,delineating GTV should be taken more attention. And the GTV should be delineated by doctors with full experiences.