CAJ | 학술논문

目的应用四维CT(4DCT)测量肺癌大体肿瘤体积(GTV)在三维方向上随呼吸运动的位移并分析其影响因素.方法选择21例肺癌患者共22个肺部病灶行4DCT扫描,勾画10个呼吸时相中的GTV0%～GTV90%.测量GTV变化及GTV质心、边界在三维方向上随呼吸运动的位移,计算出三维空间位移向量→(II)v并分析其影响因素.结果 GTV变化的平均值为+14.3%或-8.4%,GTV 中心点和GTV各边界在左右、前后、头脚方向上随呼吸运动的位移分别为(0.20±0.16)、(0.18±0.12)、(0.53±0.59)cm和(0.42±0.23)、(0.41±0.22)、(0.57±0.70)cm,其中GTV中心点在头脚方向上的位移大于左右(Z=-2.12,P=0.034)、前后方向(Z=-2.10,P=0.035),GTV各边界在头脚方向上的位移与左右、前后方向差异无统计学意义(Z=-0.81,P=0.417;Z=-0.86,P=0.391).GTV中心点随呼吸的位移大小只与所在肺叶有关,GTV位于下叶者在头脚方向的位移大于位于上叶者[(0.87±O.64)和(0.35±0.49)em,(t=-2.12,P=0.047)],在前后、左右方向上的位移无差异[(0.23±0.10)和(0.19±0.18)cm(t=-0.49,P=0.629)、(0.21±0.13)和(0.17±0.11)cm(t=-0.76,P=0.460)].GTV体积大小与GTV中心点在头脚、前后、左右方向位移以及三维空间位移向量→(II)v间无明显相关性(r=0.306、-0.062、-0.279、-0.300,P=0.189、0.796、0.234、0.199).结论肺癌患者GTV随呼吸运动的位移个体化差异明显,头脚方向位移尤为显著,应用4DCT可进行较好评价;下叶病灶位移大,GTV大小与位移间无明显相关性.
목적 응용사유CT(4DCT)측량폐암대체종류체적(GTV)재삼유방향상수호흡운동적위이병분석기영향인소.방법 선택21례폐암환자공22개폐부병조행4DCT소묘,구화10개호흡시상중적GTV0%～GTV90%.측량GTV변화급GTV질심、변계재삼유방향상수호흡운동적위이,계산출삼유공간위이향량→(II)v병분석기영향인소.결과 GTV변화적평균치위+14.3%혹-8.4%,GTV 중심점화GTV각변계재좌우、전후、두각방향상수호흡운동적위이분별위(0.20±0.16)、(0.18±0.12)、(0.53±0.59)cm화(0.42±0.23)、(0.41±0.22)、(0.57±0.70)cm,기중GTV중심점재두각방향상적위이대우좌우(Z=-2.12,P=0.034)、전후방향(Z=-2.10,P=0.035),GTV각변계재두각방향상적위이여좌우、전후방향차이무통계학의의(Z=-0.81,P=0.417;Z=-0.86,P=0.391).GTV중심점수호흡적위이대소지여소재폐협유관,GTV위우하협자재두각방향적위이대우위우상협자[(0.87±O.64)화(0.35±0.49)em,(t=-2.12,P=0.047)],재전후、좌우방향상적위이무차이[(0.23±0.10)화(0.19±0.18)cm(t=-0.49,P=0.629)、(0.21±0.13)화(0.17±0.11)cm(t=-0.76,P=0.460)].GTV체적대소여GTV중심점재두각、전후、좌우방향위이이급삼유공간위이향량→(II)v간무명현상관성(r=0.306、-0.062、-0.279、-0.300,P=0.189、0.796、0.234、0.199).결론 폐암환자GTV수호흡운동적위이개체화차이명현,두각방향위이우위현저,응용4DCT가진행교호평개;하협병조위이대,GTV대소여위이간무명현상관성.
Objective This study was to assess the three-dimensional gross tumor volume(GTV)motion of lung cancer caused by respiration using four-dimensional computed tomography(4DCT),and to analyze the influenee factors.Methotis Four-DCT scans of 22 lung focuses in 21 patients with lung cancer were analyzed.The gross tumor volume was contoured in all 10 respiration phases of 4DCT scans.The changes in volume of GTV,the 3D motion of the centroid,boundary of GTV and the 3D spatial motion vectors were calculated and the irdluenee factors were analyzed.Results The average change in volume of GTV was+14.3%(0.2%.42.5%)/-8.4%(0.4%-38.6%),the average movement amplitude of GTV centroid and GTV boundary were(0.18±0.12)cm,(0.20±0.16)cm,(0.53±0.59)cm and(0.42±0.23)cm,(0.41±0.22)cm,(0.57±0.70)cm in medio-lateral,vertro-dorsal,cranio-caudal(CC) direction,respectively.The CC movement was larger than other directions(Z=-2.12,P=0.034;Z:-2.10,P=0.035),and no significant difference was observed in 3D motion of GTV boundary(Z=-0.81.P=0.417;Z=-0.86,0.391).The CC motion of GTV eentroid in lower lobe was larger than that in upper lobe[(0.87±0.64)and(0.35±0.49)cm,(t=-2.12,P=0.047)],and no significant difference was found in other directions[(0.23±0.10)and(0.19±0.18)em(t=-0.49,P=0.629),(0.21±0.13)and(0.17±0.11)cm(t=0.76,P=0.460)].There was no correlation of the 3D movement and 3D spatial motion vector of GTV to the volume of GTV(r=-0.306,-0.062,-0.279,-0.300;P=0.189,0.796.0.234,0.199).Conclusions GTV motion of patients with lung cancer is individual,the CC movement is the moat obvious,using 4DCT to assess is comparatively accurate.The motion amplitude of lower lobe focuses is larger.No significant correlation of the GTV motion to the volume was observed.Larger sample study is needed to analyze the influence of adjacency to the GTV motion.