CAJ | 학술논문

目的比较基于三维CT (3DCT)和四维CT (4DCT)4种方法确定的食管癌内在大体肿瘤体积( IGTV)位置、体积及匹配指数(MI)的差异.方法 13例食管癌患者于同次CT模拟定位时序贯完成3DCT和4DCT扫描,并依据国际抗癌联盟或美国癌症研究联合会食管分段标准分为胸上段组(A组)和胸中下段组(B组).采用4种方式获得IGTV(:)4DCT 10个呼吸时相的GTV融合得到IGTV10；0％和50％时相融合得到IGTV2；在最大密度投影(MIP)图像上勾画得到IGTVMIP;基于3DCT图像上GTV依据4DCT图像测得的靶区运动范围外扩得到IGTV3D.结果 A组左右、前后、上下方向位移差异无统计学意义(0.11、0.09、0.18 cm,χ2=1.06,P=0.589)；B组上下方向位移＞左右、前后方向(0.47、0.15、0.12 cm,χ2=12.00,P=0.002).A组IGTV10与IGTV2、IGTV3D靶区中心三维方向位移差异均无统计学意义(t=-2.24 ～0.00,P=0.089～1.000),MI分别为0.88、0.54.B组IGTV10和IGTV3D靶区中心左右、前后、头脚位移差异无统计学意义(t=-0.80、-0.82、-1.16,P=0.450、0.438、0.285),MI为0.59;而IGTV10和IGTV2靶区中心位移在左右方向差异有统计学意义(t=2.97,P=0.021),MI为0.86.IGTVMIP体积＜IGTV10(t=-2.84,P=0.025),IGTVMIP和IGTV10靶区中心左右、前后、头脚位移差异无统计学意义(t=-0.25、0.84、-1.22,P=0.809、0.429、0.263),IGTV10对IGTV MIP的MI为0.78.结论对胸段食管原发肿瘤,基于4DCT图像进行靶区勾画在保证靶区覆盖率的同时缩小了内靶体积,但IGTV2和IGTVMIP均不能包含食管原发肿瘤的全部运动信息.
목적 비교기우삼유CT (3DCT)화사유CT (4DCT)4충방법학정적식관암내재대체종류체적( IGTV)위치、체적급필배지수(MI)적차이.방법 13례식관암환자우동차CT모의정위시서관완성3DCT화4DCT소묘,병의거국제항암련맹혹미국암증연구연합회식관분단표준분위흉상단조(A조)화흉중하단조(B조).채용4충방식획득IGTV(:)4DCT 10개호흡시상적GTV융합득도IGTV10；0％화50％시상융합득도IGTV2；재최대밀도투영(MIP)도상상구화득도IGTVMIP;기우3DCT도상상GTV의거4DCT도상측득적파구운동범위외확득도IGTV3D.결과 A조좌우、전후、상하방향위이차이무통계학의의(0.11、0.09、0.18 cm,χ2=1.06,P=0.589)；B조상하방향위이＞좌우、전후방향(0.47、0.15、0.12 cm,χ2=12.00,P=0.002).A조IGTV10여IGTV2、IGTV3D파구중심삼유방향위이차이균무통계학의의(t=-2.24 ～0.00,P=0.089～1.000),MI분별위0.88、0.54.B조IGTV10화IGTV3D파구중심좌우、전후、두각위이차이무통계학의의(t=-0.80、-0.82、-1.16,P=0.450、0.438、0.285),MI위0.59;이IGTV10화IGTV2파구중심위이재좌우방향차이유통계학의의(t=2.97,P=0.021),MI위0.86.IGTVMIP체적＜IGTV10(t=-2.84,P=0.025),IGTVMIP화IGTV10파구중심좌우、전후、두각위이차이무통계학의의(t=-0.25、0.84、-1.22,P=0.809、0.429、0.263),IGTV10대IGTV MIP적MI위0.78.결론 대흉단식관원발종류,기우4DCT도상진행파구구화재보증파구복개솔적동시축소료내파체적,단IGTV2화IGTVMIP균불능포함식관원발종류적전부운동신식.
Objective To compare the position,volume and matching index (MI) of patientspecific internal gross tumor volume (IGTV) delineated by 4 different approaches based on three- dimensional and four - dimensional CT ( 3 DCT and 4 DCT ) image for primary esophageal cancers.Methods Thirteen patients with primary esophageal cancer underwent 3DCT and 4DCT simulation scans during free breathing,and the patient were divided into group A (tumor located in the proximal thoracic esophagus) and B (tumor located in the mid-and distal thoracic esophagus).IGTV were delineated using four approaches: The gross tumor volume (GTV) contours from 10 respiratory phases were combined into IGTV10 ;IGTV2 was acquired by combining the GTV from 0％ and 50％ phases; IGTVMIP was the GTV contour delineated from the maximum intensity projection (MIP) ;IGTV3D was acquired from the enlargement of 3 DCT-based GTV by each spatial direction on the motion amplitude measured in the 4DCT.Results Target movement in lateral (LR),anterio-posterior (AP),superio-inferior (SI) directions showed no statistically significant difference (0.11 cm,0.09 cm,0.18 cm,respectively; χ2 =1.06,P=0.589),and there was no statistically significant difference in centroid positions between IGTV10 and IGTV2 or IGTV3D in group A (t =-2.24,-0.00,P =0.089,- 1.000 ),MI between IGTV10 and IGTV2,IGTV10 and IGTV3D were 0.88,0.54,respectively. For group B, target movement amplitude in SI direction was bigger than in LR, AP ( 0.47 cm,0. 15 cm,0. 12 cm,X2 = 12.00,P = 0.002).There was no significant difference between IGTV10 and IGTV3D in LR, AP, SI ( t = - 0.80.- 0.82,- 1.16,P = 0.450.0.438.0.285 ), MI was 0.59 ; but the target center coordinates was demonstrated significant difference in SI between IGTV10 and ICTV2 for group B ( t = 2.97.P = 0.021 ), Ml was 0.86. The volume of IGTVMIP was smaller than IGTV10 ( t = - 2.84,P = 0.025 ), but the position of IGTv10 and ICTVMIp were with no statistically significant difference in the LR,AP,SI ( t = - 0.25,0. 84. - 1.22,P = 0. 809,0.429.0.263 ) ,MI between IGTV10 and IGTVMIp was 0.78. Conclusions Patient-specific IGTV can be acquired from 4DCT with correct target coverage while avoiding a geographic miss for the thoracic esophageal cancer,but IGTV2 and IGTVMIP can not contain all the information about primary tumor position,shape.and size at different phases of the respiratory cycle.