CAJ | 학술논문

目的比较基于主动呼吸控制(ABC)辅助三维CT(3DCT)扫描与基于自由呼吸3DCT及四维CT(4DCT)扫描所构建周围型肺癌内大体肿瘤体积(IGTV)中心点位置、体积大小及匹配指数(MI)的差异.方法 18例周围型肺癌患者,序贯完成自由呼吸胸部3DCT和4DCT扫描及ABC辅助平静吸气末和平静呼气末3DCT扫描.4DCT 10个时相GTV融合得到IGTV10,0％和50％时相的GTV融合得到IGTV2,基于最大密度投影(MIP)图像构建IGTVMIP,自由呼吸3DCT图像GTV外扩基于4DCT测得的运动范围得到IGTV3D,平静吸气末和呼气末屏气3DCT图像GTV融合得到IGTVABC.结果上叶组IGTVABC与IGTV10中心位置在左右方向上差异有统计学意义(t=-2.377,P ＜0.05),与IGTVMIP中心位置在前后方向上差异有统计学意义(t=-2.199,P＜0.05),与IGTV2、IGTV3D中心位置在左右和前后方向上差异有统计学意义(t=-2.185 ～2.767,P＜0.05)；下叶组IGTVABC与IGTV10、IGTVMIP、IGTV3D中心位置在左右方向上差异有统计学意义(t=3.950～4.543,P ＜0.05).上叶组及下叶组IGTV10、IGTV3D与IGTVABC的体积比较,差异有统计学意义(Z=-3.180～-2.023,P＜0.05),IGTVABC与其他IGTV的匹配指数上叶组大于下叶组,差异有统计学意义(Z=-2.419～-2.119,P＜0.05).结论 IGTVABC与基于4DCT扫描图像所构建的各种IGTV和基于自由呼吸3DCT扫描图像所构建的IGTV均不完全重合,这种空间错位与肿瘤部位相关,肺中下叶肿瘤较肺上叶肿瘤显著.IGTVABC体积大于IGTV2,但小于基于4DCT图像所构建的其他各种IGTV及基于自由呼吸3DCT图像所构建的IGTV.
목적 비교기우주동호흡공제(ABC)보조삼유CT(3DCT)소묘여기우자유호흡3DCT급사유CT(4DCT)소묘소구건주위형폐암내대체종류체적(IGTV)중심점위치、체적대소급필배지수(MI)적차이.방법 18례주위형폐암환자,서관완성자유호흡흉부3DCT화4DCT소묘급ABC보조평정흡기말화평정호기말3DCT소묘.4DCT 10개시상GTV융합득도IGTV10,0％화50％시상적GTV융합득도IGTV2,기우최대밀도투영(MIP)도상구건IGTVMIP,자유호흡3DCT도상GTV외확기우4DCT측득적운동범위득도IGTV3D,평정흡기말화호기말병기3DCT도상GTV융합득도IGTVABC.결과 상협조IGTVABC여IGTV10중심위치재좌우방향상차이유통계학의의(t=-2.377,P ＜0.05),여IGTVMIP중심위치재전후방향상차이유통계학의의(t=-2.199,P＜0.05),여IGTV2、IGTV3D중심위치재좌우화전후방향상차이유통계학의의(t=-2.185 ～2.767,P＜0.05)；하협조IGTVABC여IGTV10、IGTVMIP、IGTV3D중심위치재좌우방향상차이유통계학의의(t=3.950～4.543,P ＜0.05).상협조급하협조IGTV10、IGTV3D여IGTVABC적체적비교,차이유통계학의의(Z=-3.180～-2.023,P＜0.05),IGTVABC여기타IGTV적필배지수상협조대우하협조,차이유통계학의의(Z=-2.419～-2.119,P＜0.05).결론 IGTVABC여기우4DCT소묘도상소구건적각충IGTV화기우자유호흡3DCT소묘도상소구건적IGTV균불완전중합,저충공간착위여종류부위상관,폐중하협종류교폐상협종류현저.IGTVABC체적대우IGTV2,단소우기우4DCT도상소구건적기타각충IGTV급기우자유호흡3DCT도상소구건적IGTV.
Objective To compare the differences of the position, volume and matching index (MI) between internal gross tumor volumes ( IGTVs) determined by four methods based on four dimensional CT (4DCT) and three dimensional CT (3DCT) scans during free reathing and IGTV determined hy one method based on 3DCT ssisted with active breathing control. Methods Eighteen patients with peripheral lung cancer underwent 3DCT and 4DCT simulation scans during free hreathing and then underwent 3DCT simulation scans in end inspiration hold ( CTFIH )and end expiration hold ( CTEFH ).IGTVs were acquired using five methods: the gross tumor volme ( GTV) contours from ten respiratory phases were combined into IGTV10; The GTV contours from 0％ and 50％ phases were combined into ICTV2; IGTVMIP was the GTV contour delineated from the maximum intensity projection ( MIP) ; IGTV3D was acquired from the enlargement of 3DCT-based GTV by each spatial direction on the motion amplitude measured in 4DCT; IGTVABC was acquired by combining GTVs from CTEIR and CTEEH. Results In upper lobe group, there were significant differences in centroid position between ICTVABC and IGTV10 in lateral ( LR) , and IGTVMIP in anterio-posterior ( AP) directions respectively (t = - 2. 377, - 2. 199, P ＜0. 05) ,and there were significant differences in centroid position between IGTVABC and IGTV2 , IGTV3D in both LR and AP directions (t = - 2. 185 - - 2. 767, P ＜ 0. 05). In lower lobe group, there were significant differences in centroid position between IGTVABC and ICTV10, IGTVMIP, IGTV3D in LR direction (t =3. 950 -4. 543 , P＜0. 05). ,Either in the upper lobe group or in the lower lobe group, IGTVABC was smaller than ICTV10 or IGTV3D significantly (Z = - 3. 180 - - 2. 023 , P＜ 0. 05) , and the Mls between ICTVABC and otber IGTVs were larger in the upper lobe group thanin the lower lobe group significantly (Z = -2. 419 --2. 119, P＜0. 05 ) . Conclrrsions IGTVABC is not completely coincide with IGTVs acquired based on 4DCT or 3DCT during free breathing, and the spatial mismatch correlated with the tumor position,the spatial mismatch is more significant for middle-lower lobe tumor than upper lobe tumor. IGTVABC are larger than IGTV2 but smaller than other IGTVs acquired based on 4DCT and IGTV acquired based on 3DCT during free breathing.