CAJ | 학술논문

目的探讨CT-MRI联合定位对立体定向放射外科治疗垂体腺瘤计划制定的影响.方法纳入2014年1月至4月在上海伽玛医院神经外科治疗的31例垂体腺瘤患者.患者均行头颅MRI和CT定位扫描,并将定位影像资料导入治疗计划系统后,分别请两位同样年资的医生使用统一周边剂量和等剂量线进行治疗计划设计.对照组医生仅使用MRI影像资料进行计划设计,实验组使用MRI联合CT的影像资料进行计划设计.再比较两位医生在计划设计方面的差异.结果治疗计划的常规参数比较未发现两组在设计风格上的差异有统计意义.对照组肿瘤靶区的平均体积为4.3 cm3,而CT-MRI联合定位组为3.4 cm3,两者差异有统计学意义(P ＜0.0001).12 Gy体积范围分别为8.0 cm3和7.3 cm3,两组差异有统计学意义(P =0.042).两者在视神经结构最高剂量上差异也有统计学意义.多因素分析发现视神经入口骨性结构误判是造成肿瘤靶区体积差异的原因,也是造成视神经结构最高剂量差异的主要原因.结论 CT-MRI联合定位与单独MRI定位相比,在垂体腺瘤的伽玛刀计划设计中可以有效识别鞍区骨性结构,降低对正常组织的辐射剂量.
목적 탐토CT-MRI연합정위대입체정향방사외과치료수체선류계화제정적영향.방법 납입2014년1월지4월재상해가마의원신경외과치료적31례수체선류환자.환자균행두로MRI화CT정위소묘,병장정위영상자료도입치료계화계통후,분별청량위동양년자적의생사용통일주변제량화등제량선진행치료계화설계.대조조의생부사용MRI영상자료진행계화설계,실험조사용MRI연합CT적영상자료진행계화설계.재비교량위의생재계화설계방면적차이.결과 치료계화적상규삼수비교미발현량조재설계풍격상적차이유통계의의.대조조종류파구적평균체적위4.3 cm3,이CT-MRI연합정위조위3.4 cm3,량자차이유통계학의의(P ＜0.0001).12 Gy체적범위분별위8.0 cm3화7.3 cm3,량조차이유통계학의의(P =0.042).량자재시신경결구최고제량상차이야유통계학의의.다인소분석발현시신경입구골성결구오판시조성종류파구체적차이적원인,야시조성시신경결구최고제량차이적주요원인.결론 CT-MRI연합정위여단독MRI정위상비,재수체선류적가마도계화설계중가이유효식별안구골성결구,강저대정상조직적복사제량.
Objective This study was designed to evaluate the CT-MRI co-localization in Gamma Knife radiosurgery treatment of pituitary neoplasms.Methods There were 31 patients who were diagnosed as pituitary adenomas based on MRI and endocrine disorders without microsurgical history enlisted in the study.All these patients were treated with Leksell Perfexion Gamma Knife System (GKS) and localized with CT-MRI images.Two experienced treatment plan-designers were asked to perform treatment planning based on MRI only (control group) or CT-MRI co-localization images (experiment group).The plans' parameters such as coverage,selectivity and gradient index were compared using paired t-test to evaluate the planning style differences between two plan-designers.The treatment volume (TV),12 Gy volume,average dose of TV and the maximal dose of optical structure (OS) were compared between two groups.Results There was no difference of planning style between two plan-designers.The TVs were 4.3 cm3 in the control group and 3.4 cm3 in the experiment group (P ＜0.0001).The 12 Gy volumes were 8.0 cm3 in the control group and 7.3 cm3 in the experiment group (P =0.042).The multiple factors analysis indicated that the miss definition of osseous structure of optical canal was the only statistical significant factor.Conclusion CT-MRI co-localization was a useful way to define the boundary of pituitary neoplasms.It was more accurate and could minimize the target volume / 12 Gy volume.