CAJ | 학술논문

目的探讨增强扫描与否对基于4DCT勾画的胸段食管癌原发肿瘤各时相GTV差异及对IGTV构建的影响.方法 25例胸段食管癌患者,胸上段8例、胸中段9例、胸下段8例,自由呼吸状态下序贯完成普通4DCT与增强4DCT扫描,同一勾画者按照同一标准先在平扫4DCT各图像上勾画GTV并构建相应IGTV.1个月后同一勾画者再在增强4DCT图像上勾画GTV并构建相应IGTV.结果基于增强扫描图像勾画的靶区变异系数小于平扫图像勾画的(P=0.000),但胸上、下段食管癌患者二者的GTVz轴长度、GTV、IGTV均相近(P=0.529、0.110;P=0.158、0.416;P=0.147、0.615),而对胸中段食管癌患者二者的GTV z轴长度、GTV、IGTV不同(P=0.005、0.035、0.021).结论对胸中段食管癌患者,增强4DCT扫描可减小靶区勾画误差并可构建相对精确的IGTV,而对胸上、下段食管癌患者靶区勾画及IGTV构建无显著影响.
목적 탐토증강소묘여부대기우4DCT구화적흉단식관암원발종류각시상GTV차이급대IGTV구건적영향.방법 25례흉단식관암환자,흉상단8례、흉중단9례、흉하단8례,자유호흡상태하서관완성보통4DCT여증강4DCT소묘,동일구화자안조동일표준선재평소4DCT각도상상구화GTV병구건상응IGTV.1개월후동일구화자재재증강4DCT도상상구화GTV병구건상응IGTV.결과 기우증강소묘도상구화적파구변이계수소우평소도상구화적(P=0.000),단흉상、하단식관암환자이자적GTVz축장도、GTV、IGTV균상근(P=0.529、0.110;P=0.158、0.416;P=0.147、0.615),이대흉중단식관암환자이자적GTV z축장도、GTV、IGTV불동(P=0.005、0.035、0.021).결론 대흉중단식관암환자,증강4DCT소묘가감소파구구화오차병가구건상대정학적IGTV,이대흉상、하단식관암환자파구구화급IGTV구건무현저영향.
Objective To investigate the difference between conventional and contrast-enhanced four-dimensional computed tomography (4DCT) scans in delineating the gross tumor volume (GTV) in different phases and constructing the internal gross tumor volume (IGTV) in primary thoracic esophageal cancer.Methods Twenty-five patients with thoracic esophageal cancer,including 8 upper-thoracic,9 middle-thoracic,and 8 lower-thoracic,sequentially underwent conventional and contrast-enhanced 4DCT scans during normal breathing.The GTVs were delineated by a physician under the same standard using conventional plain 4DCT images,and the IGTVs were constructed accordingly.After one month,the GTVs were delineated by contrast-enhanced 4DCT images and IGTVs were constructed by the same physician.Results The coefficient of variation for the target volume based on the contrast-enhanced 4DCT images was smaller than that based on the plain 4DCT images.There were no significant differences in the length of the z axis of GTV,GTV,and IGTV between contrast-enhanced and plain 4DCT images in patients with upperand lower-thoracic esophageal cancer (P =0.529 and 0.110 ;P =0.158 and 0.416 ;P =0.147 and 0.615).However,in patients with middle-thoracic esophageal cancer,the length of the z axis of GTV,GTV,and IGTV were significantly different between contrast-enhanced and plain 4DCT images (P =0.005,0.035,and 0.021,respectively).Conclusions Contrast-enhanced 4DCT scan can reduce the error in delineating the target volume and construct a more accurate IGTV for patients with middle-thoracic esophageal cancer.However,it has no significant benefit in patients with upper-and lower-thoracic esophageal cancer.