CAJ | 학술논문

目的同时采用胸部MRI和增强CT定位,探讨3.0T MRI中压脂T2WI及弥散加权融合图像在精确勾画肺癌中的作用和临床应用价值.方法 2012年12月至2013年12月对初治的32例原发性肺癌患者行序贯增强CT及MRI定位,利用放疗计划系统将MRI扫描序列中的T2 WI与DWI图像融合(T2 WI-DWI),分别在增强CT及T2WI-DWI图像中勾画GTV,比较两种图像下肺癌靶区勾画的差异:肿瘤与肺不张边界区分、淋巴结检出能力和定性诊断、肿瘤及淋巴结GTV勾画等方面的差异.结果与增强CT相比,在16例肺不张患者中T2WI-DWI图像更易区分(x2=4.9,P =0.021)肿瘤与肺不张边界,并缩小GTV体积(36.61±27.27)％.Logistic回归模型分析显示肺不张为影响T2 WI-DWI和增强CT图像GTV勾画差异的唯一因素(x2=10.115,P=0.001).T2 WI-DWI较增强CT多检出9个肺门或肺血管处淋巴结,两图像均可检出的43个淋巴结定性诊断(x2=0.125,P=0.727)及32个均诊断为阳性淋巴结的GTV大小(Z=-1.255,P=0.210),差异均未见统计学意义.结论 MRI中LWI-DWI技术可用于肺癌GTV精确勾画,较增强CT可以更好地区分肺不张与肿瘤边界,检出肺门及靠近肺部血管处淋巴结,同时对部分的GTV勾画产生影响.
목적 동시채용흉부MRI화증강CT정위,탐토3.0T MRI중압지T2WI급미산가권융합도상재정학구화폐암중적작용화림상응용개치.방법 2012년12월지2013년12월대초치적32례원발성폐암환자행서관증강CT급MRI정위,이용방료계화계통장MRI소묘서렬중적T2 WI여DWI도상융합(T2 WI-DWI),분별재증강CT급T2WI-DWI도상중구화GTV,비교량충도상하폐암파구구화적차이:종류여폐불장변계구분、림파결검출능력화정성진단、종류급림파결GTV구화등방면적차이.결과 여증강CT상비,재16례폐불장환자중T2WI-DWI도상경역구분(x2=4.9,P =0.021)종류여폐불장변계,병축소GTV체적(36.61±27.27)％.Logistic회귀모형분석현시폐불장위영향T2 WI-DWI화증강CT도상GTV구화차이적유일인소(x2=10.115,P=0.001).T2 WI-DWI교증강CT다검출9개폐문혹폐혈관처림파결,량도상균가검출적43개림파결정성진단(x2=0.125,P=0.727)급32개균진단위양성림파결적GTV대소(Z=-1.255,P=0.210),차이균미견통계학의의.결론 MRI중LWI-DWI기술가용우폐암GTV정학구화,교증강CT가이경호지구분폐불장여종류변계,검출폐문급고근폐부혈관처림파결,동시대부분적GTV구화산생영향.
Objective To investigate the clinical application value of 3.0T MRI fat-suppression T2 WI combined with diffusion-weighted imaging (DWI) on gross tumor volume delineation of lung cancer.Methods From December 2012 to December 2013,thirty-two consecutive untreated patients with biopsy/cytology-proven lung cancer were enrolled in our study.Each patient was examined by enhanced CT and MRI for radiotherapy localization,T2WI was merged with DWI (T2WI-DWI) by radiotherapy planning system.Enhanced CT and T2WI-DWI images were analyzed before we delineated GTV separately.The difference of two methods in diagnostic for tumors and lymph nodes,GTV changes were compared.Results Compared with enhanced CT scanning,the borders of tumors could be determined more accurately in 16 cases accompanied with atelectasis in T2WI-DWI.Meanwhile,GTV delineated by T2WI-DWI were reduced by (36.61 ± 27.27) ％ compared with enhanced CT.Multivariate Logistic regression analysis was performed to describe the association between the variables with the change of GTV in two imagery ways.Result showed that atelectasis was the only predictor of the change of GTV in two imagery ways (x2 =10.115,P =0.001).Furthermore,nine extra lymph nodes close to pulmonary hilus or pulmonary vessels were detected by T2WI-DWI compared with enhanced CT.No significant difference was observed in the qualitative diagnosis of forty three lymph nodes discovered by two imagery methods (x2 =0.125,P =0.727.Likewise,the GTV change of thirty two lymph nodes which were diagnosed as malignancies(Z =-1.255,P =0.210)revealed no statistical significance.Conclusions The technical of fatsuppression T2WI combined with DWI can be applied in gross tumor volume accurate delineation of lung cancer.Compared with enhanced CT,it is better in distinguishing the border of tumor when the primary tumor accompanies with atelectasis or detected lymph node is close to pulmonary hilus or pulmonary vessels.Meanwhile,the technique of T2WI combined with DWI has an influence on GTV delineation of lung cancer pantients.