CAJ | 학술논문

目的：研究NSCLC的SRT中基于四维CT不同ITV合成策略的几何差异性。方法对我院2013—2014年间收治的16例具有胸部SRT指征的NSCLC患者行4DCT扫描，比较目前基于全时相勾画合成（金标准）得到的IGTV10、EE或EI时相合成得到的IGTVEI＋EE、MIP重建序列MIP勾画合成得到的 IGTVMIP、AVG 重建时相勾画方法得到的 IGTVAVG ，韩国顺天乡大学4个时相确定IGTVyeo，以及我们提出的基于奇数或偶数时相勾画合成的IGTVODD、IGTVEVEN方法同IGTV10的MI、DI和体积差异，分析筛选出对肿瘤运动相关特性相对不敏感的 ITV 合成方法。组内、组间数据行Student?Newman?Keulsa 检验，同时用多参数回归分析肿瘤三维运动量、肿瘤体积和MI和DI相关性。结果患者肿瘤中心平均三维运动幅度1．23 cm （0．25～5．53 cm），三维运动矢量分别为左右3．5 mm （1．4～8．4 mm），前后4．5 mm （1．1～8．6 mm），上下9．5 mm （0～10 mm）。 IGTVMIP、IGTVAVG、IGTVEI＋EE、IGTVyeo、IGTVODD、IGTVEVEN、IGTV10之间平均MI分别为0．69、0．62、0．80、0．86、0．93、0．91（P＝0．006）；平均DI分别为0．98、0．98、0．97、0．97、0．99、0．98（P＝0．130），IGTVx 体积相比IGTV10分别偏小25．7％、35．6％、17．9％、12．8％、3．6％、4．8％（ P＝0．000）。通过回归分析得到肿瘤大小、肿瘤运动幅度不是基于奇数或偶数时相形成ITV的影响因素。结论基于奇数或偶数时相确定ITV方法对肿瘤所在位置及肿瘤运动幅度等因素不敏感，具有较好临床可靠性和较高勾画效率，在无弹性形变配准的放疗单位可作为胸部SRT靶区勾画推荐方法。
목적：연구NSCLC적SRT중기우사유CT불동ITV합성책략적궤하차이성。방법대아원2013—2014년간수치적16례구유흉부SRT지정적NSCLC환자행4DCT소묘，비교목전기우전시상구화합성（금표준）득도적IGTV10、EE혹EI시상합성득도적IGTVEI＋EE、MIP중건서렬MIP구화합성득도적 IGTVMIP、AVG 중건시상구화방법득도적 IGTVAVG ，한국순천향대학4개시상학정IGTVyeo，이급아문제출적기우기수혹우수시상구화합성적IGTVODD、IGTVEVEN방법동IGTV10적MI、DI화체적차이，분석사선출대종류운동상관특성상대불민감적 ITV 합성방법。조내、조간수거행Student?Newman?Keulsa 검험，동시용다삼수회귀분석종류삼유운동량、종류체적화MI화DI상관성。결과환자종류중심평균삼유운동폭도1．23 cm （0．25～5．53 cm），삼유운동시량분별위좌우3．5 mm （1．4～8．4 mm），전후4．5 mm （1．1～8．6 mm），상하9．5 mm （0～10 mm）。 IGTVMIP、IGTVAVG、IGTVEI＋EE、IGTVyeo、IGTVODD、IGTVEVEN、IGTV10지간평균MI분별위0．69、0．62、0．80、0．86、0．93、0．91（P＝0．006）；평균DI분별위0．98、0．98、0．97、0．97、0．99、0．98（P＝0．130），IGTVx 체적상비IGTV10분별편소25．7％、35．6％、17．9％、12．8％、3．6％、4．8％（ P＝0．000）。통과회귀분석득도종류대소、종류운동폭도불시기우기수혹우수시상형성ITV적영향인소。결론기우기수혹우수시상학정ITV방법대종류소재위치급종류운동폭도등인소불민감，구유교호림상가고성화교고구화효솔，재무탄성형변배준적방료단위가작위흉부SRT파구구화추천방법。
Objective To study the geometric difference between six different ITV generation methods from 4DCT for patients with non?small cell lung cancer ( NSCLC) treated with stereotactic ablative radiotherapy technique ( SABR) . Methods Between Dec. 2013 and Mar. 2014,16 patients were enrolled in this retrospective study. All patients underwent imaging with 4DCT scans. The MI and DI index were evaluated between six ITV generation methods:combining GTV from all 10 respiratory phases ( ITV10 );combining GTV from four respiratory phases, including two extreme phases ( 0% and 50%) plus two intermediate phases ( 20% and 70%) ( ITVYeo ) which was proposed by Seung?Gu Yeo of Soonchunhyang University;combining GTV from two extreme phases ( ITVEI+EE ) . And combining GTV from five odd phases (10%,30%,50%,70%,90%)(ITVodd).Accordingly the ITVEVEN which was combined from the remaining five even phases (20%,40%,60%,80%,0%),and ITVAVG,ITVMIP were contoured from two reconstructed 4DCT sequences,finally,a method which was not sensitive to the tumor volume and motion characteristic was selected for clinical use. Data were compared using a variance analysis followed by Student?Newman?Keulsa test both in same group or between groups. At the same time, the volume and the three dimensional movements of the tumor, the relativity of MI and DI were analyzed by Multi?parameter regression analysis. Results The mean (range) tumor motion (RLR,RAP,RCC,and R3D) are 3. 5 mm (1. 4?8. 4 mm),4. 5 mm (1. 1?8. 6 mm),9. 5 mm (0?10 mm),12. 3 mm (2. 5?55. 3 mm) respectively. The IGTVx volume are Underestimated by 25. 7%,35. 6%,17. 9%,12. 8%,3. 6%,4. 8%( P=0. 000) respectively. The MI index comparisons between six ITV generation methods and ITV10 showed statistical significance:0. 69,0. 62,0. 80, 0. 86,0. 93,0. 91 ( P=0. 006 ) . The DI index showed no statistical significance:0. 98, 0. 98, 0. 97, 0. 97, 0. 99,0. 98(P=0. 130).The tumor size and motion amplitude were certified not the independent factors for the MI index of ITVodd and ITVEVEN . Conclusions IGTVODD/EVEN based on odd or even 4DCT phases is not sensitive to the tumor size or motion characteristic and is proved to have a good marching with ITV10 meanwhile maintaining a reasonable contouring efficiency,it can be recommend to the institutions which was not equipped with the deformable registration systems.