磁共振弥散加权成像在肺癌精确放疗靶区勾画中应用价值分析  

Application of MR diffusion weighted imaging in precise radiotherapy target delineation for lung carcinoma

作　　者：张安度[1] 田华[1] 韩春[1] 王澜[1] 高超[1] 张靖[1] 任雪姣[1] 李晓宁[1] 孔洁[1] 时高峰[1] 

机构地区：[1]河北医科大学第四医院放疗科,河北石家庄050011

出　　处：《中华肿瘤防治杂志》2013年第16期1249-1252,1256,共5页Chinese Journal of Cancer Prevention and Treatment

基　　金：河北省科技计划项目(11276150)

摘　　要：目的:探讨胸部磁共振弥散加权成像技术(diffusion weighted imaging,DWI)在肺癌精确放疗靶区勾画中的应用价值。方法:序贯入组的首程放疗患者47例,采用相同体位在CT及MR下定位并进行图像采集,在CT图像上勾画GTV-ct,在DWI图像上勾画GTV-mri,GTVct-mri为CT靶区除去CT和MR共同的部分体积。观察MR对TNM分期的影响;比较GTV-ct、GTV-mri的体积差异;测量肿瘤组织及转移淋巴结的表观弥散系数(apparent diffusion coefficient,ADC)值,比较GTV-mri与GTVct-mri ADC值的差异。结果:GTV-ct和GTV-mri的平均体积分别为142.7和101.1cm3,差异有统计学意义,χ2=89.397,P<0.001。伴有肺不张/阻塞性肺炎者的GTV-ct为173.6cm3,GTV-mri为117.8cm3,Z=-4.541,P<0.001。不伴有肺不张/阻塞性肺炎者的GTV-ct平均为115.3cm3,GTV-mri为88.8cm3,Z=-3.622,P<0.001。肿瘤组织和转移淋巴结ADC值为1.25×10-3和1.54×10-3 s/mm2。肿瘤组织的ADC值低于肺不张及阻塞性炎症的ADC值,Z=-6.237,P<0.001。MR中GTV高信号区与周边低信号区ADC值之间差异有统计学意义,t=9.689,P<0.001。结论:DWI与CT显示的肿瘤体积有差异。DWI可区分肿瘤组织与肺不张、阻塞性炎症。DWI成像结合ADC值测量对肺癌靶区勾画有很大帮助。OBJECTIVE： To explore the application value of MR Diffusion Weighted imaging in precise radiotherapy target delineation for lung carcinoma. METHODS： Forty-seven patients with first process radiotherapy were included in this study. Each patient was examined by MR and CT scan using the same position. GTV-ct in CT images,and GTV-mri in DWl images were de- lineated. GTVct-mri was the section that CT target volume minus common of the CT and MR. The affects in TNM clinical sta- ges due to MR participation were observed; and the volume differences of the GTV-ct and GTV mri were compared. ADC value of tumor and metastasized lymph node~ were measured and the differences of GTV-xmri and GTVct-mri were compared. RE- NULLS： The average volume of GTV-ct and GTV-mri were 142. 7 cm3 and 101.1 cm3 ,and the differences had statistical signifi- cance Qtz =89. 397,P^0. 001）. The average volume of GTV-ct and GTV-mri were 173.6 cm3 and 117.8 cm3 in examples which accompanied with ateleetasis and obstructive pneumonia （Z=- 4. 541, P%0. 001）, while in the examples which accompanied with no atelectasis or obstructive pneumonia, the average volume of GTV-ct and GTV xmri were 115.3 cm3 , 88. 8 cm3 respectively

关 键 词：磁共振成像 弥散 肺肿瘤 放射疗法 

分 类 号：R734.2[医药卫生—肿瘤]