低剂量CT(100mA)引导下^(125)I粒子植入治疗恶性肿瘤的临床应用价值  

Clinical application of low-dose (100mA) CT-guided ^(125)I seed implantation for the treatment of malignant tumor

作　　者：谈瑞生 朱永强 许士勇 王小仁 蔡顺达 张云 刘伟 

机构地区：[1]江苏省镇江市中医院影像科,212003

出　　处：《实用医学影像杂志》2016年第4期277-281,共5页Journal of Practical Medical Imaging

基　　金：江苏省镇江市科技支撑计划(SH2013064)

摘　　要：目的探讨在低剂量CT(100m A)引导下^(125)I粒子植入治疗恶性肿瘤的临床应用价值。方法收集2010年1月至2015年5月恶性肿瘤及转移病例29例,分为低剂量CT(100 m A)定位引导下治疗组(13例)及常规剂量CT引导下(250 m A)^(125)I放射性粒子植入治疗恶性肿瘤治疗组(16例)。术前采用肿瘤治疗计划系统(Treatment Planning System,TPS)重建恶性肿瘤的三维立体图像,计算出所需粒子数目及总活度。单个病灶植入粒子数目5~76粒,平均粒子数36粒。单个粒子活度为0.5~0.9 m Ci,粒子间距为0.5~1.0 cm。常规消毒麻醉,在CT引导下选择合适穿刺点、进针角度及路径后行肿瘤病灶内^(125)I放射性粒子植入。记录CT扫描仪自动显示扫描加权容积CT剂量指数(weighted CT dose index volume,CTDIvol)、剂量长度乘积(dose-length product,DLP)并计算有效剂量(effective dose,ED),比较两种不同剂量下CT扫描在有效剂量(ED)、图像质量、穿刺植入成功率及近期疗效方面有何差异。结果低剂量CT引导植入治疗组的CTDlvol中位值为7.3 m Gy,DLP中位值为423 m Gy.cm,ED中位值为7.191 m Sv;常规剂量组CTDlvol中位值为18.3 m Gy,DLP中位值为1 089.6 m Gy.cm,ED中位值为18.52 m Sv;统计学结果示2组患者的辐射量差异有统计学意义(t=21.903,P<0.001);但在图像质量可接受性方面,2组患者的图像均为100%(评分均>2分);关于穿刺成功率及患者的近期疗效,低剂量组与常规剂量组相比差异无统计学意义(P>0.05)。结论低剂量CT(100 m A)扫描在减低患者辐射上意义显著,同时又保证了图像质量满足穿刺植入要求,由于采用了低剂量扫描,降低了CT机器的消耗,增加了机器的使用寿命,因此值得在临床上普遍开展。Objective To explore the clinical evaluation of low-dose CT （100 mA） CT-guided ^125I seed implantation for the treatment of malignant tumor. Methods Twenty-nine cases with malignant tumor and metastasis were collected from January 2010 to May 2015. Patients were divided randomly into two groups： low-dose CT （100 mA） localization guided treatment group （13 cases） and conventional dose-CT guided （250 mA） treatment group positioning under ^125I radioactive particles implantation to treat malignant tumor （16 cases）. Before the procedure treatment planning system was used to reconstruct 3-dimensional images of the tumor to calculate the quantity and total activity of ^125I seeds needed for the individual 5-76 ^125I seeds （on average 36 per patient） were implanted in the lesion under the guidance of CT. The activity of ^125I seed used in treatment was（0.5-0.9）mCi,the interval distance between implanted seeds was （0.5-1.0）cm. Wiht regular disinfection and anesthesia, CT-guided choose appropriate puncture point,into the needle point and path after ^125I radioactive particles implanted within the tumor lesion. CT scanner automatically displayed the scan weighted CT dose index volume（CTDIvol）,dose-length product（DLP）and effective dose（ED）. Two different doses of CT scan in the effective dose,image quality, puncture success rate of implants and short-term curative effect were compared between the above-mentioned two groups. Results The median CTDlvol （volume CT dose index） was 18.3 mGy,median DLP was 1 089.6 mGy.cm,median ED was 18.52 mSv respectively in low-dose CT group, whereas 7.3 mGy, 423 mGy.cm, 7.191 mSv respectively in standard-dose group, with significant statistic difference（t=21.903 ,P〈0.001 ）.However,for the image quality,the acceptance rate of these two groups was 100% ,with the score 〉2,no statistic difference was existed.No significant statistical difference was existed regarding to successful puncture rate and short-term outcome（P〉0.05）. Conclus

关 键 词：放射剂量分次 体层摄影术 螺旋计算机 基本粒子 

分 类 号：R730.55[医药卫生—肿瘤]