基于3 DCT、4 DCT和CBCT增强扫描测量正常食管壁厚度的研究  

A comparative study of three-dimensional, four-dimensional, and cone beam contrast-enhanced computed tomography in measurement of the normal thickness of the esophageal wall

作　　者：胡超月 李建彬[2] 王金之[2] 邵倩[2] 王玮[2] 郭延娈 徐敏[2] 李文武[3] 黄勇[3] Hu Chaoyue Li Jianbin Wang Jinzhi Shao Qian Wang Wei Guo Yanluan Xu Min Li Wenwu Huang Yong(School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Ji＇ nan 250117,China Department of Radiation Oncology , Department of Radiology , Shandong Cancer Hospital Affiliated to Shandong University, Ji ＇ nan 250117, China)

机构地区：[1]济南大学山东省医学科学院医学与生命科学学院,250117 [2]山东大学附属山东省肿瘤医院放疗科,济南250117 [3]山东大学附属山东省肿瘤医院影像科,济南250117

出　　处：《中华放射肿瘤学杂志》2016年第11期1187-1191,共5页Chinese Journal of Radiation Oncology

基　　金：山东省医学科学院科技计划青年基金（2015-51）;国家重点研发计划项目（2016YFC0904700）

摘　　要：目的：比较3DCT、4DCT和CBCT增强扫描图像测量的正常食管壁厚度，为食管癌靶区的勾画提供参考。方法对2009—2016年间50例肺癌或转移性肺癌患者行胸部增强3DCT、4DCT模拟定位扫描，并于首次3DCRT时进行增强CBCT扫描。分别在3DCT、4DCT呼气末时相（4DCT50）、4DCT最大密度投影图像（4DCTMIP）及CBCT图像上勾画正常食管，逐层测量各段食管壁厚度取平均值。对同段食管在不同CT图像上管壁厚度的比较行成组t检验，对不同段食管在同种CT图像上管壁厚度的比较行单因素方差分析。结果3DCT与4DCT50图像间胸段及腹段食管壁厚度差异无统计学意义（ P＝0．056～0.550）；3DCT与4DCTMIP、CBCT图像间胸段和腹段食管壁的厚度差异有统计学意义（ P＝0．000～0.004）；4DCTMIP与CBCT图像间胸上、中段食管壁厚度差异有统计学意义（ P＝0.008、0.001）。在3DCT、4DCTMIP、4DCT50图像上，胸下段食管壁均较胸上、中段厚（ P＝0．008～0.041），腹段食管壁较胸段厚（ P均＝0.000）；在 CBCT图像上，胸上、中、下段之间的差异均无统计学意义（ P＝0．088～0.945）。结论在3DCT、4DCT50图像上勾画胸段食管原发肿瘤GTV时正常食管壁厚度的判断可以使用同一标准，但在4DCTMIP、CBCT图像上采用5 mm作为勾画GTV时正常食管壁厚度的判定标准尚需谨慎。Objective To compare the normal thickness of the esophageal wall measured by contrast.enhanced three.dimensional （ 3DCT ） , four.dimensional （ 4DCT ） , and cone beam computed tomography （ CBCT） ,and to provide a basis for target volume delineation in esophageal cancer. Methods From 2009 to 2016,thoracic contrast.enhanced 3DCT and 4DCT simulations were performed in 50 patients with lung cancer or metastatic lung cancer. Contrast.enhanced CBCT scans were acquired during the first three.dimensional conformal radiotherapy. The normal esophageal wall was contoured on 3DCT images, the end.exhalation phase of 4DCT images （ 4DCT50 ） , the maximum intensity projection of 4DCT images （4DCTMIP）,and CBCT images. The wall thickness was measured on each segment and the average thickness of esophageal wall was obtained. Comparison of the thickness of a fixed segment of esophageal wall between different CT images was made by paired t test. Comparison of thickness on the same type of CT imagesbetween different segments of esophageal wall was made by one.way analysis of variance. Results For the thoracic and intra.abdominal segments,there was no significant difference in the thickness of esophageal wall between 3DCT and 4DCT50 images （ P= 0.056.0.550 ）;however, the thickness of esophageal wall was significantly smaller on 3DCT images than on 4DCTMIP or CBCT images （P=0.000.0.004）.For the upper and middle thoracic segments,the thickness of esophageal wall was significantly larger on CBCT images than on 4DCTMIP images （ P= 0.008, P= 0.001 ） . On 3DCT, 4DCT50 , and 4DCTMIP images, the thickness of esophageal wall was significantly larger in the lower thoracic segment than in the upper or middle thoracic segments （ P=0.008~0.041）;the intra.abdominal segment had a significantly larger thickness of esophageal wall than the thoracic segments （ all P=0.000 ） . There was no significant difference in wall thickness on CBCT images between three thoracic segments （ P=0.088~0.945） . Conclusions A uni

关 键 词：体层摄影术 X线计算机 三维 体层摄影术 X线计算机 四维 体层摄影术 X线计算机 锥形束 正常食管 厚度 

分 类 号：R735.1[医药卫生—肿瘤] R730.55[医药卫生—临床医学]