基于心电门控4D-CT量化冠状动脉分叉口位移及外放边界研究  

Displacements and margin of coronary artery major bifurcations based on electrocardiograph-gated 4D-CT

作　　者：李倩 佟颖[1,2] 巩贯忠 程品晶 LI Qian1,2 , TONG Ying1,2 , GONG Guan-zhong2, Cheng Pin-jing1(1. School of Nuclear Science and Technology, University of South China, Hengyang 421001, P. R. China 2. Radiation Physics Department of Shandong Cancer Hospital Affiliated to Shanclong University, Jinan 250117, P. R. Chin)

机构地区：[1]南华大学核科学技术学院,湖南衡阳421001 [2]山东大学附属山东省肿瘤医院放射物理技术科,山东济南250117

出　　处：《中华肿瘤防治杂志》2018年第16期1186-1189,共4页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的心跳引起的冠状动脉运动是影响其剂量评估精度的主要因素。本研究应用心电门控(electrocardiography-gated,ECG-gated)4D-CT测量冠状动脉主要分叉口随心跳运动的位移,并依此确定胸部肿瘤放疗中冠状动脉分叉口的外放边界。方法选取2015-04-01-2017-04-30山东大学附属山东省肿瘤医院怀疑有心脏疾患的女性患者37例为研究对象。所有患者均接受吸气屏气下ECG-gated 4D-CT增强扫描,并确诊无器质性病变。分别选取冠状动脉左主干分叉口(left main coronary artery bifurcation,LM)、第一对角支分叉口(the first diagonal branch bifurcation,D1)、第二对角支分叉口(the second diagonal branch bifurcation,D2)、左前降支末梢(the caudal portion of the left anterior descending branch,APX)、钝缘支分叉口(the obtuse marginal branch bifurcation,OM)、第一支右室支动脉分叉口(the first right ventricular artery bifurcation,V)及锐缘支分叉口(the acute marginal branch bifurcation,AM)这7个分叉口进行勾画。计算各分叉口在左右(left-right,LR)、头脚(cranio-caudal,CC)、前后(anterior-posterior,AP)方向上的位移,以每位患者心脏收缩末期分叉口矩心坐标值为基准,计算其外放边界。结果冠状动脉主要分叉口在LR、CC和AP3个方向上的位移,LM分别为7.5、6.2和6.2mm;D1分别为5.7、6.7和6.5mm;D2分别为5.3、7.1和6.3mm;APX分别为6.4、7.7和4.6mm;OM分别为11.8、11.8和10.8mm;V分别为15.4、17.4和18.4mm;AM分别为15.4、18.7和21.8mm。冠状动脉分叉口在LR、CC和AP 3个方向上的外放边界,LM分别为3、3和3mm;D1分别为6、3和3mm;D2分别为3、3和3mm;APX分别为4、4和4mm;OM分别为4、6和5mm;V分别为6、8和7mm;AM分别为6、8和7mm。结论冠状动脉分叉口位移的异质性决定了冠状动脉分叉口应作为独立的危及器官,并给予个体化的外放边界。OBJECTIVE Cardiac motion-induced the coronary movement is the main factor affecting the accuracy of dose evaluation of coronary artery. This study was to measure the displacements and calculate the margin of the coronary artery main bifurcations utilizing electrocardiography-gated（ECG-gated） 4D-CT for thoracic tumor radiotherapy. METHODS From 2015 April lth to 2017 April 30th in the Shandong Cancer Hospital Affiliated to Shandong University and Shandong Provincial Hospital, a total of 37 female patients who had a clinical suspicion of heart disease without organic lesions were enrolled. All patients underwent enhanced ECC-gate 4D-CT scaning. The left main coronary artery bifurcation（LM）, the obtuse marginal branch bifurcation（OM）, the first diagonal branch bifurcation（D1）, the second diagonal branch bifurcation（D2）, the caudal portion of the left anterior descending branch（APX）, the first right ventricular artery bifurcation（V） and the acute marginal branch bifurcation（AM） were depicted. Calculated displacement of main bifurcations for three coordinates： left-right（LR）, cranio-caudal（CC） and anterior-posterior（AP） were contoured respectively. De-fined central coordinates of cardiac systolic phase as a standard, and then calculated margin. RESULTS Displacement of coronary artery bifurcations were： LM （7.5, 6.2, 6.2 mm）, D1 （5.7, 6.7,6.5 mm）, D2 （5.3, 7. 1, 6.3 mm）, APX （6.4, 7.7, 4.6 mm）;OM（11.8, 11.8, 10.8 ram）, V（15.4, 17.4, 18.4 mm）, AM（15.4, 18.7, 21.8mm）. Marginsof coronary artery bifurcations were： LM（3, 3, 3 ram）; D1（6, 3, 3 mm）; D2（3, 3, 3 mm）; APX（4, 4, 4mm）, OM（4, 6, 5 mm）, V（6, 8, 7 mm）;AM（6, 8, 7 mm）. CONCLUSION We suggest the individual margin should be given clue to the heterogeneity of the displacements of the coronary artery bifurcations, when considering the coronary artery as a sepa-rate organ at risk.

关 键 词：4D-CT 冠状动脉分叉口 位移 外放边界 

分 类 号：R730.5[医药卫生—肿瘤]