4DCT、PET-CT与MRI勾画胸段食管癌大体肿瘤体积比较研究  

Comparison of gross target volumes based on four-dimensional CT,positron emission tomography-computed tomography and magnetic resonance imaging in thoracic esophageal cancer

作　　者：李慧敏 李建彬 李奉祥 祝猷哲 张英杰 郭延娈 徐敏 邵倩 刘希军 Li Huimin;Li Jianbin;Li Fengxiang;Zhu Youzhe;Zhang Yingjie;Guo Yanluan;Xu Min;Shao Qian;Liu Xijun(Weifang Medical University,Weifang 261053,China;Department of Radiation Oncology,Shandong Cancer Hospital and Institute,Shandong First Medical University and Shandong Academy of Medical Sciences,Jinan 250117,China;School of Medicine and Life Sciences,University of Jinan,Shandong Academy of Medical Sciences,Jinan 250022,China;Department of PET-CT,Shandong Cancer Hospital and Institute,Shandong First Medical University and Shandong Academy of Medical Sciences,Jinan 250117,China)

机构地区：[1]潍坊医学院,261053 [2]山东省肿瘤防治研究院(山东省肿瘤医院)山东第一医科大学(山东省医学科学院)放疗科,济南250117 [3]济南大学山东省医学科学院医学与生命科学学院,250022 [4]山东省肿瘤防治研究院(山东省肿瘤医院)山东第一医科大学(山东省医学科学院)PET-CT室,济南250117

出　　处：《中华放射肿瘤学杂志》2020年第7期508-512,共5页Chinese Journal of Radiation Oncology

基　　金：国家重点研发计划项目(2016YFC0904700);国家自然基金面上项目(81773287);山东省重点研发计划项目(2016GSF201093);山东省自然科学基金(ZR2019PH115)。

摘　　要：目的比较基于4DCT呼气末时相、18F-FDG PET-CT及T2加权(T2W)MRI所勾画胸段食管癌大体肿瘤体积(GTV)、位置及长度差异,探讨食管癌原发肿瘤GTV勾画时PET-CT与MRI图像结合的必要性。方法26例拟行同步放化疗的胸段食管癌患者序贯完成增强3DCT、增强4DCT、PET-CT、增强MRI胸部定位扫描,基于3DCT图像形变配准。分别基于3DCT、4DCT的呼气末时相、PET-CT SUV 2.5、T2W-MRI和DWI图像勾画GTV获得GTVCT、GTV50%、GTVPET2.5、GTVMRI和GTVDWI。结果GTVPET2.5大于GTV50%(P<0.001)和GTVMRI(P=0.008),而GTVMRI与GTV50%接近(P=0.439)。GTVMRI与GTV50%、GTVCT的适形指数(CI)大于GTVPET2.5与GTV50%、GTVCT的(P=0.004、P=0.039),GTVMRI与GTVPET2.5的CI明显小于GTVMRI、GTVPET2.5与GTV50%、GTVCT的(P=0.000~0.021)。镜检长度与GTVPET、GTVDWI长度相近(P>0.05),且GTVPET2.5与GTVDWI长度接近(P=0.072)。结论基于PET-CT SUV2.5与呼吸门控状态下T2W-MRI所勾画食管癌GTV和空间位置差异明显,PET-CT与MRI结合进行食管癌靶区勾画的必要性尚需探讨,但MRI-DWI可以代替PET-CT帮助基于CT图像勾画GTV时上下界的确定。Objective To investigate the application value of 18F-FDG PET-CT combined with MRI in the radiotherapy for esophageal carcinoma by comparing the differences in the gross target volume(GTV),position length delineated on the end expiratory(EE)phase of 4DCT,PET-CT and T2-weighted MRI(T2W-MRI).Methods Twenty-six patients with thoracic esophageal cancer scheduled to receive concurrent chemoradiotherapy sequentially underwent 3DCT,4DCT,PET-CT and enhanced MRI for thoracic localization.All images were fused with the 3DCT images by deformable registration.GTVCT,GTV50%GTVPET2.5,GTVMRI and GTVDWI were delineated on 3DCT,the EE phase of 4DCT images,PET-CT with the thresholds of SUV≥2.5,T2W-MRI and diffusion-weighted images,respectively.Results GTVPET2.5 was significantly larger than GTV50%and GTVMRI(P<0.001 and P=0.008),whereas the volume of GTVMRI was similar to that of GTV50%(P=0.439).Significant differences were observed between the CI of GTVMRI to GTV50%and GTVPET2.5 to GTV50%(P=0.004).The conformity indexes(CIs)of GTVMRI to GTVCT and GTVPET2.5 to GTVCT were statistically significant(P=0.004 and P=0.039).The CI of GTVMRI to GTVPET2.5 was significantly smaller than that of GTVMRI to GTV50%,GTVMRI to GTVCT,GTVPET2.5 to GTV50%and GTVPET2.5 to GTVCT(P=0.000-0.021).The length of gastroscopy was similar to those of GTVPET2.5 and GTVDWI(both P>0.05),and there was no significant difference in the length between GTVPET2.5 and GTVDWI(P=0.072).Conclusion GTVMRI yields significantly different volume and poor spatial matching compared with GTVPET2.5.The application of PET-CT combined with MRI under respiratory gating system in the delineation of GTV should be used with caution in thoracic squamous esophageal cancer.MRI-DWI can replace PET-CT to help determine the upper and lower boundaries of GTV based on CT images.

关 键 词：食管肿瘤 磁共振成像 体层摄影术 X线计算机 正电子发射型 大体肿瘤体积 

分 类 号：R735.1[医药卫生—肿瘤]