低剂量对比剂结合静脉团注追踪法在鼻咽癌放疗定位中的应用  

The application value of low-dose contrast agent combined with bolus tracking technique in radiotherapy localization for nasopharyngeal carcinoma

作　　者：韦婷 成肇杰 梁卫学 刘光明 王占宇 Wei Ting;Cheng Zhaojie;Liang Weixue;Liu Guangming;Wang Zhanyu(Radiation Oncology Center,Liuzhou Worker's Hospital,Liuzhou 545005,China)

机构地区：[1]柳州市工人医院肿瘤放射治疗中心,柳州545005

出　　处：《中华放射肿瘤学杂志》2024年第1期7-12,共6页Chinese Journal of Radiation Oncology

基　　金：广西壮族自治区卫生健康委员会科研课题(Z20200503、Z-B20221401);广西重点研发计划(桂科AB22035026);柳州市科技重大专项(2019AF10601)。

摘　　要：目的探讨低剂量对比剂结合静脉团注追踪法在鼻咽癌放疗定位中的应用价值。方法前瞻性收集100例拟行放疗定位CT扫描的鼻咽癌患者的相关资料,并采用随机数表法将患者分为两组。对照组(50例)给予碘对比剂80 ml,行常规定位扫描,延迟扫描时间50 s;观察组(50例)给予碘对比剂50~60 ml,采用静脉团注追踪技术定位扫描,观察时间-CT值监测曲线,待峰值跌落时手动触发扫描。比较两组图像质量评分、增强强化值、碘对比剂剂量,并评估不同造影剂用量下计划靶区的剂量计算差异。用独立样本t检验比较剂量差值,用Wilcoxon秩和检验比较图像评分的差异。结果观察组中的碘对比剂用量较对照组减少28.75%(t=-42.11,P<0.001);对照组中的颈动脉、颈静脉的CT强化值较观察组高32.58%和21.02%(t值分别为-8.11、-4.82,均为P<0.001),鼻咽部大体肿瘤体积(GTV)及胸锁乳突肌的CT强化值两组间差异无统计学意义(均为P>0.05);两组图像均能满足放疗靶区勾画的要求,主观评分间的差异无统计学意义(Z=-1.36,P=0.175),鼻咽部GTV的信噪比、对比噪声比在两组间的差异均无统计学意义(均为P>0.05),2名医师对图像主观评分及GTV靶区显示情况的结果一致性较高,κ值为0.77;不同造影剂用量下两组患者的计划靶区剂量差值间差异无统计学意义(P>0.05)。结论在鼻咽癌放疗定位中,应用低剂量对比剂结合静脉团注追踪技术可以保证图像质量并满足靶区勾画,有效降低患者碘对比剂的摄入量,降低患者碘对比剂不良反应的风险,值得推广应用。Objective To assess the application value of low-dose contrast agent combined with bolus tracking technique in radiotherapy localization for nasopharyngeal carcinoma(NPC).Methods One hundred patients with NPC for radiotherapy localization were enrolled prospectively and randomly divided into observation(n=50)and control(n=50)group using random number table.All patients in the control group underwent routine computerized tomography(CT)for radiotherapy localization with an intravenous bolus of 80 ml iodinated contrast media.Images were obtained at a fixed delay of 50 s from the beginning of contrast injection.Patients in the observation group underwent CT scan using a bolus tracking technique with an intravenous bolus of 50-60 ml iodinated contrast media.By observing the time-CT value monitoring curve,the scanning was manually triggered when the peak fell.The score of image quality,enhanced CT value,iodine contrast dose,and dose calculation variance of planning target volume were compared between the two different dose groups.The differences of dose were compared using independent sample t-tests and the differences in graph scores were compared using Wilcoxon rank sum tests.Results The dosage of iodine contrast agent in the observation group was 28.75%less than that in the control group,and the difference achieved statistical significance(t=-42.11,P<0.001).The enhanced CT value of carotid artery and jugular vein in the control group increased 32.58%and 21.02%compared with patients in the observation group,respectively(t=-8.11 and-4.82,P<0.001 for both).No statistically significant differences in the enhanced CT value were found for the gross tumor volume(GTV)of nasopharynx or sternocleidomastoid between the two groups(P>0.05).The images in both groups can met the requirements of target volume delineation,and the difference of subjective score was not statistically significant(Z=-1.36,P=0.175).There were no significant differences in the signal-to-noise ratio(SNR)or contrast-to-noise ratio(CNR)of nasopharynx between

关 键 词：鼻咽肿瘤 放射疗法 定位 静脉团注追踪法 对比剂 低剂量 

分 类 号：R739.63[医药卫生—肿瘤]