CT-MRI同体位图像融合在高级别脑胶质瘤放射治疗靶区勾画中应用  

Application of CT-MRI homoposition fusion images in delineation of high-grade Glioma radiotherapy target

作　　者：金龙[1] 杨振 张鑫[2] 刘晓斌[3] 缪星宇[3] JIN Long;YANG Zhen;ZHANG Xin;LIU Xiao-bin;MIAO Xing-yu(Department of Radiation Oncology,Shaanxi Provincial People’s Hospital,Xi’an 710068,Shaanxi,China;Department of Magnetic Resonance Room,Shaanxi Provincial People’s Hospital,Xi’an 710068,Shaanxi,China;Department of Neurosurgery,Shaanxi Provincial People’s Hospital,Xi’an 710068,Shaanxi,China)

机构地区：[1]陕西省人民医院放疗科,陕西西安710068 [2]陕西省人民医院磁共振室,陕西西安710068 [3]陕西省人民医院神经外科,陕西西安710068

出　　处：《生物医学工程与临床》2024年第1期35-41,共7页Biomedical Engineering and Clinical Medicine

基　　金：山西省重点研发计划项目(2022SF-166)。

摘　　要：目的探讨同体位MRI图像(MRIsim)与CT模拟定位图像融合在高级别脑胶质瘤放射治疗靶区勾画中的临床应用价值。方法选择20例脑胶质瘤术后放射治疗患者,其中男性13例,女性7例;年龄39~69岁,平均年龄45.5岁;全部为单发病变;均已行全切或不全切手术,全部经病理组织诊断证实;世界卫生组织(WHO)分级Ⅲ级6例,Ⅳ级14例。将每例患者的同体位MRIsim、常规MRI影像(MRIconv)分别与CT模拟定位图像融合。运用Dice相似指数(DSC)和豪斯多夫距离(HD)算法来评价配准的精确度。在CT与MRIsim融合图像(Fusion-CT MRIsim)、CT与MRIconv融合图像(Fusion-CT MRIconv)上分别勾画危及器官(OAR)及靶区[大体肿瘤靶区(GTV)、临床肿瘤靶区(CTV)]。评估两种融合图像(即Fusion-CT MRIsim组和Fusion-CT MRIconv组)OAR勾画体积、GTV、CTV及剂量学差异。结果融合精确度评估:除全脑外,Fusion-CT MRIsim组其余OAR DSC均高于Fusion-CT MRIconv组(P<0.05);Fusion-CT MRIsim组OAR HD小于Fusion-CT MRIconv组(P<0.05)。OAR勾画体积比较:Fusion-CT MRIsim组OAR勾画体积与Fusion-CT MRIconv比较,差异无统计学意义(P>0.05)。靶区:Fusion-CT MRIsim组GTV、CTV小于Fusion-CT MRIconv组[(118.2±8.0)cm^(3)vs(125.3±8.1)cm^(3)、(234.3±12.8)cm^(3)vs(256.0±13.4)cm^(3)],差异有显著统计学意义(均P=0.000)。剂量学比较:Fusion-CT MRIsim组D_(max)-PTV、D_(mean)-PTV与Fusion-CT MRIconv组[(6432.9±23.0)cGy vs(6430.4±25.2)cGy、(6159.0±13.7)cGy vs(6166.2±17.3)cGy]比较,差异无统计学意义(P>0.05)。结论CT-MRI同体位融合图像配准精确度高,可降低全脑平均剂量(D_(mean))及缩小GTV及CTV,是高级别脑胶质瘤术后精确放射治疗值得广泛应用的临床方法。Objective To explore the clinical application value of MRI imaging(MRIsim)and CT simulated localization positioning image fusion in delineation of radiotherapy target area of high-grade glioma.Methods A total of 20 glioma patients performed postoperative radiotherapy were enrolled,which included 13 males and 7 females,aged 39-69 years old with mean age of 45.5.All of the patients were single lesions,and underwent total or incomplete resection,which confirmed by pathological diagnosis.According to World Health Organization(WHO)classification,there were 6 cases of gradeⅢand 14 of gradeⅣ.The MRIsim and conventional MRI images(MRIconv)with simulated localization CT image of each patient were fused,Dice similarity index(DSC)and Hausdorff distance(HD)algorithm were used to evaluate the accuracy of registration.The organs at risk(OAR)and target areas[gross tumor target(GTV)and clinical tumor target(CTV)]were delineated on CT and MRIsim fusion images(Fusion-CT MRIsim)and CT and MRIconv fusion images(Fusion-CT MRIconv),respectively.The OAR delineation volume,GTV,CTV and dosimetric differences between the two fusion images(Fusion-CT MRIsim group and Fusion-CT MRIconv group)were evaluated.Results The fusion accuracy evaluation:Except for the whole brain,the OAR DSC of Fusion-CT MRIsim group was higher than that of Fusion-CT MRIconv group(P<0.05),while the OAR HD of Fusion-CT MRIsim group was smaller than that of Fusion-CT MRIconv group(P<0.05).There was no significant difference in volume of OAR delineation between Fusion-CT MRIsim group and Fusion-CT MRIconv group(P>0.05).Target volume:GTV and CTV in Fusion-CT MRIsim group were smaller than those in Fusion-CT MRIconv group[(118.2±8.0)cm^(3) vs(125.3±8.1)cm^(3),(234.3±12.8)cm^(3) vs(256.0±13.4)cm^(3)],and the differences were statistically significant(P=0.000).There was no significant difference in maximum dose(D_(max))-PTV,mean dose(D_(mean))-PTV between Fusion-CT MRIsim group and Fusion-CT MRIconv group[(6432.9±23.0)cGy vs(6430.4±25.2)cGy,(6159.0±13.7)cGy vs(61

关 键 词：CT-MRI同体位融合 高级别胶质瘤 放射治疗靶区 靶区勾画 

分 类 号：R739.41[医药卫生—肿瘤] R730.55[医药卫生—临床医学]