左侧乳腺癌深吸气屏气放疗中心脏亚结构运动的量化分析  

Quantitative analysis of motion of cardiac substructures in deep inspiratory breath holding radiotherapy for left breast cancer

作　　者：汤朝晖 张哲 毛玮斌 黄波 艾俊峰 朱超凡 谢植超 刘雅洁 TANG Zhao-hui;ZHANG Zhe;MAO Wei-bin;HUANG Bo;AI Jun-feng;ZHU Chao-fan;XIE Zhi-chao;LIU Ya-jie(Department of Radiation Oncology,Peking University Shenzhen Hospital,Shenzhen 518000,Guangdong Province,China;Department of Radiology,the Third Affiliated Hospital of Sun Yat-sen,Guangzhou 510630,China)

机构地区：[1]北京大学深圳医院放射治疗科,广东深圳518000 [2]中山大学附属第三医院放射科,广州510630

出　　处：《医疗卫生装备》2025年第3期54-58,共5页Chinese Medical Equipment Journal

基　　金：深圳市医疗卫生三名工程项目(SZSM202211036)。

摘　　要：目的:使用冠状动脉CT血管造影(coronary computed tomography angiography,CCTA)量化分析心脏亚结构的体积及运动,为左侧乳腺癌深吸气屏气放疗计划设计和危及器官的保护提供指导。方法:回顾性分析某院18例接受常规胸部平扫以及CCTA的女性患者影像资料,模拟左侧乳腺癌患者放疗计划设计过程。根据每位患者的CCTA数据在1个R-R间期内重建10个期相(10%~100%,间隔10%)图像,用以模拟心脏真实的运动范围。在10个期相的图像上对心脏整体(heart)、左心房(left atrium,LA)、左心室(left ventricle,LV)、右心房(right atrium,RA)、右心室(right ventricle,RV)、左前降支(left anterior descending artery,LAD)、左回旋支(left circumflex coronary artery,LCX)、右冠状动脉(right coronary artery,RCA)进行轮廓勾画。测量LAD、LCX和RCA各期相在上下(superior-inferior,SI)、前后(anterior-posterior,AP)、左右(left-right,LR)方向上质心位置到平均位置的距离,并分析1个R-R间期内LA、LV、RA、RV、heart的平均体积以及体积变化范围,同时计算计划危及器官体积(planning organs at risk volume,PRV)的外扩边界。采用SPSS 19.0软件进行统计学分析。结果:LAD在SI、AP、LR方向上的平均绝对位移为(1.8±0.7)mm、(1.2±0.5)mm、(1.5±0.5)mm,LCX在SI、AP、LR方向上的平均绝对位移为(2.1±0.7)mm、(1.5±0.6)mm、(1.9±0.7)mm,RCA在SI、AP、LR方向上的平均绝对位移为(1.6±0.5)mm、(2.2±0.9)mm、(2.2±0.8)mm。在1个R-R间期内LA、LV、RA、RV、heart的体积变化范围分别为34.3~63.9 cm^(3)、122.1~154.3 cm^(3)、29.3~53.6 cm^(3)、57.2~94.3 cm^(3)、480.1~515.4 cm^(3)。LAD、LCX、RCA在SI、AP、LR 3个方向上的理论外扩边界均在2 mm以内。结论:该研究量化了心脏亚结构的运动及体积变化范围,为左侧乳腺癌深吸气屏气放疗计划设计提供了参考依据,有利于危及器官的保护。Objective To quantify the volume and movement of cardiac substructures by using coronary computed tomography angiography(CCTA)to provide guidance for the design of deep inspiratory breath-holding radiation therapy for left breast cancer and the protection of organs at risk.Methods Totally 18 female patients who received conventional chest plain scan and CCTA were selected to simulate the design process of radiotherapy plan for left breast cancer patients with internal mammary lymph nodes.Retrospective reconstruction of CCTA data was performed for each patient,with 10 phase images(with an interval of 10%)within a R-R cardiac cycle(10%-100%)to simulate the true range of motion of the heart.The heart,left atrium(LA),left ventricle(LV),right atrium(RA),right ventricle(RV),left anterior descending artery(LAD),left circumflex coronary artery(LCX)and right coronary artery(RCA)were contoured at each phase.The distances from the centroid position to the average position of LAD,LCX and RCA were measured at each phase in the superior-inferior(SI),anterior-posterior(AP)and left-right(LR).The average volume and range of volume changes of LA,LV,RA,RV and heart were analyzed within a cardiac cycle.The expansion margins of planning organs at risk volume(PRV)were calculated.SPSS 19.0 software was used for statistical analysis.Results The following average absolute displacements were found in SI,AP and LR coordinates:(1.8±0.7)mm,(1.2±0.5)mm and(1.5±0.5)mm for LAD,respectively;(2.1±0.7)mm,(1.5±0.6)mm and(1.9±0.7)mm for LCX,respectively;(1.6±0.5)mm,(2.2±0.9)mm and(2.2±0.8)mm for RCA,respectively.The volume changes of LA,LV,RA,RV and heart within a cardiac cycle ranged from 34.3 to 63.9 cm^(3),122.1 to 154.3 cm^(3),29.3 to 53.6 cm^(3),57.2 to 94.3 cm^(3) and 480.1 to 515.4 cm^(3),respectively.The theoretical expansion margins of LAD,LCX and RCA in all the three directions were within 2 mm.Conclusion The ranges of movement and volume changes of cardiac substructure are quantitati-vely displayed,and references are provided for

关 键 词：乳腺癌 深吸气屏气 放疗 心脏亚结构 冠状动脉CT血管造影 

分 类 号：R318[医药卫生—生物医学工程] R815[医药卫生—基础医学]