Comparison of gross target volumes based on four-dimensional CT, positron emission tomography-computed tomography and magnetic resonance imaging in thoracic esophageal cancer
Li Huimin1, Li Jianbin2, Li Fengxiang2, Zhu Youzhe3, Zhang Yingjie2, Guo Yanluan4, Xu Min2, Shao Qian2, Liu Xijun2
1Weifang Medical University, Weifang 261053, China; 2Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250117, China; 3School of Medicine and Life Sciences, University of Jinan, Shandong Academy of Medical Sciences, Jinan 250022, China; 4Department of PET-CT, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250117, China
Abstract：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.
Li Huimin,Li Jianbin,Li Fengxiang et al. Comparison of gross target volumes based on four-dimensional CT, positron emission tomography-computed tomography and magnetic resonance imaging in thoracic esophageal cancer[J]. Chinese Journal of Radiation Oncology, 2020, 29(7): 508-512.
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2020, Vol. 29 
