Abstract：Objective To explore the value of BLADE sequence in determining the target range of esophageal cancer radiotherapy through the correlation and consistency between measured esophageal cancer length on the MRI-BLADE sequence and the surgical pathological specimens. Methods Clinical data of 36 patients who were pathologically diagnosed with esophageal carcinoma and received preoperative esophageal MRI in the Affiliated Cancer Hospital of Zhengzhou University between January 2016 to June 2019 were collected. The CT, DWI and BLADE sequence images of all participants were collected and imported into the Monaco system, by which the correlation and consistency between the tumor length measured based on these three imaging methods were statistically compared. Furthermore, the differences in gross tumor volume (GTV) delineated by different physicians in different images were compared. Results The correlation coefficients of the tumor length measured by CT, DWI and BLADE and pathological specimen length were 0.467, 0.723 and 0.896, respectively. The consistency analysis indicated that all the differences between the BLADE sequence and pathological specimen length were within the 95% consistency limit. The consistency and correlation between the BLADE sequence and actual tumor length were significantly better than those between the DWI sequence and CT images (both P<0.05). The volume of DWI and BLADE images obtained by four physicians was significantly smaller than that of CT images (both P<0.05). The differences in GTV delineated by different physicians by these three imaging methods were insignificant (all P>0.05), but the GTV delineated by the four physicians on the BLADE sequence were more similar (all P>0.05). Conclusions BLADE sequence can help physicians to determine the upper and lower boundaries of esophageal tumors more accurately and reduce the differences in GTV delineation among different physicians. And it can effectively improve the unity of individual′s understanding of the scope of target area delineation, and improve the objectivity of clinicians′ judgment of GTV. BLADE sequence can be used as an important imaging tool for accurate target delineation in radiotherapy.
Ge Hong,Wang Nan. Value of MRI T2WI-TSE-BLADE sequence in accurately delineating the gross tumor volume of esophageal carcinoma based on pathological specimens[J]. Chinese Journal of Radiation Oncology, 2021, 30(7): 676-681.
[1] Wang Z, Guo J, Qin J, et al. Accuracy of 3-T MRI for preoperative T staging of esophageal cancer after neoadjuvant chemotherapy, with histopathologic correlation[J]. AJR Am J Roentgenol, 2019, 212(4):788-795. DOI:10.2214/AJR. 18.20204. [2] Giganti F, Ambrosi A, Petrone MC, et al. Prospective comparison of MR with diffusion-weighted imaging, endoscopic ultrasound, MDCT and positron emission tomography-CT in the pre-operative staging of oesophageal cancer:results from a pilot study[J]. Br J Radiol, 2016, 89(1068):20160087. DOI:10.1259/bjr.20160087. [3] 王昭琦,郭佳,鲁亚南,等. 磁共振成像在可切除性食管癌术前T分期中的应用[J]. 协和医学杂志,2017, 8(2):112-116. DOI:10.3969/j.issn.1674-9081.2017.03.007. Wang ZQ, Guo J, Lu YN, et al. Application of magnetic resonance imaging in the preoperative T stagingevaluation of resectable esophageal cancer[J]. Med J Peking Union Med College Hospital, 2017, 8(2):112-116. DOI:10.3969/j.issn.1674-9081.2017.03.007. [4] Liu LP, Cui LB, Zhang XX, et al. Diagnostic performance of diffusion-weighted magnetic resonance imaging in bone malignancy:Evidence from a meta-analysis[J]. Medicine (Baltimore), 2015, 94(45):e1998. DOI:10.1097/MD.0000000000001998. [5] 王军,韩春,祝淑钗,等. 基于食管癌病理标本长度推算的实际长度与CT长度的比较研究[J]. 中华放射肿瘤学杂志, 2008, 17(2):93-96. DOI:10.3321/j.issn:1004-4221.2008.02.004. Wang J, Han C, Zhu SC, et al. Compare the tumor length in CT images with the real length calculated from surgical specimen in esophageal carcinoma[J]. Chin J Radiat Oncol, 2008, 17(2):93-96. DOI:10.3321/j.issn:1004-4221.2008.02.004. [6] Gao XS, Qiao X, Wu F, et al. Pathological analysis of clinical target volume margin for radiotherapy in patients with esophageal and gastroesophageal junction carcinoma[J]. Int J Radiat Oncol Biol Phys, 2007, 67(2):389-396. DOI:10.1016/j.ijrobp.2006.09.015. [7] Sillah K, Williams LR, Laasch HU, et al. Computed tomography overestimation of esophageal tumor length:implications for radiotherapy planning[J]. World J Gastrointest Oncol, 2010, 2(4):197-204. DOI:10.4251/wjgo.v2.i4.197. [8] Joint H, Neck Radiotherapy MRIDC. Dynamic contrast-enhanced magnetic resonance imaging for head and neck cancers[J]. Sci Data, 2018, 5:180041. DOI:10.1038/sdata.2018.41. [9] 肖安岭,王海涛,张秡秡,等. 磁共振动态增强联合弥散加权成像对原发性肝癌的诊断及其临床价值研究[J]. 临床和实验医学杂志,2018, 17(14):1526-1529. DOI:10.3969/j.issn.1671-4695.2018.14.019. Xiao AL, Wang HT, Zhang BB, et al. MRI dynamic enhancement combined with diffusion weighted imaging in the diagnosis and clinical value of primary hepatocellular carcinoma[J] J Clin Exper Med, 2018, 17(14):1526-1529. DOI:10.3969/j.issn.1671-4695.2018.14.019. [10] 翟冲亚,葛红,贾丽洁,等. 压脂T2WI联合弥散加权成像在肺癌靶区勾画中的可行性研究[J]. 中华放射医学与防护杂志,2014, 34(5):362-363. DOI:10.3760/cma.j.issn.0254-5098.2014.05.011. Zhai CY, Ge h, Jia LJ, et al. Study on the application of fat-suppression T2WI combined with diffusion weighted imaging in target delineation of lung carcinoma[J]. Chin J Radiol Med Protect, 2014, 34(5):362-363. DOI:10.3760/cma.j.issn.0254-5098.2014.05.011. [11] Hou DL, Shi GF, Gao XS, et al. Improved longitudinal length accuracy of gross tumor volume delineation with diffusion weighted magnetic resonance imaging for esophageal squamous cell carcinoma[J]. Radiat Oncol, 2013, 8(1):169-176. DOI:10.1186/1748-717X-8-169. [12] 侯栋梁,房彤,刘博,等. 定位CT图像和CT/MRI扩散加权成像融合图像对食管癌放疗GTV勾画的比较[J]. 中华放射医学与防护杂志, 2014, 34(12):916-918. DOI:10.3760/cma.j.issn.0254-5098.2014.12.009. Hong DL, Fang T, Liu B, et al. Comparative evaluation of CT and CT/MR DWI images for GTV delineation in precision radiotherapy for esophageal squamous cell carcinoma[J]. Chin J Radiol Med Protect, 2014, 34(12):916-918. DOI:10.3760/cma.j.issn.0254-5098.2014.12.009. [13] 常晓斌,吴湘阳,袁渊. 磁共振弥散加权成像对局部晚期食管癌放疗靶区勾画的作用[J]. 西安交通大学学报(医学版),2017, 38(4):611-616. DOI:10.7652/jdyxb201704029. Chang XB, Wu XY, Yuan Y, et al. Effects of magnetic resonance diffusion weighted image on the target volume delineation of advanced esophageal cancer[J]. J Xi′an Jiaotong Univ (Medi Sci), 2017, 38(4):611-616. DOI:10.7652/jdyxb201704029. [14] 李慧敏,李建彬,李奉祥,等.4DCT、PET-CT与MRI勾画胸段食管癌大体肿瘤体积比较研究[J]. 中华放射肿瘤学杂志,2020, 29(7):508-512. DOI:10.3760/cma.j.cn113030-20191008-00405. Li HM, Li JB, Li FX, 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]. Chin J Radiat Oncol, 2020, 29(7):508-512. DOI:10.3760/cma.j.cn113030-20191008-00405.
2021, Vol. 30 
