宫颈癌PET-CT图像放疗靶区四种勾画方法的初步研究

doi:10.3760/cma.j.issn.1004-4221.2012.01.016

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摘要目的通过比较4种勾画方法在宫颈癌FDG PET-CT图像上大体肿瘤体积(GTV)差异,寻找适合临床应用的方法。方法 16例行FDG PET-CT放疗前定位的28个宫颈癌病灶的PET图像,分别用视觉勾画法(GTV_vis)、SUV=2.5为边界勾画法(GTV_2.5)、40%阈值边界勾画法(GTV₄₀)、拟合公式勾画法(GTV_公式)对GTV勾画,其差异比较采用成组t检验。结果 GTV_vis、GTV_2.5 、GTV₄₀、GTV_公式勾画的平均体积分别为63.41、53.20、41.33、61.84 cm³,除GTV₄₀vis外(t=2.32,P=0.029),GTV_2.5、GTV_公式与GTV_vis均相似(t=1.05、0.91,P=0.305、0.370)。最大SUV值>6或<6、靶本底比值>3∶1或<3∶1对GTV₄₀和GTV_公式与GTV_vis差值均无影响(t=0.00、－0.34、0.92、0.35,P=1.000、0.746、0.374、0.737),但对GTV_2.5与GTV_vis差值有影响(t=－3.87、3.16,P=0.002、0.016)。结论在GTV_2.5、GTV_公式能勾画出靶区情况下,GTV_公式、GTV_2.5和GTV_vis均相似且可用于临床,GTV_公式与GTV_vis最为接近;但GTV₄₀vis,应用时应谨慎;GTV_2.5明显受病灶SUV_max值及靶本底比值影响。

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	林琳
	郑容
	吴令英
	吴宁
	张雯杰
	刘瑛
	梁颖
	赵平
	李晔雄

关键词 ：氟代脱氧葡萄糖, 正电子发射断层显像术, 靶区勾画, 宫颈肿瘤

Abstract：Objective To compare the differences in 4 sets of gross tumor volumes (GTVs) generated from FDG PET/CT in cervical cancer, and determine the optimal method for target volume delineation of cervical cancer. Methods Sixteen cervical cancer patients with 28 primary or metastatic lesions underwent FDG PET/CT. CT and PET images were coregistered, and transferred to Pinnacle therapy planning workstation. Four sets of GTVs were defined. The first set (GTV_vis) was manually contoured using a visual method on PET images. The second set (GTV₄₀) was autocontoured using a threshold of 40% of the maximum intensity level for PET images. The third set (GTV_2.5) used an autocontour of standardized uptake value (SUV) of 2.5 around the tumor. By phantom measurements we determined an algorithm (threshold=(mean target concentration+2.623)/1.975),GTV_function was defined using this method as the fourth approach. The volumes of 4 sets of GTVs were compared with group t-test. Results The average volumes of GTV_vis, GTV_2.5, GTV₄₀, and GTV_function were 63.41, 53.20, 41.33, and 61.84 cm³. There was no significant difference between GTV_function,GTV_2.5 and GTV_vis (t=1.05,0.91, P=0.305,0.37),but GTV₄₀ were smaller than GTV_vis. The SUV_max and target to background value had no significant influence on the differences between GTV₄₀ and GTV_function or GTV_vis (t=0.00, －0.34, 0.92, 0.35, P=1.000, 0.746, 0.374, 0.737), but they had significant influence on the difference between GTV_2.5 and GTV_vis (t=－3.87,3.16,P=0.002,0.016). Conclusions GTV_vis, GTV_2.5 and GTV_function all could be used for target delineation if the method can define the GTV. The difference between the GTV_function and GTV_vis was the smallest;GTV₄₀ was smaller than GTV_vis. GTV_2.5 was significantly influenced by SUV_max and target to background value of the legions.

Key words： Fluorodeoxyglucose Positron-emission tomography Target delineation Cervical neoplasms

收稿日期: 2011-08-08

基金资助:卫生部临床学科重点项目(07090010)

通讯作者: 郑容 E-mail: zhengrong_2004@yahoo.com.cn

引用本文:

林琳,郑容,吴令英等. 宫颈癌PET-CT图像放疗靶区四种勾画方法的初步研究[J]. 中华放射肿瘤学杂志, 2012, 21(1): 56-59.

LIN Lin^*,ZHENG Rong,WU Ling-ying et al. Comparison of four methods for delineation of gross tumor volume on FDG PET/CT for patients with cervical cancer[J]. Chinese Journal of Radiation Oncology, 2012, 21(1): 56-59.

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