肺癌伴肺不张者放疗前MRI与CT模拟定位比较研究

doi:10.3760/cma.j.issn.1004-4221.2016.02.016

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摘要目的探讨MRI定位在合并阻塞性肺不张(POLC)肺癌患者中进行靶区勾画的可行性及优势。方法对14例合并POLC肺癌患者同时行CT、MRI定位,分别采集CT、T₁WI、 T₂WI、DWI图像并测量癌肿与POLC在T₂WI、DWI图像上的比信噪比(CNRs)。将CT、MRI定位图像在TPS中进行融合,分别在CT、MRI上进行靶区勾画,制定放疗计划。Plan_CT 、Plan_MRI 均以CT为基础实现剂量计算,采用相同射野数目及角度。系统自动计算GTV,比较2个计划的DVH。配对t检验差异。结果
T₂WI可以显示12/14癌肿与POLC的界限,6/6中肿块与POLC的分界均可被DWI显示。GTV_MRI为(149.317±229.670) cm³,GTV_CT为(178.073±236.604) cm³(P=0.000)。DWI图像CNRs为77.295±49.273,T₂WI的为12.942±5.553(P=0.027)。DVH比较显示在靶区适形度及均匀性无差异的前提下,Plan_MRI比Plan_CT患侧肺平均剂量低(P=0.002),健侧肺平均剂量相近(P=0.052),总肺平均剂量、食管平均剂量、脊髓最大剂量均低(P=0.009、0.038、0.038),患侧肺V₅、V₁₀和心脏V₂₅均低(P=0.010、0.031、0.044)。

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	赵丹
	余荣
	胡俏俏
	张健
	吴昊
	于会明
	耿建昊
	齐丽萍
	朱广迎

关键词 ：磁共振成像定位, 肺肿瘤, 阻塞性肺不张
, , , 基金项目:国家自然科学基金(30870738, 81472814)

Abstract：Objective To study the potential of MRI simulation in lung cancer patients with post-obstructive lobar collapse (POLC). Methods 14 patients with POLC were enrolled. Before radiotherapy,two sets of simulating images were obtained for each patient using CT and MRI with T₁/T₂-weighted and diffuse-weighted images (T₁W/T₂WI/DWI). Simulating MRI were fused with corresponding simulating CT for dose calculation. Contrast-to-noise-ratios (CNRs) of tumor and POLC on T₂WI and DWI were measured and calculated. The GTV and OARs were delineated separately by radiation oncologists both on simulating CT and MRI. Plan_CT and Plan_MRI/CT were carried out on CT sets with same beam number and direction. Dose distributions of OARs were compared on the basis of DVH. Results 12 out of 14 cases were distinguishable by T₂WI and all the 6 cases could be figured out by DWI. The mean volume of GTV_MRI was significantly smaller than GTV_CT(149.317±229.670 cm³ vs.178.073±236.604 cm³,P=0.000).The mean CNR of DWI was much higher than T₂WI (77.295±49.273 vs.12.942±5.553,P=0.027).The DVH comparison showed OARs of Plan_MRI got less exposure compared to those of Plan_CT. with no significant differences in HI and CI (The mean dose of lung with cancer was lower (P=0.002),and withno cancer similar (P=0.052). Total lung mean dose was lower (P=0.009),and with esophagus lower (P=0.038). The maximal dose of spinal cord was lower (P=0.038). The V₅,V₁₀ of lung and V₂₅ of heart were lower (P=0.010,0.031,0.044). Conclusions MRI simulation with coregistered simulating CT is more competent than CT simulation alone,in identifying and defining the borderlines of tumor masses and reducing the exposure of OARs.

Key words： Magnetic resonance imaging simulation Lung neoplasms Post-obstructive lobar collapse
Fund program:National Natural Science Fund of China (30870738,81472814)

收稿日期: 2015-04-26

基金资助:国家自然科学基金(30870738,81472814)

通讯作者: 朱广迎,Email:zgypu163@163.com

引用本文:

赵丹,余荣,胡俏俏等. 肺癌伴肺不张者放疗前MRI与CT模拟定位比较研究[J]. 中华放射肿瘤学杂志, 2016, 25(2): 158-159.

Zhao Dan,Yu Rong,Hu Qiaoqiao et al. Using MRI simulation in radiotherapy of lung cancer with post-obstructive lobar collapse:a preliminary study[J]. Chinese Journal of Radiation Oncology, 2016, 25(2): 158-159.

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