基于MR灌注成像进行脑转移瘤亚靶区分割的研究

doi:10.3760/cma.j.cn113030-20200613-00306

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摘要目的探讨MR灌注成像进行脑转移瘤(BMs)亚靶区分割的可行性,为BMs患者基于血流灌注异质性引导个体化放疗提供参考。方法选取 96例BMs放疗患者,肿瘤内部有坏死组 55例,无坏死组 41例,每位患者放疗前行CT模拟定位及MR模拟定位。应用MIM Maestro6.8.8软件分别在强化T1WI图像和T2 Propeller图像中勾画大体肿瘤体积(GTV)及肿瘤坏死区(GTVN),二者相减得肿瘤实性区(GTVS)。应用三维动脉自旋标记(3D-ASL)灌注成像的脑血流量图确定高灌注区(GTVH)与低灌注区(GTVL)。比较有、无坏死组亚靶区体积、占比及各亚靶区相关性。结果有、无坏死组GTV分别为19.56、7.34cm³,GTV与坏死的ROC曲线AUC达0.749。有坏死组GTVN、GTVS、GTVH、GTVL占GTV比分别为20.47%、79.53%、33.03%、46.50%(P<0.05),其中GTVS与GTV的r值达0.963,GTVL与GTV、GTVS的r值分别达0.849、0.840,高于GTVH与GTV、GTVS的r值0.683、0.764(均 P<0.05)。无坏死组GTVH占GTV比高于有坏死组(58.95%∶33.03%,P<0.05),GTVL 占GTV比略低于有坏死组(41.05%∶46.50%,P>0.05)。GTVH与GTV的r值高于GTVL与GTV的(0.776∶0.574,P<0.05)。结论 MR-3D-ASL可以定量分析BMs肿瘤靶区内异质性血流灌注,可用于指导亚靶区分割及肿瘤局部亚靶区剂量提升。

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关键词 ：磁共振成像, 三维动脉自旋标记灌注, 亚靶区分割, 肿瘤转移,脑/放射疗法

Abstract：Objective To evaluate the feasibility of magnetic resonance (MR) perfusion imaging for sub-region segmentation of brain metastases (BMs), and to provide reference for individualized radiotherapy based on blood flow perfusion heterogeneity in BMs patients. Methods 96 BMs patients were selected, including 55 patients with necrosis and 41 without necrosis. Each patient was scanned with CT simulation and MR simulation before radiotherapy. MIM Maestro 6.8.8software was used to delineate the gross tumor volume (GTV) and necrosis GTV (GTVN) from enhanced T1W images and T2 Propeller images, respectively, and the solid GTV (GTVS) was obtained by the subtraction of the two. Then, the cerebral blood flow map of three dimensional arterial spin labeling (3D-ASL) was employed to determine the high perfused GTV (GTVH) and low perfused GTV (GTVL). The volume and proportion of sub-regions were counted and compared between two groups and the correlation of each sub-region was analyzed. Results The volume of GTV in the necrosis and non-necrosis groups was 19.56 and 7.34cm³, respectively. Besides, the AUC of the ROC between GTV volume and necrosis was 0.749. In the necrosis group, the ratio of GTVN, GTVS, GTVH and GTVL to GTV was 20.47%, 79.53%, 33.03% and 46.50%, respectively (all P<0.05). Among them, the r value between GTVS and GTV was 0.963, 0.849 for GTVL and GTV, and 0.840 for GTVL and GTVS, significantly higher than 0.683 for GTVH and GTV and 0.764 for GTVH and GTVS (all P<0.05). In the non-necrosis group, the ratio of GTVH to GTV was higher than that in the necrosis group (58.95% vs. 33.03%, P<0.05). In addition, the ratio of GTVL to GTV was slightly lower than that in the necrosis group (41.05% vs. 46.50%, P>0.05). The r value between GTVH and GTV was 0.776, significantly higher than 0.574 between GTVL and GTV (P<0.05). Conclusion MR-3D-ASL can quantitatively analyze the heterogeneous blood perfusion of BMs, which could guide the sub-region segmentation and local dose escalation of tumors.

Key words： Magnetic resonance imaging Three dimensional arterial spin labeling perfusion Sub-region segmentation Neoplasm metastasis,brain/radiotherapy

收稿日期: 2020-06-13

基金资助:山东省肿瘤医院临床研究培育项目(YYPY2020-016)

通讯作者: 尹勇,Email:yinyongsd@126.com

引用本文:

侯传珂,巩贯忠,王俪臻等. 基于MR灌注成像进行脑转移瘤亚靶区分割的研究[J]. 中华放射肿瘤学杂志, 2021, 30(10): 1047-1053.

Hou Chuanke,Gong Guanzhong,Wang Lizhen et al. Study of sub-region segmentation of brain metastases based on magnetic resonance perfusion imaging[J]. Chinese Journal of Radiation Oncology, 2021, 30(10): 1047-1053.

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