摘要
目的利用四维CT(4DCT)测量肝脏八段内病灶随呼吸运动产生的位移,用以确定体部伽玛刀肝脏各段病灶放射治疗所需的内靶区(ITV)。方法选择2014年3月至2018年10月在解放军总医院第五医疗中心医院行伽玛刀治疗肝癌患者30例,其中男性13例,女性17例;年龄32~76岁,中位年龄60岁。分别行非门控扫描(计划图像)和4DCT扫描,在4DCT得到的10个呼吸时相的图像上分别勾画肝内占位性病灶并测量靶区体积(GTV)中心在三维(3D)方向的位移大小,得到呼吸动度值,此动度值作为计划图像上GTV需要外扩的范围,得到ITV。结果共有75个肝内占位性病灶,Ⅰ段内病灶9个,Ⅱ段12个,Ⅲ段10个,Ⅳ段11个,Ⅴ段9个,Ⅵ段7个,Ⅶ段7个,Ⅷ段10个。肝脏八段内病灶的呼吸动度不同,其中Ⅰ段内病灶3D方向呼吸动度最小,病灶中心点在左右、前后、头脚方向的位移分别为(0.14±0.06)cm、(0.19±0.05)cm、(0.70±0.19)cm;Ⅱ段内病灶3D方向呼吸动度最大,病灶中心点在左右、前后、头脚方向的位移分别为(0.22±0.09)cm、(0.31±0.15)cm、(1.05±0.22)cm;病灶在头脚方向的呼吸动度大于左右方向、前后方向,差异均有统计学意义(P均<0.05)。病灶在前后方向的呼吸动度大于左右方向,但差异无统计学意义(P>0.05)。结论应用4DCT得到的肝脏八段内的病灶动度,可以准确确定肝脏各段病灶ITV。在体部伽玛刀治疗肝脏肿瘤时应用4DCT扫描能够保证治疗的精度,提高疗效。
Objective To measure respiratory motion of eight hepatic segments using four-dimensional CT(4DCT),and determine internal target volume(ITV)of hepatic segments lesions in gamma-knife radiotherapy.Methods From March 2014 to October 2018,a total of 30 patients with hepatocellular carcinoma underwent gamma-knife radiotherapy were enrolled,which included 13 males and 17 females,aged 32-76 years old with median age of 60 years old.All of them performed scanning with non-gated imaging(planning images)or 4 DCT imaging.The hepatic space-occupying lesions were delineated on the 10 respiratory phase images of 4 DCT,and center displacement of target volume(GTV)was measured at three-dimensional(3 D)direction,the breathing mobility value was obtained,which was used as the extension range of GTV on the planning image to obtain ITV.Results There were 75 intrahepatic space-occupying lesions,which of 9 in segmentⅠ,12 in segmentⅡ,10 in segmentⅢ,11 in segmentⅣ,9 in segmentⅤ,7 in segmentⅥ,7 in segmentⅦand 10 in segmentⅧ.The respiration motions of eight hepatic segments were different.The respiratory motion at 3 D direction of lesion in segmentⅠwas the smallest,and displacement of lesion center at left-right direction(X),anterior-posterior direction(Y)and superior-inferior direction(Z)was(0.14±0.06)cm,(0.19±0.05)cm and(0.70±0.19)cm,respectively.The respiratory motion at 3 D direction of lesion in segmentⅡwas the largest,and lesion center displacement at X,Y and Z was(0.22±0.09)cm,(0.31±0.15)cm and(1.05±0.22)cm,respectively.The respiratory motion of lesion at Z was statistically significantly larger than that at X and Y(P<0.05).The respiratory motion of lesion at Y was larger than that at X,but the difference was no statistically significant(P>0.05).Conclusion It is demonstrated that respiratory motion of eight hepatic segments using 4 DCT could confirm ITV of each hepatic segments,which could improve treatment accuracy and clinical therapeutic effect in gamma-knife radiotherapy.
作者
高文超
郑倩倩
曹井丽
林鸿宇
王军良
GAO Wen-chao;ZHENG Qian-qian;CAO Jing-li;LIN Hong-yu;WANG Jun-liang(Department of Radiation Oncology,South District of the Fifth Medical Center of PLA General Hospital,Beijing 100071,China;Department of Oncology,Shijingshan Hospital,Beijing 100043,China)
出处
《生物医学工程与临床》
CAS
2021年第4期421-424,共4页
Biomedical Engineering and Clinical Medicine
基金
“十三五”国家重点研发计划资助项目(2017YFC0113702)。
关键词
4DCT
体部伽玛刀
肝脏八段
呼吸动度
内靶区
靶区勾画
four-dimensional CT(4DCT)
gamma-knife
eight hepatic segments
breathing mobility
internal target volume
target delineation
