四维CT在肺部肿瘤内靶区勾画方法中的差异性研究

张梦雨; 段诗苗; 吴烨; 郭子文; 李伟; 江浩

doi:10.16766/j.cnki.issn.1674-4152.003111

四维CT在肺部肿瘤内靶区勾画方法中的差异性研究

doi: 10.16766/j.cnki.issn.1674-4152.003111

张梦雨¹,
段诗苗¹,
吴烨¹,
郭子文¹,
李伟²,
江浩^1, ,

1.
蚌埠医学院第一附属医院放疗科，安徽蚌埠 233004
2.
安徽省呼吸系统疾病(肿瘤)临床医学研究中心，安徽蚌埠 233004

基金项目:

2021年第二批安徽省中央引导地方科技发展资金项目 2020b07030008

蚌埠医学院自然科学重点项目 BYKY2019077ZD

详细信息

通讯作者:
江浩，E-mail：jianghao1223@163.com

中图分类号: R734.2 R730.4
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- 文章访问数: 115
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- PDF下载量: 7
- 被引次数: 0
出版历程
- 收稿日期: 2023-01-11
- 网络出版日期: 2023-09-13

Study on differences in target delineation methods for lung tumors using on four-dimensional CT

1.
Department of Radiotherapy, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的基于不同部位的肺部肿瘤患者四维CT(4DCT)图像，比较采用哪种靶区勾画方法更高效。方法选择2019年10月—2021年12月于蚌埠医学院第一附属医院行4DCT模拟定位扫描的130例肺部肿瘤患者。医生在4DCT的10个时相进行大体肿瘤体积(GTV)靶区勾画，融合得到IGTV₁₀；基于最大密度投影(MIP)、平均密度投影(AIP)、4DCT的0%和50%时相图像勾画得到IGTV_MIP、IGTV_AIP、IGTV₂。从体积和质心位移对上述靶区勾画方法进行差异对比。结果肺上叶组IGTV_MIP、IGTV_AIP、IGTV₂对IGTV₁₀比值分别为1.00、0.98、0.99(P=0.143, < 0.001, < 0.001)，肺中下叶组比值分别为0.99、0.96、0.98 (P=0.603, < 0.001, < 0.001)。肺上叶组IGTV₁₀与IGTV_MIP相互包含度差异无统计学意义(P>0.05)，IGTV₁₀与IGTV_AIP、IGTV₂相互包含度差异有统计学意义(均P < 0.05)，肺中下叶组IGTV₁₀与IGTV_MIP、IGTV_AIP、IGTV₂相互包含度差异有统计学意义(均P < 0.05)。结论 10个时相融合的图像所包含的运动信息明显大于AIP图像和0%+50%时相融合的图像，但接近于MIP图像，在使用MIP图像勾画靶区时也要考虑肿瘤所在位置。
- 肺部肿瘤 /
- 四维计算机断层扫描 /
- 内在大体肿瘤靶体积 /
- 最大密度投影 /
- 平均密度投影
Abstract: Objective Based on four dimensional CT (4DCT) images of patients with lung tumors in different parts, the study compares which target delineation method is more efficient. Methods A total of 130 patients with lung tumors, who underwent 4DCT simulation scans at the First Affiliated Hospital of Bengbu Medical College from October 2019 to December 2021 were selected. The doctor delineated the gross tumor volume (GTV) targets in 10 phases of 4DCT, and IGTV₁₀ was obtained by fusion. IGTV_MIP, IGTV_AIP and IGTV₂ were obtained based on maximum density projection (MIP), average density projection (AIP) images, 0% and 50% time-phase of 4DCT. The above delineation methods were compared in terms of volume and centroid displacement. Results The ratios of IGTV_MIP, IGTV_AIP and IGTV₂ to IGTV₁₀ in the upper lobe group were 1.00, 0.98 and 0.99, respectively (P=0.143, < 0.001, < 0.001). The ratios for the middle and lower lobe groups were 0.99, 0.96 and 0.98, respectively (P=0.603, < 0.001, < 0.001). There was no significant difference in the degree of mutual inclusion between IGTV₁₀ and IGTV_MIP in the upper lung lobe group (P>0.05), while there was a significant difference in the degree of mutual inclusion between IGTV₁₀, IGTV_AIP and IGTV₂ in the upper lung lobe group (all P < 0.05). The degree of mutual inclusion of IGTV₁₀, IGTV_MIP, IGTV_AIP and IGTV₂ in the middle and lower lung lobe group was significantly different (all P < 0.05). Conclusion The motion information contained in the 10 time-fused images is significantly greater than that of the AIP images and the 0%+50% fused images, but close to that of the MIP images. The location of the tumor should also be considered when using MIP images to delineate the target area.
- Lung tumor /
- Four-dimensional computed tomography /
- Internal gross tumor volume /
- Maximum intensity projection /
- Average intensity projection

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表 1 130例肺癌患者不同肺叶靶区移动度比较[M(P₂₅, P₇₅)，mm]

Table 1. Comparison of target area mobility of different lung lobes in 130 patients with lung cancer[M(P₂₅, P₇₅), mm]

组别	例数	左右	前后	头脚	三维运动矢量
肺上叶组	65	1.40(0.70, 2.55)	1.70(0.80, 2.25)	1.20(0.55, 2.90)	5.67(3.94, 8.33)
肺中下叶组	65	1.60(0.95, 2.65)	1.90(1.10, 3.20)	2.70(0.85, 7.05)	8.18(6.74, 11.00)
Z值		-1.272	-2.048	-3.401	-4.421
P值		0.203	0.041	0.001	<0.001

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表 2 130例肺癌患者不同靶区间质心3个方向的位移和三维运动矢量比较[M(P₂₅, P₇₅)，mm]

Table 2. Comparison of centroid displacement in three directions and three-dimensional motion vector in 130 patients with lung cancer at different target intervals[M(P₂₅, P₇₅), mm]

组别	例数	左右方向	前后方向	头脚方向	三维运动矢量
IGTV_MIP-IGTV₁₀	130	0.00(-0.40, 0.20)	0.00(-0.20, 0.48)	-0.15(-0.98, 0.30)	1.06(0.50, 3.47)
IGTV_AIP-IGTV₁₀	130	-0.10(-0.50, 0.40)	0.20(-0.28, 0.90)	0.00(-0.80, 0.30)	1.21(0.64, 3.27)
IGTV₂-IGTV₁₀	130	0.00(-0.28, 0.20)	0.00(-0.20, 0.20)	0.00(-0.30, 0.30)^a	0.70(0.26, 1.34)^ab
H值		0.928	3.087	6.209	15.344
P值		0.629	0.214	0.045	<0.001
注：与IGTV_MIP-IGTV₁₀组比较，^aP<0.05；与IGTV_AIP-IGTV₁₀组比较，^bP<0.05。

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表 3 130例肺癌患者肺上叶组及肺中下叶组不同靶区勾画方法体积比较[M(P₂₅, P₇₅)]

Table 3. Volume Comparison of target delineation methods between upper lobe group and middle or inferior lobe group of 130 patients with lung cancer[M(P₂₅, P₇₅)]

组别	例数	IGTV₁₀(cm³)	IGTV_MIP(cm³)	IGTV_AIP(cm³)	IGTV₂(cm³)	IGTV_MIP/IGTV₁₀	IGTV_AIP/IGTV₁₀	IGTV₂/IGTV₁₀
肺上叶组	65	61.63(14.45, 121.98)	53.08(15.06, 119.17)	51.27(14.50, 114.73)^a	52.60(12.90, 118.89)^a	1.00(0.94, 1.02)	0.98(0.88, 1.00)^b	0.99(0.93, 1.00)^b
肺中下叶组	65	49.49(17.20, 113.32)	42.74(17.26, 114.05)	42.44(16.66, 108.32)^a	45.60(16.26, 110.99)^a	0.99(0.91, 1.05)	0.96(0.86, 1.01)^b	0.98(0.93, 1.00)^b
Z值		-0.610	-0.654	-0.724	-0.487	-0.291	-0.975	-0.682
P值		0.542	0.513	0.469	0.627	0.771	0.329	0.495
注：与同组IGTV₁₀比较，^aP<0.01；与同组IGTV_MIP /IGTV₁₀比较，^bP<0.05。

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表 4 130例肺癌患者不同CT图像勾画的靶区相互包含度比较[M(P₂₅, P₇₅)，%]

Table 4. Comparison of mutual inclusion of target areas outlined on different CT images of 130 patients with lung cancer[M(P₂₅, P₇₅), %]

组别	例数	IGTV_MIP对IGTV₁₀	IGTV₁₀对IGTV_MIP	IGTV_AIP对IGTV₁₀	IGTV₁₀对IGTV_AIP	IGTV₂对IGTV₁₀	IGTV₁₀对IGTV₂
肺上叶组	65	0.96(0.88, 0.99)	0.99(0.97, 1.00)	0.92(0.83, 0.98)	0.99(0.96, 0.99)^a	0.98(0.89, 0.99)	1.00(0.99, 1.00)^a
肺中下叶组	65	0.95(0.83, 0.98)	0.98(0.92, 0.99)^a	0.92(0.81, 0.96)	0.99(0.96, 1.00)^a	0.98(0.90, 1.00)	1.00(1.00, 1.00)^a
Z值		-1.608	-2.359	-1.104	-0.453	-0.207	-2.735
P值		0.108	0.018	0.270	0.651	0.836	0.006
注：同组IGTV_MIP、IGTV_AIP、IGTV₂与IGTV₁₀相互包含度比较，^aP<0.01。

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