圖像融合對(duì)鼻咽癌初程放療和再計(jì)劃中腫瘤體積的研究
發(fā)布時(shí)間：2018-08-11 15:05
【摘要】：目的：比較分別基于CT、MRI影像勾畫靶區(qū)對(duì)于鼻咽癌調(diào)強(qiáng)放射治療初程計(jì)劃中靶區(qū)體積及主要危及器官劑量分布的影像。從而探討進(jìn)一步探討CT/MRI圖像融合對(duì)鼻咽癌調(diào)強(qiáng)放射治療中的作用。 試驗(yàn)方法：(1)隨機(jī)抽取鼻咽癌的10例患者,在治療前進(jìn)行CT、MRI掃描,圖像傳至計(jì)劃系統(tǒng),將CT與MRI圖像使用Landmark法融合,在初程計(jì)劃時(shí)我們選擇A、B、C三位經(jīng)驗(yàn)豐富的放療醫(yī)師分別在CT、MRI圖像上逐層勾畫靶區(qū)。我們對(duì)以下進(jìn)行比較：(ⅰ)A、B、C醫(yī)師勾畫的三組GTVCT與GTVMRI之間的差異(ⅱ)分別比較CT、MRI圖像上GTVA、GTVB、GTVC醫(yī)師三者之間的差異；(ⅲ)三位醫(yī)師在CT、MRI圖像上勾畫原發(fā)腫瘤差異體積(GTVMRI-CT)；(ⅳ)對(duì)三位醫(yī)師在CT、MRI圖像勾畫原發(fā)腫瘤體積時(shí),原發(fā)腫瘤體積勾畫差異較大的區(qū)域進(jìn)行描述。我們比較找出CT、MRI圖像上勾畫差異最小的一位醫(yī)師,根據(jù)其在CT、MRI圖像上勾畫的GTV均放臨床靶區(qū)體積1(CTV1)、臨床靶區(qū)體積2(CTV2),勾畫周圍主要正常器官,制定放療計(jì)劃,比較腫瘤靶區(qū)劑量覆蓋和主要危及器官受照劑量差異。 結(jié)果：對(duì)在CT、MRI圖像上勾畫的原發(fā)腫瘤體積分別進(jìn)行比較,可以發(fā)現(xiàn),A、B、C醫(yī)師三人在CT、MRI圖像上勾畫的原發(fā)腫瘤體積比較均GTVMRI＞GTVCT,均有統(tǒng)計(jì)學(xué)差異。CT、MRI圖像上比較GTVA、GTVB、GTVC,結(jié)果表明在MRI圖像上勾畫靶區(qū)的腫瘤體積均大于CT圖像上勾畫的靶區(qū)體積,而且三位醫(yī)師在MRI圖像上勾畫靶區(qū)無(wú)統(tǒng)計(jì)學(xué)差異性；而三位醫(yī)師在CT圖像上勾畫靶區(qū)時(shí),統(tǒng)計(jì)結(jié)果P0.05,有統(tǒng)計(jì)學(xué)差異。三位醫(yī)師在CT、MRI圖像上勾畫靶區(qū)體積差異(GTVMRI-CT)比較結(jié)果表明,B醫(yī)師在CT、MRI圖像上勾畫靶區(qū)體積差異(GTVMRI-CT)均數(shù)較A、C醫(yī)師勾畫的小。我們對(duì)A、B、C醫(yī)師在CT、MRI圖像勾畫靶區(qū)原發(fā)腫瘤體積勾畫差異較大的解剖區(qū)域進(jìn)行描述,我們可以認(rèn)為B醫(yī)師在CT、MRI圖像上勾畫原發(fā)腫瘤體積差異較小。我們選擇B醫(yī)師CT、MRI圖像上勾畫的靶區(qū)制定計(jì)劃,對(duì)制定的放療計(jì)劃進(jìn)行比較,結(jié)果顯示在CT、MRI圖像上勾畫靶區(qū)對(duì)于腫瘤靶區(qū)劑量覆蓋無(wú)明顯影響,P0.05。危及器官比較中,患側(cè)側(cè)腮腺受照量在按CT勾畫靶區(qū)時(shí)大于按照MRI勾畫上,P0.05,有統(tǒng)計(jì)意義；視交叉、腦干受照劑量在MRI勾畫時(shí)大于CT上勾畫靶區(qū),P0.05,有統(tǒng)計(jì)學(xué)意義。 結(jié)論：(1)MRI與CT比較,MRI在顱底、顱內(nèi)、鼻竇、咽旁間隙、頸動(dòng)脈鞘區(qū)域、翼內(nèi)外肌、頭長(zhǎng)肌顯示更具優(yōu)勢(shì),故利用MRI圖像勾畫靶區(qū)能夠提高靶區(qū)勾畫的精確性。 (2)在MRI圖像上勾畫靶區(qū)時(shí)降低醫(yī)師之間靶區(qū)勾畫差異性,能提高勾畫的一致性。 (3)劑量比較：利用MRI勾畫靶區(qū)制定計(jì)劃優(yōu)于根據(jù)CT圖像勾畫靶區(qū)。靶區(qū)緊貼正常組織的情況下在滿足靶區(qū)劑量的同時(shí)有可能導(dǎo)致正常器官的受量增加,我們可以利用在放療過(guò)程中再計(jì)劃“縮野”減少正常器官的受量,從而更好地保護(hù)正常器官。 目的：調(diào)強(qiáng)放療第5周(50Gy左右)再次計(jì)劃修改時(shí),比較基于CT和CT/MRI圖像融合后結(jié)合CT、MRI圖像勾畫原發(fā)腫瘤的體積及腫瘤退縮率。 試驗(yàn)方法：收集20例鼻咽癌患者放療第5周時(shí),再次行CT、MRI圖像掃描,采用Landmark法將CT、MRI融合,先由經(jīng)驗(yàn)豐富放療醫(yī)師根據(jù)CT顯示腫瘤大小勾畫原發(fā)腫瘤體積,然后再在CT/MRI融合圖像上結(jié)合CT、MRI勾畫；結(jié)合該20例患者放療前勾畫的腫瘤體積,計(jì)算放療第5周時(shí)分別在CT、CT/MRI融合圖像上勾畫靶區(qū)的腫瘤退縮率,并對(duì)二者進(jìn)行比較。 試驗(yàn)結(jié)果：全組患者在第5周修改計(jì)劃時(shí),CT、CT/MRI融合圖像勾畫的平均腫瘤體積Vct,5w,,Vfusion,5w分別為39.07±11.15 cm3、29.81±10.42 cm3,p＜0.05。分層比較后,早期與顯示局部晚期在CT、CT/MRI融合圖像勾畫平均腫瘤體積均有統(tǒng)計(jì)學(xué)差異。我們對(duì)基于CT和CT/MRI融合圖像勾畫的兩組腫瘤體積計(jì)算其腫瘤消退率,結(jié)果表明在CT/MRI融合圖像顯示腫瘤消退率大于CT顯示腫瘤消退率,P0.05,有統(tǒng)計(jì)學(xué)意義,我們對(duì)CT、CT/MRI圖像勾畫的腫瘤體積差異影像進(jìn)行分析,結(jié)果顯示在放療第5周(50Gy左右)評(píng)價(jià)腫瘤消退率時(shí),利用CT/MRI圖像優(yōu)于單獨(dú)采用CT評(píng)價(jià)。 結(jié)論：在放療第5周(50Gy左右)評(píng)價(jià)腫瘤消退率時(shí),利用CT/MRI圖像勾畫腫瘤體積評(píng)價(jià)消退率優(yōu)于單獨(dú)采用CT。
[Abstract]:Objective: To compare CT and MRI images of target volume and dose distribution of major organs at risk in intensity modulated radiation therapy (IMRT) for nasopharyngeal carcinoma (NPC), and to explore the role of CT/MRI image fusion in intensity modulated radiation therapy (IMRT) for NPC.
Methods: (1) 10 patients with nasopharyngeal carcinoma were randomly selected for CT, MRI scanning and image transmission to the planning system before treatment. CT and MRI images were fused by Landmark method. Three experienced radiotherapists, A, B and C, were selected to delineate the target area layer by layer on CT and MRI images in the initial planning. Differences between GTVCT and GTVMRI in three groups (II) Comparing the differences among CT, MRI, GTVA, GTVB, GTVC physicians respectively; (III) Three physicians delineating the primary tumor volume on CT, MRI images (GTVMRI-CT); (_) Three physicians delineating the primary tumor volume on CT, MRI images, the primary tumor volume delineation difference between the three physicians in CT, MRI images. We compared the CT and MRI images of a physician with the smallest difference in delineation. According to their CT and MRI images of GTV delineated clinical target volume 1 (CTV1), clinical target volume 2 (CTV2), delineated the main normal organs around, formulated a radiotherapy plan, compared the tumor target dose coverage and major organs at risk by exposure. Dose difference.
Results: Comparing the volumes of primary tumor on CT and MRI images, it was found that the volumes of primary tumor on CT and MRI images were all GTVMRI > GTVCT. Comparing the volumes of GTVA, GTVB and GTVC on CT and MRI images, the volumes of primary tumor on MRI images were larger than those on CT images. There was no statistical difference in the volume of the target area on the MRI images between the three doctors, but there was statistical difference between the three doctors when they drew the target area on the CT images (P 0.05). Target volume difference (GTVMRI-CT) was smaller than that of A and C. We describe the anatomical regions of primary tumor in the target area on CT and MRI images. We think that the difference of primary tumor volume between CT and MRI images is smaller. The results showed that there was no significant effect on tumor target dose coverage in CT and MRI images, P 0.05. In organ-at-risk comparisons, the irradiation dose of parotid gland on the affected side was greater than that on MRI according to CT, P 0.05, which was statistically significant. When delineated, the target area was larger than CT, and P0.05 was statistically significant.
Conclusion: (1) Compared with CT, MRI has more advantages in displaying the skull base, intracranial, parapharyngeal space, parapharyngeal space, carotid sheath area, pterygoid and medial and lateral muscles, and long head muscle. Therefore, MRI can improve the accuracy of target area delineation.
(2) Reducing the difference of target delineation between doctors can improve the consistency of target delineation in MRI images.
(3) Dose comparison: MRI is superior to CT in planning the target area. When the target area is close to the normal tissue, it may lead to the increase of normal organ's dose while meeting the dose of the target area. Normal organs.
Objective:To compare CT and CT/MRI image fusion combined with CT and MRI images to delineate the volume and shrinkage rate of primary tumor in intensity modulated radiation therapy (IMRT) revision plan at the 5th week (about 50Gy).
Methods: 20 patients with nasopharyngeal carcinoma were scanned by CT and MRI at the 5th week after radiotherapy. CT and MRI were fused by Landmark method. The primary tumor volume was first delineated by experienced radiotherapists according to the size of the tumor displayed by CT, and then delineated by CT and MRI on the CT / MRI fusion image. Volume, the tumor regression rates were calculated and compared on CT, CT/MRI fusion images at the 5th week of radiotherapy.
Results: At the 5th week of revision of the plan, the mean tumor volumes of Vct, 5w, Vfusion and 5W were 39.07, 29.81 65 The tumor regression rate was calculated by CT and CT/MRI fusion images. The results showed that the tumor regression rate on CT/MRI fusion images was higher than that on CT images, P 0.05. There was statistical significance. We analyzed the tumor volume differences between CT and CT/MRI images, and the results showed that the tumor regression rate in CT/MRI fusion images was higher than that in CT images, P 0.05. The CT/MRI image was better than the CT alone when the tumor regression rate was reduced.
Conclusion: CT/MRI is superior to CT alone in the evaluation of tumor regression rate at the 5th week of radiotherapy (about 50 Gy).
【學(xué)位授予單位】：瀘州醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2010
【分類號(hào)】：R739.63
本文編號(hào)：2177353
[Abstract]:Objective: To compare CT and MRI images of target volume and dose distribution of major organs at risk in intensity modulated radiation therapy (IMRT) for nasopharyngeal carcinoma (NPC), and to explore the role of CT/MRI image fusion in intensity modulated radiation therapy (IMRT) for NPC.
Methods: (1) 10 patients with nasopharyngeal carcinoma were randomly selected for CT, MRI scanning and image transmission to the planning system before treatment. CT and MRI images were fused by Landmark method. Three experienced radiotherapists, A, B and C, were selected to delineate the target area layer by layer on CT and MRI images in the initial planning. Differences between GTVCT and GTVMRI in three groups (II) Comparing the differences among CT, MRI, GTVA, GTVB, GTVC physicians respectively; (III) Three physicians delineating the primary tumor volume on CT, MRI images (GTVMRI-CT); (_) Three physicians delineating the primary tumor volume on CT, MRI images, the primary tumor volume delineation difference between the three physicians in CT, MRI images. We compared the CT and MRI images of a physician with the smallest difference in delineation. According to their CT and MRI images of GTV delineated clinical target volume 1 (CTV1), clinical target volume 2 (CTV2), delineated the main normal organs around, formulated a radiotherapy plan, compared the tumor target dose coverage and major organs at risk by exposure. Dose difference.
Results: Comparing the volumes of primary tumor on CT and MRI images, it was found that the volumes of primary tumor on CT and MRI images were all GTVMRI > GTVCT. Comparing the volumes of GTVA, GTVB and GTVC on CT and MRI images, the volumes of primary tumor on MRI images were larger than those on CT images. There was no statistical difference in the volume of the target area on the MRI images between the three doctors, but there was statistical difference between the three doctors when they drew the target area on the CT images (P 0.05). Target volume difference (GTVMRI-CT) was smaller than that of A and C. We describe the anatomical regions of primary tumor in the target area on CT and MRI images. We think that the difference of primary tumor volume between CT and MRI images is smaller. The results showed that there was no significant effect on tumor target dose coverage in CT and MRI images, P 0.05. In organ-at-risk comparisons, the irradiation dose of parotid gland on the affected side was greater than that on MRI according to CT, P 0.05, which was statistically significant. When delineated, the target area was larger than CT, and P0.05 was statistically significant.
Conclusion: (1) Compared with CT, MRI has more advantages in displaying the skull base, intracranial, parapharyngeal space, parapharyngeal space, carotid sheath area, pterygoid and medial and lateral muscles, and long head muscle. Therefore, MRI can improve the accuracy of target area delineation.
(2) Reducing the difference of target delineation between doctors can improve the consistency of target delineation in MRI images.
(3) Dose comparison: MRI is superior to CT in planning the target area. When the target area is close to the normal tissue, it may lead to the increase of normal organ's dose while meeting the dose of the target area. Normal organs.
Objective:To compare CT and CT/MRI image fusion combined with CT and MRI images to delineate the volume and shrinkage rate of primary tumor in intensity modulated radiation therapy (IMRT) revision plan at the 5th week (about 50Gy).
Methods: 20 patients with nasopharyngeal carcinoma were scanned by CT and MRI at the 5th week after radiotherapy. CT and MRI were fused by Landmark method. The primary tumor volume was first delineated by experienced radiotherapists according to the size of the tumor displayed by CT, and then delineated by CT and MRI on the CT / MRI fusion image. Volume, the tumor regression rates were calculated and compared on CT, CT/MRI fusion images at the 5th week of radiotherapy.
Results: At the 5th week of revision of the plan, the mean tumor volumes of Vct, 5w, Vfusion and 5W were 39.07, 29.81 65 The tumor regression rate was calculated by CT and CT/MRI fusion images. The results showed that the tumor regression rate on CT/MRI fusion images was higher than that on CT images, P 0.05. There was statistical significance. We analyzed the tumor volume differences between CT and CT/MRI images, and the results showed that the tumor regression rate in CT/MRI fusion images was higher than that in CT images, P 0.05. The CT/MRI image was better than the CT alone when the tumor regression rate was reduced.
Conclusion: CT/MRI is superior to CT alone in the evaluation of tumor regression rate at the 5th week of radiotherapy (about 50 Gy).
【學(xué)位授予單位】：瀘州醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2010
【分類號(hào)】：R739.63
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