结合肺灌注影像参数的等效均匀剂量模型与放射性肺炎的相关性研究

发布时间：2018-04-01 19:10

本文选题：等效均匀剂量　切入点：肺灌注　出处：《中国癌症杂志》2017年03期

【摘要】：背景与目的:目前,临床上用来预测放射性肺损伤的肺剂量体积参数准确度较低,且阈值不统一。该研究通过肺功能影像,探讨结合肺血流参数的等效均匀剂量(equivalent uniform dose,EUD)在预测放射性肺炎方面的价值。方法:将15例肺癌放疗患者肺灌注影像与定位CT影像形变融合,以肺灌注最高计数为归一点,将肺依功能状态分为四级区域,取每级区域中的平均计数与最高计数的比值作为肺灌注系数代入EUD模型中,获得肺部的功能等效均匀剂量(functional equivalent uniform dose,f EUD)模型。比较单肺及双肺的f EUD与不含肺功能指数的等效均匀剂量(general equivalent uniform dose,g EUD)、V5、V20在预测放射性肺炎方面的统计学差异,并进一步分析上述参数的统计学分布特征及彼此之间的相关性。放射性肺炎的判断标准采用不良事件常用术语评定标准(Common Terminology Criteria for Adverse Events,CTCAE)4.03版肺部症状3级以上,P0.05为差异有统计学意义。结果:该研究的样本中,当V5、V20等指标显示与放射性肺炎无关时,高剂量侧肺的f EUD值呈现与放射性肺炎显著相关(P=0.007)。单侧肺f EUD值与g EUD值呈显著线性关系(t=0.815,P=0.000)。结论:单侧肺f EUD较传统剂量-体积指标更好地体现了肺功能不同区域间的放射生物学差异,可以作为放射性肺炎预测指标,建议阈值为21 Gy。
[Abstract]:Background & AIM: at present, the lung dose volume parameters used to predict radiation-induced lung injury are less accurate and the threshold is not uniform. To explore the value of equivalent uniform uniform dose (uniform) combined with pulmonary blood flow parameters in the prediction of radiation pneumonia. Methods: 15 lung cancer patients with radiotherapy were treated with lung perfusion images and CT images, and the highest lung perfusion counts were taken as a point. The lung was divided into four regions according to its functional status. The ratio of the average count to the highest count in each region was taken as the lung perfusion coefficient to be substituted into the EUD model. A functional equivalent uniform doseof the lung model was established. The statistical differences in the prediction of radiation pneumonia between the f EUD of single and double lungs and that of general equivalent uniform doseg EUD5 / V20 without pulmonary function index were compared. The statistical distribution characteristics of the above parameters and their correlation were further analyzed. The criteria for judging radiation pneumonia were common Terminology Criteria for Adverse event Adverse CTCAE3 grade 3 or higher than P05 for poor pulmonary symptoms. The difference was statistically significant. Results: in the study sample, When V5 + V20 and other indicators showed no correlation with radiation pneumonia, The f EUD value of high dose side lung was significantly correlated with radiation pneumonitis. There was a significant linear relationship between f EUD value and g EUD value in unilateral lung. Conclusion: compared with traditional dose-volume index, f EUD in unilateral lung is better than that in different areas of lung function. Radiobiological differences between domains, It can be used as a predictor of radiation pneumonia, and the recommended threshold is 21 Gy.
【作者单位】：上海交通大学医学院附属仁济医院放疗科;上海交通大学附属胸科医院放疗科;上海交通大学生物医学工程学院;上海交通大学医学院附属仁济医院核医学科;
【分类号】：R730.55

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