图像融合对鼻咽癌初程放疗和再计划中肿瘤体积的研究
发布时间：2018-08-11 15:05
【摘要】：目的：比较分别基于CT、MRI影像勾画靶区对于鼻咽癌调强放射治疗初程计划中靶区体积及主要危及器官剂量分布的影像。从而探讨进一步探讨CT/MRI图像融合对鼻咽癌调强放射治疗中的作用。 试验方法：(1)随机抽取鼻咽癌的10例患者,在治疗前进行CT、MRI扫描,图像传至计划系统,将CT与MRI图像使用Landmark法融合,在初程计划时我们选择A、B、C三位经验丰富的放疗医师分别在CT、MRI图像上逐层勾画靶区。我们对以下进行比较：(ⅰ)A、B、C医师勾画的三组GTVCT与GTVMRI之间的差异(ⅱ)分别比较CT、MRI图像上GTVA、GTVB、GTVC医师三者之间的差异；(ⅲ)三位医师在CT、MRI图像上勾画原发肿瘤差异体积(GTVMRI-CT)；(ⅳ)对三位医师在CT、MRI图像勾画原发肿瘤体积时,原发肿瘤体积勾画差异较大的区域进行描述。我们比较找出CT、MRI图像上勾画差异最小的一位医师,根据其在CT、MRI图像上勾画的GTV均放临床靶区体积1(CTV1)、临床靶区体积2(CTV2),勾画周围主要正常器官,制定放疗计划,比较肿瘤靶区剂量覆盖和主要危及器官受照剂量差异。 结果：对在CT、MRI图像上勾画的原发肿瘤体积分别进行比较,可以发现,A、B、C医师三人在CT、MRI图像上勾画的原发肿瘤体积比较均GTVMRI＞GTVCT,均有统计学差异。CT、MRI图像上比较GTVA、GTVB、GTVC,结果表明在MRI图像上勾画靶区的肿瘤体积均大于CT图像上勾画的靶区体积,而且三位医师在MRI图像上勾画靶区无统计学差异性；而三位医师在CT图像上勾画靶区时,统计结果P0.05,有统计学差异。三位医师在CT、MRI图像上勾画靶区体积差异(GTVMRI-CT)比较结果表明,B医师在CT、MRI图像上勾画靶区体积差异(GTVMRI-CT)均数较A、C医师勾画的小。我们对A、B、C医师在CT、MRI图像勾画靶区原发肿瘤体积勾画差异较大的解剖区域进行描述,我们可以认为B医师在CT、MRI图像上勾画原发肿瘤体积差异较小。我们选择B医师CT、MRI图像上勾画的靶区制定计划,对制定的放疗计划进行比较,结果显示在CT、MRI图像上勾画靶区对于肿瘤靶区剂量覆盖无明显影响,P0.05。危及器官比较中,患侧侧腮腺受照量在按CT勾画靶区时大于按照MRI勾画上,P0.05,有统计意义；视交叉、脑干受照剂量在MRI勾画时大于CT上勾画靶区,P0.05,有统计学意义。 结论：(1)MRI与CT比较,MRI在颅底、颅内、鼻窦、咽旁间隙、颈动脉鞘区域、翼内外肌、头长肌显示更具优势,故利用MRI图像勾画靶区能够提高靶区勾画的精确性。 (2)在MRI图像上勾画靶区时降低医师之间靶区勾画差异性,能提高勾画的一致性。 (3)剂量比较：利用MRI勾画靶区制定计划优于根据CT图像勾画靶区。靶区紧贴正常组织的情况下在满足靶区剂量的同时有可能导致正常器官的受量增加,我们可以利用在放疗过程中再计划“缩野”减少正常器官的受量,从而更好地保护正常器官。 目的：调强放疗第5周(50Gy左右)再次计划修改时,比较基于CT和CT/MRI图像融合后结合CT、MRI图像勾画原发肿瘤的体积及肿瘤退缩率。 试验方法：收集20例鼻咽癌患者放疗第5周时,再次行CT、MRI图像扫描,采用Landmark法将CT、MRI融合,先由经验丰富放疗医师根据CT显示肿瘤大小勾画原发肿瘤体积,然后再在CT/MRI融合图像上结合CT、MRI勾画；结合该20例患者放疗前勾画的肿瘤体积,计算放疗第5周时分别在CT、CT/MRI融合图像上勾画靶区的肿瘤退缩率,并对二者进行比较。 试验结果：全组患者在第5周修改计划时,CT、CT/MRI融合图像勾画的平均肿瘤体积Vct,5w,,Vfusion,5w分别为39.07±11.15 cm3、29.81±10.42 cm3,p＜0.05。分层比较后,早期与显示局部晚期在CT、CT/MRI融合图像勾画平均肿瘤体积均有统计学差异。我们对基于CT和CT/MRI融合图像勾画的两组肿瘤体积计算其肿瘤消退率,结果表明在CT/MRI融合图像显示肿瘤消退率大于CT显示肿瘤消退率,P0.05,有统计学意义,我们对CT、CT/MRI图像勾画的肿瘤体积差异影像进行分析,结果显示在放疗第5周(50Gy左右)评价肿瘤消退率时,利用CT/MRI图像优于单独采用CT评价。 结论：在放疗第5周(50Gy左右)评价肿瘤消退率时,利用CT/MRI图像勾画肿瘤体积评价消退率优于单独采用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).
【学位授予单位】：泸州医学院
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R739.63
本文编号：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).
【学位授予单位】：泸州医学院
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R739.63
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