Comparison of gross target volumes based on four-dimensional CT, positron emission tomography-computed tomography, and magnetic resonance imaging in thoracic esophageal cancer
Comparison of gross target volumes based on four-dimensional CT, positron emission tomography-computed tomography, and magnetic resonance imaging in thoracic esophageal cancer
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基于四维CT、正电子发射断层扫描-计算机断层扫描和磁共振成像的胸段食管癌大体靶体积比较。
DOI：
10.1002/cam4.3072
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发表时间：
2020-06-08
期刊：
影响因子：
4
通讯作者：
Liu, Xijun
中科院分区：
文献类型：
--
作者：
Li, Huimin;Li, Fengxiang;Liu, Xijun
目的通过比较4DCT、F18-FDG PET-CT和T2 W-MRI在呼气末（EE）时相显示GTV的位置、体积和长度的差异，探讨F18-FDG PET-CT联合MRI在食管癌放射治疗中的应用价值。和MRI模拟进行胸部定位。采用变形配准的方法将所有图像与3DCT图像进行融合。GTV（CT）和GTV（50%）分别在3DCT和4DCT图像的EE期被描绘。基于PET-CT图像的GTV由SUV >= 2.5的阈值确定，并指定为GTV（PET2.5）。T2加权序列图像称为GTV（MRI），弥散加权序列图像称为GTV（DWI）。结果GTV（PET2.5）明显大于GTV（50%）和GTV（MRI）（P = 0.000和0.008），GTV（MRI）与GTV（50%）体积相似（P = 0.439）。GTV（MRI）与GTV（50%）和GTV（PET2.5）与GTV（50%）的CI之间观察到显著差异（P = .004）。GTV（MRI）与GTV（CT）和GTV（PET 2.5）与GTV（CT）的CI具有统计学意义（P = .039）。GTV（MRI）与GTV（PET2.5）的CI显著低于GTV（MRI）与GTV（50%）、GTV（MRI）与GTV（CT）、GTV（PET2.5）与GTV（50%）和GTV（PET2.5）与GTV（CT）（P = 0.000 -0.021）。内镜测量的肿瘤长度与PET和DWI测量的肿瘤长度相似（P > 0.05），GTV纵向长度（PET 2.5）与GTV纵向长度（DWI）无显著性差异（P = 0.072）。然而，GTV（MRI）与GTV（PET2.5）相比，体积不同，空间匹配性差，MRI成像不能包括整个呼吸。4DCT结合MRI成像可作为指导食管癌靶区勾画和构建的良好选择。DWI在食管癌治疗计划中的应用可提供更多信息，以协助靶区勾画。需要进一步的研究来确定这项技术是否会转化为临床结果的有意义的差异。
Purpose The application value of F-18-FDG PET-CT combined with MRI in the radiotherapy of esophageal carcinoma was discussed by comparing the differences in position, volume, and the length of GTVs delineated on the end-expiration (EE) phase of 4DCT, F-18-FDG PET-CT, and T2W-MRI.Methods A total of 26 patients with thoracic esophageal cancer sequentially performed 3DCT, 4DCT, F-18-FDG PET-CT, and MRI simulation for thoracic localization. All images were fused with the 3DCT images by deformable registration. GTV(CT) and GTV(50%) were delineated on 3DCT and the EE phase of 4DCT images, respectively. The GTV based on PET-CT images was determined by thresholds of SUV >= 2.5 and designated as GTV(PET2.5). The images of T-2-weighted sequence and diffusion-weighted sequence were referred as GTV(MRI) and GTV(DWI), respectively. The length of the abnormality seen on the 4DCT, PET-CT, and DWI was compared.Results GTV(PET2.5) was significantly larger than GTV(50%) and GTV(MRI) (P = .000 and 0.008, respectively), and the volume of GTV(MRI) was similar to that of GTV(50%) (P = .439). Significant differences were observed between the CI of GTV(MRI) to GTV(50%) and GTV(PET2.5) to GTV(50%) (P = .004). The CI of GTV(MRI) to GTV(CT) and GTV(PET2.5) to GTV(CT) were statistically significant (P = .039). The CI of GTV(MRI) to GTV(PET2.5) was significantly lower than that of GTV(MRI) to GTV(50%), GTV(MRI) to GTV(CT), GTV(PET2.5) to GTV(50%), and GTV(PET2.5) to GTV(CT) (P = .000-0.021). Tumor length measurements by endoscopy were similar to the tumor length as measured by PET and DWI scan (P > .05), and there was no significant difference between the longitudinal length of GTV(PET2.5) and GTV(DWI) (P = .072).Conclusion The volumes of GTV(MRI) and GTV(50%) were similar. However, GTV(MRI) has different volumes and poor spatial matching compared with GTV(PET2.5).The MRI imaging could not include entire respiration. It may be a good choice to guide target delineation and construction of esophageal carcinoma by combining 4DCT with MRI imaging. Utilization of DWI in treatment planning for esophageal cancer may provide further information to assist with target delineation. Further studies are needed to determine if this technology will translate into meaningful differences in clinical outcome.