收稿日期: 2024-12-20
网络出版日期: 2025-04-23
基金资助
国家自然科学基金项目(12405390);四川省科技计划项目(24ZDYF1028)
Radiotherapy treatment comparison of liver SBRT between 4D⁃CT and deep inspiration breath hold troughmagnetic resonance imaging
Received date: 2024-12-20
Online published: 2025-04-23
目的 探讨深吸气屏气（DIBH）技术和四维CT（4D-CT）技术下肝癌SBRT后的放射治疗精度差异，并分析其相关因素。 方法 回顾性分析2020年11月至2024年7月接受肝癌SBRT治疗的28例患者，患者均出现磁共振影像（MRI）上的局部形态学变化。其中，DIBH组11例，4D-CT组17例。在放疗后MRI上勾画局部放疗改变的区域（MMA），在定位CT生成若干剂量线。进行基于肝脏感兴趣区的形变配准后，选择最适形剂量线和MMA进行轮廓比较，从而得到了量化的精度指标。进一步分析了GTV、PTV、肝脏体积，体积变化等因素和精度指标的相关关系。 结果 DIBH组的DSC精度是0.32 ~ 0.90，平均（0.66 ± 0.17），4D-CT组的DSC精度是0.49 ~ 0.80，平均（0.69 ± 0.10）。DIBH和4D-CT组的各精度指标上差异无统计学意义（P > 0.05）。在相关性分析中，DIBH组和4D-CT组的距离指标（HD、MDA、3D-CoMD）比适形指数（DSC、CIMI）表现更显著的相关。 结论 DIBH和4D-CT的精度无显著差异，但DIBH的最高精度高于4D-CT。DIBH可作为评价肝脏SBRT放疗精度的有效工具。建议采用此种方法评估肝癌SBRT的治疗精度时，优先选择适形指标DSC和CIMI。
关键词： 立体定向体部放射治疗; 四维CT; 深吸气屏气; 磁共振影像; 放疗精度
叶惠玲 , 陈郑超逸 , 黄奕涵 , 张英杰 , 张祥斌 , 蒲越虎 , 钟仁明 . 磁共振影像评估四维CT和深吸气屏气技术下肝癌SBRT实施精度的差异[J]. 实用医学杂志, 2025 , 41(7) : 1044 -1049 . DOI: 10.3969/j.issn.1006-5725.2025.07.017
Objective To compare the radiotherapy treatment accuracy between 4D-CT and DIBH following liver SBRT， and to illustrate the relevant factors. Methods A retrospective analysis was conducted on the clinical data of 28 liver cancer patients who underwent SBRT from November 2020 to July 2024， all of whom exhibited and localizedmorphological changes on magnetic resonance imaging （MRI）. Among them， 8 patients used DIBH， and 17 patients used 4D- CT. The areas of localized MRI-morphologic alterations （MMA） were delineated on post-therapeutic MRI. Different isodose structures were generated on the planning CT， and after performing deformation registration based on the liver's region of interest （ROI）， the most suitable isodose structure and MMA contours were compared to obtain quantitative accuracy indices. Correlations between factors such as GTV， PTV， liver volume， and volume changes， and the accuracy indices were analyzed. Results The DSC accuracy for the DIBH group was （0.66 ± 0.17）， range 0.32 ~ 0.90， while the DSC accuracy for the 4D CT group was （0.69 ± 0.10）， range 0.49 ~ 0.80. T-test analysis showed no significant statistical differences in accuracy indices between the DIBH and 4D CT groups （P < 0.05）. Correlation analysis revealed that， in both groups， distance-based indices （HD， MDA， 3D-CoMD） were more strongly correlated with accuracy indices than conformality indices （DSC， CIMI）. Conclusion There was no significant difference in treatment accuracy between the DIBH and 4D-CT groups， although the maximum accuracy in the DIBH group was higher than that in the 4D-CT group. This method can serve as an bench-markingtool for evaluating the accuracy of liver SBRT.It is recommended to prioritize the use of conformality indices， DSC and CIMI， when assessing the treatment accuracy of liver cancer SBRT using this approach.
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