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

doi:10.3969/j.issn.1006-5725.2025.07.017

Abstract

Abstract:

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.

Key words: stereotactic body radiotherapy, 4-dimensional computed tomography, deep inspiratory breath hold, magnetic resonance imaging, radiotherapy treatment accuracy

CLC Number:

R735.7

Huiling YE,Zhengchaoyi CHEN,Yihan HUANG,Yingjie ZHANG,Xiangbin ZHANG,Yuehu PU,Renming ZHONG. Radiotherapy treatment comparison of liver SBRT between 4D⁃CT and deep inspiration breath hold troughmagnetic resonance imaging[J]. The Journal of Practical Medicine, 2025, 41(7): 1044-1049.

Figures/Tables 4

Tab.1

Fig.1

Tab.2

Fig.2

References 27

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项目	DIBH组（n = 11）	4D-CT组（n = 17）	t值	P值
年龄（x ± s）/岁	49.7± 18.1	53.2 ± 7.7	1.176	0.260
原发性肝癌			-	1.000^*
肝细胞癌	11（100.0）	16（94.1）
肝内胆管细胞癌	0（0.0）	1（5.9）
分期（巴塞罗那）			-	0.251^*
0/A/B	8（72.7）	8（47.1）
C	3（27.3）	9（52.9）
HBV（+/-）			-	1.000^*
+	10（90.9）	16（94.1）
-	1（9.1）	1（5.9）
TACE（+/-）			-	0.064^*
+	9（81.8）	8（47.1）
-	2（18.2）	9（52.9）
MRI 间隔（x ± s）/周	20.1 ± 9.7	23.4 ± 12.5	-3.806	0.010

因素	DIBH（n = 11）	4D-CT（n = 17）	t/Z值	P值
肝脏体积［M（P₂₅，P₇₅ ）］/cc	1 195.2（1 000.1，1 338.7）	1 236.5（1 105.0，1 440.0）	114.000	0.611
肝体积变化［M（P₂₅，P₇₅ ）］/ cc	-27.7（-76.8，17.5）	-1.4（-30.5，66.5）	126.000	0.298
MMA 体积［M（P₂₅，P₇₅ ）］/cc	112.7（29.4，202.5）	131.4（44.4，340.0）	117.000	0.527
剂量线体积［M（P₂₅，P₇₅ ）］/cc	138.3（65.0，205.5）	154.7（104.4，377.1）	121.000	0.413
剂量线［M（P₂₅，P₇₅ ）］/Gy	29.3（24.4，34.5）	33.5（26.5，38.3）	117.000	0.527
DSC［M（P₂₅，P₇₅ ）］	0.68（0.61，0.77）	0.71（0.64，0.78）	114.000	0.616
CIMI（x ± s）	0.47 ± 0.20	0.50 ± 0.12	0.562	0.582
HD［M（P₂₅，P₇₅ ）］/mm	23.49（13.96，32.21）	26.62（19.98，29.99）	112.000	0.679
MDA（x ± s）/mm	4.85 ± 2.92	4.90 ± 1.80	0.061	0.952
3D-CoMD（x ± s）/mm	9.94 ± 6.75	8.92 ± 4.48	-0.491	0.628
呼吸幅度（x ± s）/mm	-	14.17 ± 3.48	-	-
呼吸周期［M（P₂₅，P₇₅ ）］/s	-	6.2（6.1，6.3）	-	-

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Radiotherapy treatment comparison of liver SBRT between 4D⁃CT and deep inspiration breath hold troughmagnetic resonance imaging

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