肺灌注显像在保护非小细胞肺癌患者功能肺中的研究

The application of lung perfusion imaging in radiotherapy of patients with non-small-cell lung cancer

目的应用单光子发射计算机体层扫描仪（SPECT）行肺灌注扫描显像，区分有功能肺及无功能肺。比较解剖图像及功能图像引导放疗计划的区别，探讨通过SPECT肺灌注显像指导调强放疗计划对非小细胞肺癌（NSCI。c）患者肺功能的保护价值。方法收集济南军区总院放疗科肺癌患者36例，男26例，女10例，年龄平均62岁。经病理证实的Ⅰ～Ⅲ期NSCI。C患者，放疗前行肺功能检查，并将肺灌注图像传至放疗计划系统进行图像融合制定两套放疗计划（planl和plan2），planl没有考虑SPECT肺灌注图像仅根据解剖信息进行设计，plan2考虑SPECT肺灌注图像提供的肺功能信息进行优化，尽可能降低正常肺组织的照射剂量，观察plan2与planl在保护功能肺方面的差别。结果36例IⅢ期非小细胞肺癌患者的调强放疗（IMRT）放疗计划优化后fV。fV20、fV30、MI。D及PTV90／fV2。有显著性下降（t一8．75，6．13，11．57，11．93，～9．61，均P=0．000），fV20、fMLD分别减少了（4．9±2．0）％，（1．7±0．9）％。结论核素肺灌注显像可有效评价放疗前肿瘤对局部肺动脉血流灌注功能的影响及减少肺癌患者放射治疗后正常肺组织的受照射剂量。

Objective To observe the changes of lung function before and after radiotherapy with the lung perfusion of single photon emission computed tomography and compare the difference between radiotherapy plans conducted by functional imagines and anatomical imagines in radiotherapy of patients with non-small-cell lung cancer. Methods A total of 36 patients （26 males and 10 females, aged 36 80 years） with lung cancer diagnosed as stage I to stage [[[ non-small cell lung cancer confirmed by histological proof were selected. The lung perfusion image was delivered to radiotherapy planning system and the two plan （planl and plan 2） were made by lung perfusion image fusion. Plan 1 was only based on the anatomical informations and no lung perfusion images of SPECT considering. Plan 2 was optimized based on the lung perfusion image to reduce the irradiation dose of the normal tissues. The differences of protecting lung function between plan ] and plan 2 were compared. Results 36 patients were stratified for clinical stage. FV,0, fV20, fV^0, MI.D and PTV^0 fig〉 were decreased significantly after optimized with IMRT （all P = 0. 000）. FV^0, fMI.D were decreased by （4.89＋2.0）~, （1.74~0.9）~. The 1MRT plan based on the lung perfusion fusion images of SPECT could reduce the irradiation dose of normal lung tissues and the incidence of radiation pneumonitis. Conclusions Radionuclide puhnonary perfusion imaging can assess effectively the effect of tumor to regional pulmonary artery perfusion function before radiotherapy and reduce the irradiation dose of normal lung tissue in lung cancer patients undergoing IMRT.