定量CT评价三维适形放疗后肺功能影响的研究

Quantitative CT Assessment of Pulmonary Function Injury After Three-Dimensional Conformal Radiation Therapy

目的探讨CT肺功能定量指标分析对三维适形放疗(3DCRT)放射性肺损伤的早期诊断价值。方法搜集本院2008年1月至2011年12月经病理确诊为肺癌后行3DCRT的52例患者临床随访资料。调取每位患者3DCRT之前与之后第1、3、6、9、12个月影像随访资料,由3位高级职称医师对肺部影像表现作出评价,并对发现的放射性肺损伤进行分级,同时利用西门子工作站Pulmo软件进行CT肺功能定量分析,观察相关CT定量指标变化。应用SPSS 13.0统计软件对数据进行统计学分析。结果 3DCRT后第1个月CT肺功能定量分析发现:"PI-900/-801"值较放疗前降低(t=1.710,P<0.05),有42例减低,10例稍增高;"PI-800/-701"、"双侧肺的肺平均密度(MLD)"等数值较放疗前均无明显变化(t=1.315,P>0.05);而通过肺部CT影像形态学改变有22例。3DCRT后第3个月CT肺部定量分析示,"PI-900/-801"值52例均出现明显降低(t=2.573,P<0.01),患侧肺"PI-800/-701"及"MLD"明显增高(t=2.611;t=2.607,P<0.01),差异有统计学意义;经肺部CT影像形态学观察所照射肺野透亮度均有不同程度增高。结论利用定量CT肺功能"PI-900/-801"指标能够发现3DCRT后第1个月复查肺部影像形态学结果为阴性的肺部放射性轻微损伤,其对临床提前干预放射性肺损伤具有一定的参考价值。

Objective To study the value of quantitative CT in early diagnosing pulmonary function injury after three dimensional eonformal radiation （3DCRT） therapy. Methods 52 patients with lung cancer underwent 3DCRT treatment from January 2008 to December 2011 were collected. Imaging data of each patient obtained before 3DCRT treatment and at the 1 st,3rd, 6th , 9th and 12th month after treatment were retrospectively analyed by three senior radiologists to evaluate the radiation induced lung injury. At the same time, pulmonary function were calculated by Siemens pulmo software. Re- suits At the 1st month after 3DCRT, PI-900/-801 values were decreased in 42 cases on quantitative CT, while the value of PI-800/-701 and MLD of both lungs did not change compared with that before 3DCRT. At that time, CT images showed mor-phological changes in 22 cases. At the 3rd month after 3DCRT,on quantitative CT, PI-900/-801 values decreased in 52 pa-tients ,PI-800/-701 value and the average lung density （MLD） was significantly increased. Conclusion The quantitave val-ue of PI-900/-801 can indicate the early pulmonary function injury due to 3DCRT, which is help for early clinical interven-tion.