基于ADC的融合图像在晚期宫颈癌放疗前中期的靶区勾画

APPLICATION OF CT/MR IMAGE FUSION BASED ON ADC MAP IN TARGET DELINEATION FOR CERVICAL CANCER AT PRE-AND MID-RADIOTHERAPY

目的探讨CT/WAVE/ADC融合图像在局部晚期宫颈癌放疗前和放疗中期勾画靶区(GTV)的变化意义。方法 12例晚期宫颈癌患者分别在放疗前和放疗中期(约15d)行CT、MRI异机非同步扫描。CT和MRI图像手工配准后传送至飞利浦公司PINNACLE V8.0放射治疗计划系统,并分别进行图像融合。由有经验的放疗计划物理师对患者放疗前和中期融合图像的肿瘤靶区(GTV)按最大径、ADC值低密区和ADC值高密区进行勾画及评价分析。结果放疗中期与前期相比,GTVFUSION-b产生明显缩小的0例;有所缩小的0例;无明显变化的12例。GTVHIGHT-b明显增大的4例;相对增大的7例;变化不大的1例(P<0.01)。结论融合了ADC图的CT/MRI图像融合技术对肿瘤生物靶区的勾画成为可能,有利于晚期宫颈癌放疗靶区的确定,提高了临床对晚期宫颈癌靶区(GTV)勾画的准确性和放疗剂量的有效分布,值得进一步研究。

Objective To discuss the significance of CT/WAVE/ADC image fusion in delineation of the target volumes for cervical cancer at pre-and mid-radiotherapy.Methods At pre-and mid-radiotherapy,twelve patients suffering from cervical cancer received CT scans and MRI scans.All of the CT and MRI images were registered manually and transported to the radiation treatment planning（RTP）system,Pinnacle（3）v8.0（Phillips Healthcare）,then the CT and MRI images were performed image fusion respectively.The tumor volumes of fusion images were delineated and analyzed based on the maximum diameter,the region of lower and higher ADC values by the experienced radiotherapy physicist.Results Comparing the volume of GTVFUSION-bbetween the pre-and mid-radiotherapy,non-case reduced significantly;non-cases reduced slightly;12 cases had no apparent change.Moreover,four cases increased significantly;seven cases increased relatively;one case had a little change（P0.01）.Conclusion The technology of CT-MR image fusion based on ADC map enables the delineation of tumor biological target,and it is useful to confirm the target volume for cervical cancer.The technology will improves the accuracy of target volume delineation,and promotes the distribution of radiation dose.