DWI-T_2WI图像融合在中央型肺癌伴肺不张放射治疗靶区勾画中的价值

Application of fused DWI-T2WI imaging in target delineation for central-type lung cancer combined with pulmonary atelectasis

目的探讨DWI-T2WI图像融合在中央型肺癌伴肺不张放射治疗靶区勾画中的作用。方法选取2015年5月—2016年10月金华广福医院就诊收治经支气管镜或穿刺活检病理证实中央型肺癌患者共60例,行增强CT及MRI模拟定位,使用Pinnacle^39.6放疗计划系统对T2WI与DWI图像进行融合,勾画大体肿瘤靶区(GTV)进行对比,分析增强CT与DWI-T2WI图像融合图像和边界区分情况,检出淋巴结的结果分析,分析合并肺不张和无合并肺不张患者GTVt差异定量分析,采用配对四格表χ~2检验;GTVt差异影响因素采用Logistic回归分析。结果DWI-T2WI融合图像较增强CT更易区分肺不张和肿瘤的边界,差异具有统计学意义(χ~2=8.47,P<0.05);DWIT2WI融合图像与增强CT均诊断为阳性淋巴结的有32枚,差异无统计学意义(χ~2=0.40,P=0.53);中央型肺癌合并肺不张累计GTV差异较大,差异有统计学意义(t=7.22,P<0.05),差异因素主要与是否合并肺不张(Wald=12.58,P<0.05)、肿瘤病理类型(Wald=5.22,P<0.05)相关。结论 DWI-T2WI图像融合在中央型肺癌伴肺不张放射治疗靶区勾画中能够很好的区分肿瘤边界和肺不张组织。

Objective To explore the values of fused DWI-T2WI imaging in target delineation for central-type lung cancer （CTLC） combined with pulmonary atelectasis. Methods Total 60 cases of central-type lung cancer confirmed by bron- choscopy or biopsy in our hospital from May ,2015 to October,2016 were recruited. CT and MRI images were positioning, and we use TzWI and DWI technology to fusion the images by to by Pinnacle39.6 radiotherapy planning system. We can compared the the tumor target （GTV） , and we analysis the enhanced CT and DWI - T2 WI image fusion images and distin- guished the border,and we check out the lymph node,the result of the analysis with pulmonary merger or no merger with atelectasis, GTVt differences in quantitative analysis, the matching pair four tables X2 test. The GTVt differences influence factors we used logistic regression analysis. Results DWI-T2 WI fusion images were more easily to distinguish the border- line between pulmonary atelectasis and tumor differentiated as compared with contrast-enhanced CT （ X2 = 8.47, P 〈 0.05） ;Both DWI-T2 WI fusion images and enhanced CT showed positive lymph nodes in 32 cases,the difference was not statistically significant（ x2 = 0.40 ,P = 0.53 ）. The cumulative GTV of central-type lung cancer combined with pulmonary atelectasis differed greatly, the difference was significant（ t = 7.22, P 〈 0.05 ）, the factors including the combining atelec- tasis（Wald=12.58,P〈0.05） and tumor pathologic type（Wald=5.22,P〈0. 05）. Conclusion DWI-T2WI image fu- sion can differentiate pulmonary atelectasis from tumor boundary in target delineation for central-type lung cancer com- bined with pulmonary atelectasis during the radiotherapy.