DWI联合T2WI检查对COPD合并中央型肺癌患者靶区勾画的临床研究

Application of DWI combined with T2WI in target delineation of COPD patients with central lung cancer

目的:探讨扩散加权成像(Diffusion weighted imaging,DWI)联合压脂T2WI检查在慢性阻塞性肺病(Chronic obstructive pulmonary disease,COPD)合并中央型肺癌患者靶区勾画的临床运用。方法:回顾性分析2017年1月—2019年1月我院收治的72例经支气管镜检查或病理检查确诊的COPD合并中央型肺癌患者临床病例资料,所有患者均经增强CT及DWIT2WI模拟定位,比较边界分区情况、淋巴结检出结果、大体肿瘤体积(GTV)、临床靶区体积(CTV)。结果:增强CT能区分边界52例,不能区分边界20例;DWI联合T2WI成像能区分边界66例,不能区分边界6例,两种方法比较有明显差异(P<0.05);增强CT检出淋巴结104个,其中恶性81个,良性23个,DWI联合T2WI检出淋巴结134个,恶性89个,良性45个,两者在淋巴结定性上比较无明显差异(P>0.05);增强CT检查影像中CTV、GTV值均显著高于DWI联合T2WI检查(P<0.05)。结论:DWI联合T2WI成像在COPD合并中央型肺癌患者靶区勾画中能较好区分癌灶与肺部组织,淋巴结检出率较高,提高了靶区定位精确性,降低了正常肺组织受辐射风险,提高了放疗效率以及安全性。

Objective:To investigate the clinical application of diffusion weighted imaging(DWI)combined with T2WI in the target delineation of chronic obstructive pulmonary disease(COPD)patients with central lung cancer.Methods:The clinical data of 72 COPD patients with central lung cancer in our hospital from January 2017 to January 2019 were analyzed retrospectively.All patients underwent enhanced CT and DWI-T2WI fused images.Then the border differentiation,lymph node detection results,gross tumor volume(GTV),and clinical target volume(CTV)were recorded and compared.Results:The boundary could be distinguished in 52 cases and could not be distinguished in 20 cases according to the contrast-enhanced CT,while DWI combined with T2WI could distinguish the boundary in 66 cases,but not in 6 cases,with statistic difference between two methods(P<0.05).One hundred and four lymph nodes were detected by enhanced CT,among which 81 were malignant nodes and 23 were benign nodes.One hundred and thirty-four lymph nodes were detected by DWI combined with T2WI,89 were malignant nodes and 45 were benign nodes,with no statistic difference in the lymph node detection(P>0.05).CTV and GTV in enhanced CT were significantly higher than those in MRI(P<0.05).Conclusion:DWI combined with T2WI imaging has better target delineation and high lymph node detection rate for COPD patients with central type lung cancer,which can improve the accuracy of target location,reduce the radiation risk of normal lung tissue,and improve the efficiency and safety of radiotherapy.