基于病理标本探索MRI T_(2)WI-TSE-BLADE序列精确勾画食管癌大体体积的价值

Value of MRI T_(2)WI-TSE-BLADE sequence in accurately delineating the gross tumor volume of esophageal carcinoma based on pathological specimens

目的通过MRI的T_(2)WI-TSE-BLADE序列上测得食管癌肿瘤长度与手术病理标本长度相关性与一致性,探讨BLADE序列在确定食管癌放疗靶区范围的价值。方法收集郑州大学附属肿瘤医院2016—2019年间经病理学证实为食管鳞癌并行术前食管MRI检查的36例初治患者资料。将CT、DWI序列、BLADE序列图像导入Monaco系统,比较3种影像学基础上测量的肿瘤长度与病理长度间的相关性及一致性。采用ANOVA分析不同医师在不同影像学图像上勾画的大体肿瘤体积(GTV)的差异性。结果基于CT、DWI、BLADE序列测量肿瘤长度与病理标本长度的R值分别为0.467、0.723、0.896。一致性分析显示BLADE序列与病理标本长度所有差值全部落在95%界限内。BLADE序列与实际肿瘤长度的一致性及相关性均优于DWI序列及CT(P<0.05)。4位医师使用DWI、BLADE图像得出的体积均小于CT图像(P<0.05)。不同医师在3种影像学图像上勾画的GTV相近(P>0.05),但4位医师在BLADE序列上勾画的GTV更接近(P>0.05)。结论BLADE序列有助于临床医师更加准确地判断食管癌上下界以及减少不同医师之间勾画GTV差异,有效地提高个体对靶区勾画范围认识的统一性。BLADE序列可能作为放疗精准靶区勾画的重要影像工具。

Objective To explore the value of BLADE sequence in determining the target range of esophageal cancer radiotherapy through the correlation and consistency between measured esophageal cancer length on the MRI-BLADE sequence and the surgical pathological specimens.Methods Clinical data of 36 patients who were pathologically diagnosed with esophageal carcinoma and received preoperative esophageal MRI in the Affiliated Cancer Hospital of Zhengzhou University between January 2016 to June 2019 were collected.The CT,DWI and BLADE sequence images of all participants were collected and imported into the Monaco system,by which the correlation and consistency between the tumor length measured based on these three imaging methods were statistically compared.Furthermore,the differences in gross tumor volume(GTV)delineated by different physicians in different images were compared.Results The correlation coefficients of the tumor length measured by CT,DWI and BLADE and pathological specimen length were 0.467,0.723 and 0.896,respectively.The consistency analysis indicated that all the differences between the BLADE sequence and pathological specimen length were within the 95%consistency limit.The consistency and correlation between the BLADE sequence and actual tumor length were significantly better than those between the DWI sequence and CT images(both P<0.05).The volume of DWI and BLADE images obtained by four physicians was significantly smaller than that of CT images(both P<0.05).The differences in GTV delineated by different physicians by these three imaging methods were insignificant(all P>0.05),but the GTV delineated by the four physicians on the BLADE sequence were more similar(all P>0.05).Conclusions BLADE sequence can help physicians to determine the upper and lower boundaries of esophageal tumors more accurately and reduce the differences in GTV delineation among different physicians.And it can effectively improve the unity of individual′s understanding of the scope of target area delineation,and improve the objectivity of clinicians′judgment of GTV.BLADE sequence can be used as an important imaging tool for accurate target delineation in radiotherapy.