可变形图像配准的CT与MRI对肝癌体积测定的前瞻性比较

Prospective comparison of CT and MRI in delineation of hepatocellular carcinoma using deformable image registration

目的通过比较MRI与CT对肝癌肿瘤的诊断情况,进而进行高精度放疗计划。方法选择2020年7月~2022年7月收治的26例不可切除的肝转移(n=8)、肝细胞癌(n=10)和胆管癌(n=8)患者作为研究对象,患者在放疗计划时进行了具有诊断质量的MRI扫描和三期CT扫描,并确定了肝内解剖参考点。在最能显示肿瘤的CT和MRI系列中,勾画了肝脏和肿瘤体积,确定了肝内解剖参考点。采用形变配准对CT和MRI的肝脏进行配准。结果5例肝癌CT病灶数量与MRI有差异,MRI病灶多3例,CT病灶多2例。肝脏变形配准后,CT肿瘤表面与MRI肿瘤表面平均距离的人群中位数为3.7(2.2~21.3)mm。肿瘤表面积相差5 mm的中位百分比为26%(38%~86%)。转移瘤的中位符合率为81%(77%~86%),肝细胞癌的一致性为78%(44%~86%),胆管癌的一致性为69%(25%~85%)。结论MRI诊断的肝癌肿瘤体积与CT诊断的肝癌肿瘤体积存在显著差异,且在原发性肝癌中更为常见。

Objective To compare MRI and CT in the diagnosis of hepatocellular carcinoma tumors and to conduct high-precision radiotherapy planning.Methods Twenty-six patients with unresectable liver metastases(n=8),hepatocellular carcinoma(n=10)and cholangiocarcinoma(n=8)from July 2020 to July 2022 were selected.All patients underwent MRI and three-phase CT scans of diagnostic quality at the time of radiotherapy planning,and intrahepatic anatomical reference points were identified.In the CT and MRI series that best visualized the tumor,liver and tumor volume were delineated and intrahepatic anatomical reference points were identified.Deformable registration was used to register CT and MRI livers.Results The number of CT lesions was different from that of MRI in 5 cases of liver cancer.MRI lesions were more in 3 cases and CT lesions were more in 2 cases.After liver deformation registration,the average distance between CT tumor surface and MRI tumor surface in the population was 3.7(2.2-21.3)mm.The median percentage of tumor surface area difference of 5 mm was 26%(38%-86%).The median coincidence rate was 81%(77%-86%)for metastases,78%(44%-86%)for hepatocellularcarcinoma,and 69%(25%-85%)for cholangiocarcinoma.Conclusion The tumor volume of hepatocellular carcinoma diagnosed by MRI is significantly different from that diagnosed by CT,and it is more common in primary hepatocellular carcinoma.