CT联合DWI在食管癌靶区勾画中的应用价值

目的探讨X线计算机断层摄影(Computed Tomography,CT)联合磁共振扩散加权成像(diffusion weighted imaging,DWI)在食管癌靶区勾画中的应用价值。方法选取我院2016年1月～2018年12月肿瘤科收治的食管癌并拟行放射治疗患者60例作为研究对象,使用随机数字表法分为CT组及联合组,每组30例。CT组仅使用CT进行靶区勾画,联合组使用CT联合DWI融合图像进行靶区勾画。观察两组影像学检测结果,比较两组患者靶区勾画结果、肺组织放射体积剂量及肺部放射性损伤发生率。结果 CT与DWI融合图像对食管癌病变边界及周围解剖结构显示更为清晰;联合组大体肿瘤靶区(gross target volume,GTV)、临床靶区(clinical target volume,CTV)长度及体积,GTV体积变异系数CV、GTV最大值与最小值比值、不同医生对GTV勾画的最大差值、V5、V20、MLD水平及肺部放射性损伤发生率均显著低于CT组(P0.05)。结论 CT联合DWI能有效提高检测清晰度,降低食管癌靶区勾画体积及长度,提高勾画准确性并可减少肺部健康组织放射剂量,减少食管癌放疗患者肺部放射性损伤的发生,具有临床推广意义。

The value of CT combined with DWI in the delineation of esophageal cancer target area

Objective To investigate the value of computed tomography(CT) combined with diffusion weighted imaging(DWI) in the delineation of esophageal cancer target area.Methods Sixty patients with esophageal cancer admitted to our oncology department who were undergoing radiotherapy from January 2016 to December 2018 in our hospital were enrolled in the study.They were randomly divided into CT group and combined group,with 30 cases in each group.The CT group only used CT to delineate the target area,and the combined group used CT combined with DWI fusion image to delineate the target area.The imaging findings of the two groups were observed.The results of target area delineation,lung tissue radiation volume dose and lung radiation injury rate were compared between the two groups.Results CT and DWI fusion images showed clearer boundaries of esophageal cancer lesions and surrounding anatomical structures,length and volume of gross target volume(GTV),clinical target volume(CTV),GTV volume coefficient of variation CV,GTV maximum and minimum ratio,the maximum difference between different doctors for GTV,V5,V20,MLD level and the incidence of lung radiation injury in the combined group were significantly lower than those of the CT group(P<0.05).Conclusion CT combined with DWI can effectively improve the detection clarity,reduce the volume and length of the esophageal cancer target area,improve the accuracy of delineation and reduce the radiation dose of healthy tissue in the lung,and reduce the occurrence of radioactive injury in the lung of patients with esophageal cancer.It has clinical promotion significance.