| 王利宁,李建彬,徐敏,张英杰,马志芳,黄勇,李奉祥,王玮,王素贞.勾画者及勾画标准对基于4D-CT周围型肺癌靶区勾画的影响[J].中华放射医学与防护杂志,2012,32(5):494-497 |
| 勾画者及勾画标准对基于4D-CT周围型肺癌靶区勾画的影响 |
| Impact of delineator and delineating criteria on the target delineation of the peripheral lung cancer based on four-dimensional computed tomography |
| 投稿时间：2012-01-21 |
| DOI：10.3760/cma.j.issn.0254-5098.2012.05.011 |
| 中文关键词: 周围型肺癌 靶区勾画标准 四维CT |
| 英文关键词:Peripheral lung cancer Target delineation criteria Four-dimensional computed tomography |
| 基金项目:山东省科技发展计划项目(2012GSF11839);山东省自然科学基金项目(ZR2011HM004) |
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| 中文摘要: |
| 目的 探讨勾画者及勾画标准对基于4D-CT周围型肺癌原发肿瘤靶区勾画的影响。方法 选择12例行4D-CT模拟定位扫描的周围型肺癌患者,在勾画标准制定前后,6名放疗医生分别在4D-CT的吸气末时相(0%)、呼气末时相(50%)和3D-CT图像上勾画大体肿瘤体积GTV0、GTV50和GTV3D,GTV0和GTV50分别融合得到勾画标准制定前后的内大体肿瘤体积IGTVIN+EX,在4D-CT的最大密度投影(MIP)图像上勾画内大体肿瘤体积IGTVMIP。对勾画标准制定前后同一勾画者及勾画者之间靶区勾画进行比较。结果 勾画标准制定前后,6位勾画者所勾画的GTV0、GTV50、GTV3D、IGTVMIP及融合靶区IGTVIN+EX的平均变异系数为0.50±0.25和0.24±0.10,0.52±0.38和0.26±0.12,0.45±0.19和0.20±0.07, 0.54±0.27和0.23±0.09,0.44±0.23和0.26±0.09,两两间差异有统计学意义(t=3.38、2.44、3.60、4.20、3.11,P<0.05);勾画标准制定前及后6位不同勾画者所勾画GTV0、GTV50、GTV3D、IGTVMIP中同一靶区体积间差异无统计学意义;勾画者3、6在标准制定前后所勾画GTV0、GTV50及IGTVIN+EX差异有统计学意义(t=2.46、2.91、3.28,P<0.05;t=2.40、2.79、3.22,P<0.05),勾画者4所勾画GTV0、GTV50、IGTVIN+EX、IGTVMIP、GTV3D前后差异有统计学意义(t=2.70、3.21、3.04、3.99、3.00,P<0.05)。结论 无论基于3D-CT还是4D-CT图像勾画周围型肺癌GTV或基于4D-CT勾画其IGTVMIP,就勾画者群体而言,统一的勾画标准指导可减少勾画者间的差异,但对勾画者个体而言,统一的勾画标准对其勾画某一特定靶区的影响不一。 |
| 英文摘要: |
| Objective To investigate the impact of delineator and delineating criteria on the target delineation of the peripheral lung cancer based on four-dimensional computed tomography (4D-CT).Methods The 4D simulation CT images of twelve patients with peripheral lung cancer were selected. Before and after the establishment of the target delineation criteria, six radiation oncologists were asked to delineate the targets based on 4D-CT images at the end-inhalation phase (0%), end-exhalation phase (50%), and three-dimensional computed tomography (3D-CT) images respectively. The delineated targets were denominated as GTV0, GTV50, GTV3D. IGTVIN+EX was created by combining GTV0 and GTV50. IGTVMIP was delineated based on the maximum intensity projection (MIP) of 4D-CT. The inter- and intra-observer variability before and after the establishment of the delineation criteria was compared. Results The mean coefficients of variation of GTV0,GTV50,GTV3D,IGTVMIP and IGTVIN+EX delineated by the six delineators before and after the establishment of the delineation criteria were 0.50±0.25 vs 0.24±0.10, 0.52±0.38 vs 0.26±0.12, 0.45±0.19 vs0.20±0.07, 0.54±0.27 vs 0.23±0.09 and 0.44±0.23 vs 0.26±0.09, respectively. The differences were statistically significant(t=3.38,2.44,3.60,4.20,3.11,P<0.05). No statistically significant difference was found in the volume of the same target for GTV0, GTV50, GTV3D, IGTVMIP and IGTVIN+EX delineated by the six oncologists before and after the establishment of the delineation criteria. For delineator 3 and 6, the differences of GTV0, GTV50,IGTVIN+EX before and after establishment of the delineation criteria were statistically significant(t=2.46,2.91,3.28,P<0.05;t=2.40,2.79,3.22,P<0.05).For delineator 4, the differences of GTV0, GTV50,IGTVIN+EX, IGTVMIP,GTV3Dbefore and after establishment of the delineation criteria were statistically significant(t=2.70,3.21,3.04,3.99,3.00,P<0.05).Conclusions The unified delineation criteria can significantly reduce the inter-observer variability in delineating the GTVs based on 3D-CT or 4D-CT images, and in delineating the IGTVMIP based on 4D-CT images of peripheral lung cancer patients. However, regarding the same delineator, various influences of the unified delineation criteria on the target delineation are observed. |
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