本文選題：磁共振成像 + 部分乳腺外照射��； 參考：《濟南大學》2017年碩士論文

【摘要】：目的探討保乳患者術(shù)前MRI腫瘤體積與術(shù)后標本測量體積及基于金屬夾勾畫的瘤床體積之間的差異性與相關(guān)性,同時探討基于4DCT的0時相(CT0)與50時相(CT50)剛性配準與形變配準基礎(chǔ)上所構(gòu)建保乳術(shù)后瘤床體積及位置的差異性。方法1.50例早期乳腺癌患者入組,基于保乳術(shù)前MRI勾畫大體腫瘤體積(gross tumor volume,GTV)并定義為GTVMRI,其邊界外擴1.0 cm得到GTVMRI+1。測量切除標本體積并測量和計算病理體積,分別定義為GTVES和GTVPAT。在定位CT圖像上基于術(shù)腔邊界金屬夾勾畫GTV,并定義為GTVTB。2.44例保乳術(shù)后已行4DCT模擬定位掃描的患者入組。由同一位放療科醫(yī)生分別基于4DCT的0時相和50時相勾畫GTV及選定金屬夾。將CT0與CT50分別運行剛性配準(rigid image registration,RIR)與形變配準(deformable image registration,DIR),并將基于CT0圖像勾畫的GTV及金屬夾分別通過形變配準與剛性配準映射到CT50圖像上。以相似度指數(shù)(Dice similarity coefficient,DSC)、三維空間方向上靶區(qū)中心點位移的差異評估不同圖像配準技術(shù)對CT0與CT50圖像之間靶區(qū)體積及位置的差異。結(jié)果1.GTVMRI、GTVMRI+1、GTVPAT、GTVES、GTVTB中位數(shù)(范圍)分別為0.97(0.01~6.88)cm3、12.58(3.90~34.13)cm3、0.97(0.01~2.36)cm3、15.46(1.15~70.69)cm3、19.24(4.72~54.33)cm3。GTVMRI與GTVPAT、GTVMRI+1與GTVES、GTVTB與GTVES差異均無統(tǒng)計學意義(P=0.188,0.07,0.264)。GTVTB、GTVES與GTVMRI均無相關(guān)性(P=0.378,0.071),GTVTB、GTVES與GTVMRI+1也均無相關(guān)性(P=0.375,0.068),而GTVTB與GTVES呈正相關(guān)(r=0.488,P=0.004)。2.RIR與DIR靶區(qū)的平均DSC分別為0.860±0.042與0.870±0.040(P=0.000)。RIR在三維空間方向上靶區(qū)中心點的位移明顯大于DIR(分別為1.22 mm和1.10 mm,P=0.000)。而且在前后方向上,GTV及金屬夾通過RIR的位移明顯大于DIR(P=0.000)。但是,在左右及上下方向上,RIR與DIR對GTV及金屬夾位移的差異均沒有統(tǒng)計學意義(均P0.050)。結(jié)論在非影像引導(dǎo)情況下,保乳治療的患者基于觸診范圍行局部腫瘤擴大切除術(shù)時,切除標本體積及基于金屬夾勾畫的術(shù)腔體積與基于術(shù)前MRI圖像所勾畫與構(gòu)建的腫瘤體積均無相關(guān)性。形變配準可以顯著改善4DCT的0時相與50時相配準時靶區(qū)的重合度。同時,基于形變配準測量呼吸運動所致的靶區(qū)及選定金屬夾在前后方向上的位移明顯優(yōu)于剛性配準。
[Abstract]:Objective to investigate the difference and correlation between preoperative MRI tumor volume and postoperative measurement volume and tumor bed volume based on metal clip in breast conserving patients. At the same time, the difference of volume and location of tumor bed after breast conserving operation was discussed on the basis of rigid registration and deformation registration based on 0time phase CT0 (4DCT) and CT50 (50time phase). Methods 1.Fifty patients with early breast cancer were enrolled in the study. Gross tumor volume was defined as GTV MRI based on the gross tumor volume before breast conserving. The volume of excision specimen was measured and the pathological volume was measured and calculated, which were defined as GTVES and GTVPATrespectively. GTV was delineated on the localization CT image based on the metal clip of the surgical cavity boundary, and was defined as GTVTB.2.44 patients who had undergone 4DCT analog localization scanning after breast conserving surgery were included in the group. The GTV and the selected metal clip were delineated by the same radiotherapy doctor based on the 4 DCT 0 and 50 time phases, respectively. The rigid image registration and deformable image registration based on CT0 and CT50 are respectively applied to CT50 images, and the GTVs and metal clips based on CT0 images are mapped to CT50 images by deformation registration and rigid registration respectively. The difference of the center displacement of target in 3D direction is evaluated by using the similarity index (Dice similarity efficient) and the difference of target volume and position between CT0 and CT50 images by different image registration techniques. 緇撴灉1.GTVMRI,GTVMRI 1,GTVPAT,GTVES,GTVTB涓綅鏁，

本文編號：2014711