多模态MR对脑胶质瘤术后放疗靶区勾画的一致性分析
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摘要
目的探讨使用不同模态MR成像进行脑胶质瘤放疗靶区勾画的一致性。方法对33例胶质瘤术后放疗患者进行回顾性分析,分别在T2WI、FLAIR以及DWI模态上手动勾画肿瘤靶区,通过面积求和法计算临床靶体积(Clinical Target Volume,CTV)。以随机区组方差分析法比较3组MR模态下CTV的差异;以Bland-Atlman法评估3组MR模态下勾画胶质瘤CTV的95%一致性界限(95%Limits of Agreement, 95%LoA)。结果 T2WI、FLAIR以及DWI不同模态下的CTV无统计学差异(F=0.088,P=0.916)。Bland-Atlman法结果表明:T2WI组与FLAIR组、DWI组比较的95%Lo A分别为-78.3～98.4 mm~3、-91.2～114.1 mm~3;FLAIR组与DWI组的95%Lo A为-101.3～98.4 mm~3;均存在6.06%(2/33)的点位于95%Lo A以外,超出临床可接受范围。结论不同模态MR图像测量胶质瘤术后放疗CTV一致性欠佳,尚不能相互取代,临床应用时应注意不同模态的联合分析。
Objective To explore the consistency of different modality MR imaging in target delineation of brain glioma radiotherapy.Methods A total of 33 patients with postoperative radiotherapy for glioma were retrospectively analyzed. Tumor target areas were manually delineated on T2 WI, FLAIR and DWI modes, respectively. Clinical Target Volume(CTV) was calculated by area summation method.The differences of CTV among the 3 groups using different MR mode were compared by randomized blocks analysis of variance. The 95% limits of agreement(95%LoA) of CTV between the 3 groups were assessed by Bland-Atlman method. Results There was no significant difference in CTV among different modes of T2 WI, FLAIR and DWI(F=0.088,P=0.916).The 95% LoA of T2 WI and FLAIR, T2 WI and DWI, FLAIR and DWI were(-78.3-98.4)mm~3,(-91.2-114.1)mm~3 and(-101.3-98.4)mm~3, respectively.There were 6.06%(2/33) points outside 95%LoA, beyond the clinically acceptable range. Conclusion The consistency of CTV measurment using different modality MR images for gliomas postoperative radiotherapy is not good and can not be replaced by each other. Clinical application should pay more attention to the joint analysis of different modes.
Objective To explore the consistency of different modality MR imaging in target delineation of brain glioma radiotherapy.Methods A total of 33 patients with postoperative radiotherapy for glioma were retrospectively analyzed. Tumor target areas were manually delineated on T2 WI, FLAIR and DWI modes, respectively. Clinical Target Volume(CTV) was calculated by area summation method.The differences of CTV among the 3 groups using different MR mode were compared by randomized blocks analysis of variance. The 95% limits of agreement(95%LoA) of CTV between the 3 groups were assessed by Bland-Atlman method. Results There was no significant difference in CTV among different modes of T2 WI, FLAIR and DWI(F=0.088,P=0.916).The 95% LoA of T2 WI and FLAIR, T2 WI and DWI, FLAIR and DWI were(-78.3-98.4)mm~3,(-91.2-114.1)mm~3 and(-101.3-98.4)mm~3, respectively.There were 6.06%(2/33) points outside 95%LoA, beyond the clinically acceptable range. Conclusion The consistency of CTV measurment using different modality MR images for gliomas postoperative radiotherapy is not good and can not be replaced by each other. Clinical application should pay more attention to the joint analysis of different modes.
引文
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[14]萨建,刘桂芬.定量测量结果的一致性评价及Bland-Altman法的应用[J].中国卫生统计,2011,28(4):409-411.
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[17]朱向帜,康铮,何侠.磁共振弥散加权成像对鼻咽癌靶区勾画和复发转移预测的临床价值研究[J].中华放射肿瘤学杂志,2012,21(2):105-107.C
[2]Chinot OL,Wick W,Mason W,et al.Bevacizumab plus radiotherapy-temozolomide for newly diagnosed glioblastoma[J].N Engl J Med,2014,370(8):709-722.
[3]黄蓉,吴慧,卢晓旭,等.CT-MRI图像融合在脑胶质瘤术后精确放疗中的应用分析[J].中华放射肿瘤学杂志,2017,26(2):192-196.
[4]袁峰,林志仁,羊华高,等.不同靶区确定法放射治疗脑胶质瘤的临床研究[J].中华肿瘤防治杂志,2010,17(5):384-387.
[5]黎珊,张纬建,蔡传书,等.基于磁共振指导靶区勾画的高级别胶质瘤术后调强放射治疗的疗效分析[J].中华放射医学与防护杂志,2017,37(10):767-770.
[6]刁焕荣,孙成英,刘丹,等.不同MRI成像序列用于恶性胶质瘤靶区勾画的比较[J].实用肿瘤杂志,2013,28(1):79-81.
[7]Law M,Yang S,Wang H,et al.Glioma grading:sensitivity,specificity,and predictive values of perfusion MR imaging and proton MR spectroscopic imaging compared with conventional MR imaging[J].AJNR Am J Neuroradiol,2003,24(10):1989-1998.
[8]杜伟,陈义兵,魏新亭.2016版《WHO中枢神经系统肿瘤分类》更新解读[J].中华神经外科杂志,2016,32(11):1095-1098.
[9]Fiorentino A,Caivano R,Pedicini P,et al.Clinical target volume definition for glioblastoma radiotherapy planning:magnetic resonance imaging and computed tomography[J].Clin Transl Oncol,2013,15(9):754-758.
[10]Minniti G,Amelio D,Amichetti M,et al.Patterns of failure and comparison of different target volume delineations in patients with glioblastoma treated with conformal radiotherapy plus concomitant and adjuvant temozolomide[J].Radiother Oncol,2010,97(3):377-381.
[11]Lotar Cordova A Jr,Almeida TVR,Silva CMD,et al.Evaluation of high-grade astrocytoma recurrence patterns after radiotherapy in the era of temozolomide:a single institution experience[J].Rep Pract Oncol Radiother,2018,23(3):154-160.
[12]Nougaret S,Reinhold C,Alsharif SS,et al.Endometrial cancer:combined MR volumetry and diffusion-weighted imaging for assessment of myometrial and lymphovascular invasion and tumor grade[J].Radiology,2015,276(3):797-808.
[13]古冬连,刘树英,朱小东,等.多模态MR图像测量鼻咽癌GTV一致性评价[J].中华放射肿瘤学杂志,2016,25(12):1281-1284.
[14]萨建,刘桂芬.定量测量结果的一致性评价及Bland-Altman法的应用[J].中国卫生统计,2011,28(4):409-411.
[15]闻浩,陆梦洁.定量测量Bland-Altman一致性评价方法研究及临床应用[J].医学研究生学报,2015,28(10):1107-1111.
[16]Dalah E,Moraru I,Paulson E,et al.Variability of target and normal structure delineation using multimodality imaging for radiation therapy of pancreatic cancer[J].Int J Radiat Oncol Biol Phys,2014,89(3):633-640.
[17]朱向帜,康铮,何侠.磁共振弥散加权成像对鼻咽癌靶区勾画和复发转移预测的临床价值研究[J].中华放射肿瘤学杂志,2012,21(2):105-107.C