三维可视化技术与公式法测定肝脏肿瘤体积的对比研究
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摘要
目的比较肿瘤体积计算公式与三维可视化技术测得肿瘤体积的差异性,探讨目前医学研究中广泛应用的公式法还能否满足精准医疗的需求。方法①根据阿基米德原理,通过排水法验证三维重建脏器体积的准确性;②收集来自海军军医大学东方肝胆外科医院的200例肝脏肿瘤病人的薄层CT图像及原始DICOM数据,采用三维可视化技术进行肿瘤体积计算(结果记为V4)。两位外科医生采用传统方法测量肿瘤长径(A)、宽(B)、高(C),用三种公式[V=AB~2/2、V=ABC/2和球体公式V=4/3×π×(A/2)~3]计算肿瘤体积,结果分别记为V1、V2、V3(第一位测量者)和V5、V6、V7(第二位测量者)。结果①三维重建的预切除肝脏体积与排水法测定的真实切除体积高度相关(P<0.01)。②不同公式法与三维可视化技术测定的肝脏肿瘤体积在总体上有较大误差(均P<0.05);AB~2/2、ABC/2两种公式与三维可视化结果在男性组、女性组、A≤3 cm组、3 cm10 cm组差异均有统计学意义(均P<0.05);球体公式在3 cm Objective To compare the difference between the traditional calculation formula and the three-dimensional(3 D) visualization technology for tumor volume, and to prove whether the traditional formula widely used in medical research cannot meet the needs of precision medical treatment.Methods ① According to the Archimedes' principle, the accuracy of 3 D reconstruction volume of organ was verified by drainage method; ② This study collected thin-slice computed tomography(CT) images and original DICOM data of 200 patients with liver tumors from the Eastern Hepatobiliary Surgery Hospital of Naval Military Medical University.The 3 D visualization technology(Shenzhen, Xudong) was used to calculate the tumor volume, and the result was V4.Two surgeons used conventional methods to measure tumor length(A), width(B), and height(C) to calculate the tumor volume by formulae [V = AB~2/2, V = ABC/2, and the spherical formula V = 4/3 × π×(A/2)~3].The results were V1-V3 and V5-V7, respectively.Results ① The predicted excisional liver volume determined by 3 D technology was highly correlated with the true volume determined by the drainage method(P<0.01).② The liver tumor volume measured by different traditional formulae was generally smaller than 3 D visualization technology(P<0.05).The results for two formulae(AB~2/2 and ABC/2) were different from the 3 D visualization results in male group, female group, A ≤3 cm group, 3 cm10 cm group(P<0.05).The difference between V3, V7(spherical formula) and 3 D technology was not statistically significant in 3 cm
引文
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[28] Chuang CC, Lin SY, Pai PC,et al.Different Volumetric Measurement Methods for Pituitary Adenomas and Their Crucial Clinical Significance[J].Sci Rep, 2017, 7:40792.DOI:10.1038/srep40792.
[29] Lee YH, Hsia CY, Hsu CY,et al.Total tumor volume is a better marker of tumor burden in hepatocellular carcinoma defined by the Milan criteria[J].World J Surg, 2013, 37(6):1348-1355.DOI:10.1007/s00268-013-1978-9.
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[31] Li PP, Wang ZH, Huang G,et al.Application of liver three-dimensional visualization technologies in the treatment planning of hepatic malignant tumor[J].Zhonghua Wai Ke Za Zhi, 2017, 55(12):916-922.DOI:10.3760/cma.j.issn.0529-5815.2017.12.008.
[2] Mo HY, Zhong JH, Li LQ.Comment on tumor size as a prognostic factor for solitary HCC after resection[J].J Surg Oncol, 2016,113(5):593.DOI:10.1002/jso.24173.
[3] Kim DJ, Clark PJ, Heimbach J,et al.Recurrence of hepatocellular carcinoma:importance of mRECIST response to chemoembolization and tumor size[J].Am J Transplant, 2014, 14(6):1383-1390.DOI:10.1111/ajt.12684.
[4] Hwang S, Lee YJ, Kim KH, et al.The Impact of Tumor Size on Long-Term Survival Outcomes After Resection of Solitary Hepatocellular Carcinoma:Single-Institution Experience with 2558 Patients[J].J Gastrointest Surg, 2015, 19(7):1281-1290.DOI:10.1007/s11605-015-2849-5.
[5] Huang WJ, Jeng YM, Lai HS, et al.Tumor size is a major determinant of prognosis of resected stage I hepatocellular carcinoma[J].Langenbecks Arch Surg, 2015, 400(6):725-734.DOI:10.1007/s00423-015-1329-4.
[6] Ho CM, Hu RH, Lee PH, et al.Long-term survival in patients with T2 hepatocellular carcinoma after primary curative resection can be further stratified by tumor size[J].Medicine (Baltimore), 2014,93(27):e203.DOI:10.1097/md.0000000000000203.
[7] Fernandez JA, Robles R, Marin C,et al.Can we expand the indications for liver transplantation among hepatocellular carcinoma patients with increased tumor size?[J].Transplant Proc, 2003, 35(5):1818-1820.
[8] Chen YL, Ko CJ, Chien SY,et al.Tumor size as a prognostic factor in resected small hepatocellular carcinoma:a controversy revisited[J].J Gastroenterol Hepatol, 2011, 26(5):851-857.DOI:10.1111/j.1440-1746.2010.06595.x.
[9] Ericson K, Hakansson S.Hakansson.Computed tomography of epidural hematomas.Association with intracranial lesions and clinical correlation[J].Acta Radiol Diagn (Stockh), 1981, 22(5):513-519.
[10] Kothari RU, Brott T, Broderick JP,et al.The ABCs of measuring intracerebral hemorrhage volumes[J].Stroke, 1996, 27(8):1304-1305.
[11] Ishi, Y, Terasaka S, Yamaguchi S, et al.Reliability of the Size Evaluation Method for Meningiomas:Maximum Diameter, ABC/2 Formula, and Planimetry Method[J].World Neurosurg, 2016, 94:80-88.DOI:10.1016/j.wneu.2016.06.108.
[12] Hsu CY, Huang YH, Hsia CY, et al.A new prognostic model for hepatocellular carcinoma based on total tumor volume:the Taipei Integrated Scoring System[J].J Hepatol, 2010, 53(1):108-117.DOI:10.1016/j.jhep.2010.01.038.
[13] Toso C, Meeberg G, Hernandez-Alejandro R,et al.Total tumor volume and alpha-fetoprotein for selection of transplant candidates with hepatocellular carcinoma:A prospective validation[J].Hepatology, 2015, 62(1):158-165.DOI:10.1002/hep.27787.
[14] Sorensen AG, Patel S, Harmath C,et al.Comparison of diameter and perimeter methods for tumor volume calculation[J].J Clin Oncol, 2001, 19(2):551-557.DOI:10.1200/jco.2001.19.2.551.
[15] Hwang RF, Yokoi K, Bucana CD, et al.Inhibition of platelet-derived growth factor receptor phosphorylation by STI571 (Gleevec) reduces growth and metastasis of human pancreatic carcinoma in an orthotopic nude mouse model[J].Clin Cancer Res, 2003, 9(17):6534-6544.
[16] Subramaniam V, Vincent IR, Gilakjan M, et al.Suppression of human colon cancer tumors in nude mice by siRNA CD44 gene therapy[J].Exp Mol Pathol, 2007, 83(3):332-340.DOI:10.1016/j.yexmp.2007.08.013.
[17] Stull KE, Tise ML, Ali Z, et al.Accuracy and reliability of measurements obtained from computed tomography 3D volume rendered images[J].Forensic Sci Int, 2014, 238:133-140.DOI:10.1016/j.forsciint.2014.03.005.
[18] Begin A, Martel G, Lapointe R,et al.Accuracy of preoperative automatic measurement of the liver volume by CT-scan combined to a 3D virtual surgical planning software (3DVSP)[J].Surg Endosc, 2014, 28(12):3408-3412.DOI:10.1007/s00464-014-3611-x.
[19] Alyassin AM, Lancaster JL, Downs JH 3rd,et al.Evaluation of new algorithms for the interactive measurement of surface area and volume[J].Med Phys, 1994, 21(6):741-752.DOI:10.1118/1.597333.
[20] Wang W, Bai W, Wang E, et al.mRECIST response combined with sorafenib-related adverse events is superior to either criterion alone in predicting survival in HCC patients treated with TACE plus sorafenib[J].Int J Cancer, 2017,140(2):390-399.DOI:10.1002/ijc.30451.
[21] Meyer T, Palmer DH, Cheng AL,et al.mRECIST to predict survival in advanced hepatocellular carcinoma:Analysis of two randomised phase II trials comparing nintedanib vs sorafenib[J].Liver Int, 2017, 37(7):1047-1055.DOI:10.1111/liv.13359.
[22] Hyun D, Shin SW, Cho SK,et al.Efficacy of RECIST and mRECIST criteria as prognostic factors in patients undergoing repeated iodized oil chemoembolization of intermediate stage hepatocellular carcinoma[J].Acta Radiol, 2015, 56(12):1437-1445.DOI:10.1177/0284185114560937.
[23] Edeline J, Palmer D, Blanc JF, et al.mRECIST for systemic therapies:More evidence is required before recommendations can be made[J].J Hepatol, 2017, 67(1):195.DOI:10.1016/j.jhep.2017.02.033.
[24] Treska V, Skalicky T, Liska V,et al.Liver hemangiomas - when is invasive treatment indicated?[J].Rozhl Chir, 2017,96(4):151-155.
[25] Sakamoto Y, Kokudo N, Watadani T,et al.Proposal of size-based surgical indication criteria for liver hemangioma based on a nationwide survey in Japan[J].J Hepatobiliary Pancreat Sci, 2017, 24(7):417-425.DOI:10.1002/jhbp.464.
[26] Lencioni R, Llovet JM.Modified RECIST (mRECIST) assessment for hepatocellular carcinoma[J].Semin Liver Dis, 2010, 30(1):p.52-60.DOI:10.1055/s-0030-1247132.
[27] Seymour L, Bogaerts J, Perrone A, et al.iRECIST:guidelines for response criteria for use in trials testing immunotherapeutics[J].Lancet Oncol, 2017, 18(3):e143-e152.DOI:10.1016/s1470-2045(17)30074-8.
[28] Chuang CC, Lin SY, Pai PC,et al.Different Volumetric Measurement Methods for Pituitary Adenomas and Their Crucial Clinical Significance[J].Sci Rep, 2017, 7:40792.DOI:10.1038/srep40792.
[29] Lee YH, Hsia CY, Hsu CY,et al.Total tumor volume is a better marker of tumor burden in hepatocellular carcinoma defined by the Milan criteria[J].World J Surg, 2013, 37(6):1348-1355.DOI:10.1007/s00268-013-1978-9.
[30] Yang B, Yin J, Chen Y, et al.2D-Black-Phosphorus-Reinforced 3D-Printed Scaffolds:A Stepwise Countermeasure for Osteosarcoma[J].Adv Mater, 2018,30(10):1705611.DOI:10.1002/adma.201705611.
[31] Li PP, Wang ZH, Huang G,et al.Application of liver three-dimensional visualization technologies in the treatment planning of hepatic malignant tumor[J].Zhonghua Wai Ke Za Zhi, 2017, 55(12):916-922.DOI:10.3760/cma.j.issn.0529-5815.2017.12.008.