Plathow Christian, Hof Holger, Kuhn Sabine, Puderbach Michael, Ley Sebastian, Biederer Juergen, Claussen Claus D, Huber Peter E, Schaefer Juergen, Tuengerthal Siegfried, Kauczor Hans-Ulrich
Department of Diagnostic Radiology, Eberhard-Karls University Tuebingen, Hoppe-Seyler 3, 72060, Tuebingen, Germany.
Eur Radiol. 2006 Sep;16(9):1942-50. doi: 10.1007/s00330-006-0237-y. Epub 2006 Apr 21.
A frequent side effect after radiotherapy of lung tumors is a decrease of pulmonary function accompanied by dyspnea due to developing lung fibrosis. The aim of this study was to monitor lung motion as a correlate of pulmonary function and intrathoracic tumor mobility before and after radiotherapy (RT) using dynamic MRI (dMRI). Thirty-five patients with stage I non-small-cell lung carcinoma were examined using dMRI (trueFISP; three images/s). Tumors were divided into T1 and T2 tumors of the upper, middle and lower lung region (LR). Maximum craniocaudal (CC) lung dimensions and tumor mobility in three dimensions were monitored. Vital capacity (VC) was measured and correlated using spirometry. Before RT, the maximum CC motion of the tumor-bearing hemithorax was 5.2 +/- 0.9 cm if the tumor was located in the lower LR (middle LR: 5.5 +/- 0.8 cm; upper LR: 6.0 +/- 0.6 cm). After RT, lung motion was significantly reduced in the lower LR (P < 0.05). Before RT, the maximum CC tumor mobility was significantly higher in tumors of the lower LR 2.5 +/- 0.6 vs. 2.0 +/- 0.3 cm (middle LR; P < 0.05) vs. 0.7 +/- 0.2 cm (upper LR; P < 0.01). After RT, tumor mobility was significantly reduced in the lower LR (P < 0.01) and in T2 tumor patients (P < 0.05). VC showed no significant changes. dMRI is capable of monitoring changes in lung motion that were not suspected from spirometry. This might make the treatment of side effects possible at a very early stage. Changes of lung motion and tumor mobility are highly dependent on the tumor localization and tumor diameter.
肺部肿瘤放疗后的常见副作用是肺功能下降，并因肺纤维化加重而出现呼吸困难。本研究的目的是使用动态磁共振成像（dMRI）监测放疗（RT）前后肺运动情况，作为肺功能和胸内肿瘤活动度的相关指标。对35例I期非小细胞肺癌患者进行dMRI检查（真稳态进动快速成像序列；每秒采集3幅图像）。将肿瘤分为上、中、下肺区（LR）的T1和T2肿瘤。监测最大头脚方向（CC）肺尺寸和肿瘤的三维活动度。使用肺活量计测量肺活量（VC）并进行相关性分析。放疗前，如果肿瘤位于下肺区，患侧半胸的最大CC运动为5.2±0.9 cm（中肺区：为5.5±0.8 cm；上肺区：为6.0±0.6 cm）。放疗后，下肺区的肺运动明显减少（P<0.05）。放疗前，下肺区肿瘤的最大CC肿瘤活动度明显更高，为2.5±0.6 cm，而中肺区为2.0±0.3 cm（P<0.05），上肺区为0.7±0.2 cm（P<0.01）。放疗后，下肺区（P<0.01）和T2期肿瘤患者（P<0.05）的肿瘤活动度明显降低。VC无明显变化。dMRI能够监测到肺活量计未发现的肺运动变化。这可能使在非常早期阶段就对副作用进行治疗成为可能。肺运动和肿瘤活动度的变化高度依赖于肿瘤的定位和肿瘤直径。
