Wang Minglei, Ma Hui, Wang Xiaodong, Guo Yanhong, Xia Xinshe, Xia Hechun, Guo Yulin, Huang Xueying, He Hong, Jia Xiaoxiong, Xie Yan
Department of Radiology, General Hospital of Ningxia Medical University, Yinchuan, China.
Ningxia Key Laboratory for Cerebrocranial Diseases, Yinchuan, China.
Radiat Oncol. 2015 Mar 8;10:64. doi: 10.1186/s13014-015-0364-1.
The main objective of this study was to evaluate the efficacy of integrating the blood oxygen level dependent functional magnetic resonance imaging (BOLD-fMRI) and diffusion tensor imaging (DTI) data into radiation treatment planning for high-grade gliomas located near the primary motor cortexes (PMCs) and corticospinal tracts (CSTs).
A total of 20 patients with high-grade gliomas adjacent to PMCs and CSTs between 2012 and 2014 were recruited. The bilateral PMCs and CSTs were located in the normal regions without any overlapping with target volume of the lesions. BOLD-fMRI, DTI and conventional MRI were performed on patients (Karnofsky performance score ≥ 70) before radical radiotherapy treatment. Four different imaging studies were conducted in each patient: a planning computed tomography (CT), an anatomical MRI, a DTI and a BOLD-fMRI. For each case, three treatment plans (3DCRT, IMRT and IMRT_PMC&CST) were developed by 3 different physicists using the Pinnacle planning system.
Our study has shown that there was no significant difference between the 3DCRT and IMRT plans in terms of dose homogeneity, but IMRT displayed better planning target volume (PTV) dose conformity. In addition, we have found that the Dmax and Dmean to the ipsilateral and contralateral PMC and CST regions were considerably decreased in IMRT_PMC&CST group (p < 0.001).
In conclusion, integration of BOLD-fMRI and DTI into radiation treatment planning is feasible and beneficial. With the assistance of the above-described techniques, the bilateral PMCs and CSTs adjacent to the target volume could be clearly marked as OARs and spared during treatment.
本研究的主要目的是评估将血氧水平依赖性功能磁共振成像（BOLD-fMRI）和弥散张量成像（DTI）数据整合到位于初级运动皮层（PMC）和皮质脊髓束（CST）附近的高级别胶质瘤放射治疗计划中的疗效。
招募了2012年至2014年间共20例PMC和CST附近的高级别胶质瘤患者。双侧PMC和CST位于正常区域，与病变靶区无任何重叠。在根治性放射治疗前对患者（卡诺夫斯基功能状态评分≥70）进行BOLD-fMRI、DTI和传统MRI检查。每位患者进行四项不同的影像学检查：计划计算机断层扫描（CT）、解剖MRI、DTI和BOLD-fMRI。对于每个病例，由3名不同的物理师使用Pinnacle计划系统制定三个治疗计划（3DCRT、IMRT和IMRT_PMC&CST）。
我们的研究表明，3DCRT和IMRT计划在剂量均匀性方面无显著差异，但IMRT显示出更好的计划靶区（PTV）剂量适形性。此外，我们发现IMRT_PMC&CST组同侧和对侧PMC及CST区域的Dmax和Dmean显著降低（p<0.001）。
总之，将BOLD-fMRI和DTI整合到放射治疗计划中是可行且有益的。借助上述技术，可将靶区附近的双侧PMC和CST清晰标记为危及器官，并在治疗过程中予以保护。
