Sakuma Kotaro, Yamashiro Tsuneo, Moriya Hiroshi, Murayama Sadayuki, Ito Hiroshi
Department of Radiology, Ohara General Hospital, 6-11 Omachi, Fukushima City, Fukushima 960-8611, Japan; Department of Radiology and Nuclear Medicine, Fukushima Medical University, 1 Hikariga-oka, Fukushima City, Fukushima 960-1295, Japan.
Department of Radiology, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan.
Eur J Radiol. 2017 Feb;87:36-44. doi: 10.1016/j.ejrad.2016.12.004. Epub 2016 Dec 6.
Using 4-dimensional dynamic-ventilatory scanning by a 320-row computed tomography (CT) scanner, we performed a quantitative assessment of parietal pleural invasion and adhesion by peripheral (subpleural) lung cancers.
Sixteen patients with subpleural lung cancer underwent dynamic-ventilation CT during free breathing. Neither parietal pleural invasion nor adhesion was subsequently confirmed by surgery in 10 patients, whereas the other 6 patients were judged to have parietal pleural invasion or adhesion. Using research software, we tracked the movements of the cancer and of an adjacent structure such as the rib or aorta, and converted the data to 3-dimensional loci. The following quantitative indices were compared by the Mann-Whitney test: cross-correlation coefficient between time curves for the distances moved from the inspiratory frame by the cancer and the adjacent structure, the ratio of the total movement distances (cancer/adjacent structure), and the cosine similarities between the inspiratory and expiratory vectors (from the cancer to the adjacent structure) and between vectors of the cancer and of the adjacent structure (from inspiratory to expiratory frames).
Generally, the movements of the loci of the lung cancer and the adjacent structure were similar in patients with parietal pleural invasion/adhesion, while they were independent in patients without. There were significant differences in all the parameters between the two patient groups (cross-correlation coefficient and the movement distance ratio, P<0.01; cosine similarities, P<0.05).
These observations suggest that quantitative indices by dynamic-ventilation CT can be utilized as a novel imaging approach for the preoperative assessment of parietal pleural invasion/adhesion.
通过320排计算机断层扫描（CT）扫描仪进行四维动态通气扫描，我们对周围型（胸膜下）肺癌的壁层胸膜侵犯和粘连进行了定量评估。
16例胸膜下肺癌患者在自由呼吸时接受了动态通气CT检查。随后，10例患者经手术证实无壁层胸膜侵犯及粘连，而另外6例患者被判定存在壁层胸膜侵犯或粘连。我们使用研究软件追踪肿瘤及相邻结构（如肋骨或主动脉）的运动，并将数据转换为三维轨迹。通过Mann-Whitney检验比较以下定量指标：肿瘤和相邻结构从吸气相帧开始移动的距离的时间曲线之间的互相关系数、总移动距离之比（肿瘤/相邻结构），以及吸气和呼气向量之间（从肿瘤到相邻结构）以及肿瘤和相邻结构的向量之间（从吸气相帧到呼气相帧）的余弦相似度。
一般来说，壁层胸膜侵犯/粘连患者中肺癌和相邻结构轨迹的运动相似，而无侵犯/粘连患者中两者运动相互独立。两组患者在所有参数上均存在显著差异（互相关系数和移动距离比，P<0.01；余弦相似度，P<0.05）。
这些观察结果表明，动态通气CT的定量指标可作为一种新的影像学方法用于术前评估壁层胸膜侵犯/粘连。
