用于下食管鳞癌放射治疗计划的呼吸门控（4D）对比增强 FDG PET-CT：可行性及对计划靶体积的影响。
Respiratory-gated (4D) contrast-enhanced FDG PET-CT for radiotherapy planning of lower oesophageal carcinoma: feasibility and impact on planning target volume.
机构信息
Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Department of Nuclear Medicine, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Level 1, Bexley Wing, Beckett Street, Leeds, LS9 7TF, UK.
出版信息
BMC Cancer. 2017 Oct 4;17(1):671. doi: 10.1186/s12885-017-3659-9.
BACKGROUND
To assess the feasibility and potential impact on target delineation of respiratory-gated (4D) contrast-enhanced Fluorine fluorodeoxyglucose (FDG) positron emission tomography - computed tomography (PET-CT), in the treatment planning position, for a prospective cohort of patients with lower third oesophageal cancer.
METHODS
Fifteen patients were recruited into the study. Imaging included 4D PET-CT, 3D PET-CT, endoscopic ultrasound and planning 4D CT. Target volume delineation was performed on 4D CT, 4D CT with co-registered 3D PET and 4D PET-CT. Planning target volumes (PTV) generated with 4D CT (PTV 4D CT co-registered with 3D PET-CT (PTV and 4D PET-CT (PTV) were compared with multiple positional metrics.
RESULTS
Mean PTV, PTV and PTV were 582.4 ± 275.1 cm, 472.5 ± 193.1 cm and 480.6 ± 236.9 cm respectively (no significant difference). Median DICE similarity coefficients comparing PTV with PTV PTV with PTV and PTV with PTV were 0.85 (range 0.65-0.9), 0.85 (range 0.69-0.9) and 0.88 (range 0.79-0.9) respectively. The median sensitivity index for overlap comparing PTV with PTV PTV with PTV and PTV with PTV were 0.78 (range 0.65-0.9), 0.79 (range 0.65-0.9) and 0.89 (range 0.68-0.94) respectively.
CONCLUSIONS
Planning 4D PET-CT is feasible with careful patient selection. PTV generated using 4D CT, 3D PET-CT and 4D PET-CT were of similar volume, however, overlap analysis demonstrated that approximately 20% of PTV and PTV are not included in PTV, leading to under-coverage of target volume and a potential geometric miss. Additionally, differences between PTV and PTV suggest a potential benefit for 4D PET-CT.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier - NCT02285660 (Registered 21/10/2014).
背景
评估呼吸门控（4D）对比增强氟脱氧葡萄糖（FDG）正电子发射断层扫描-计算机断层扫描（PET-CT）在治疗计划位置对下三分之一食管癌前瞻性队列患者靶区勾画的可行性和潜在影响。
方法
招募了 15 名患者参与研究。成像包括 4D PET-CT、3D PET-CT、内镜超声和计划 4D CT。在 4D CT、与 3D PET 配准的 4D CT 和 4D PET-CT 上进行靶区勾画。用 4D CT（PTV 与 3D PET-CT 配准的 PTV 4D CT）、4D CT 生成的计划靶区体积（PTV）（PTV 与 4D PET-CT 生成的 PTV 与 4D PET-CT 生成的 PTV）与多个位置指标进行比较。
结果
平均 PTV、PTV 和 PTV 分别为 582.4±275.1cm、472.5±193.1cm 和 480.6±236.9cm（无显著差异）。比较 PTV 与 PTV、PTV 与 PTV 和 PTV 与 PTV 的 DICE 相似系数中位数分别为 0.85（范围 0.65-0.9）、0.85（范围 0.69-0.9）和 0.88（范围 0.79-0.9）。比较 PTV 与 PTV、PTV 与 PTV 和 PTV 与 PTV 的重叠灵敏度指数中位数分别为 0.78（范围 0.65-0.9）、0.79（范围 0.65-0.9）和 0.89（范围 0.68-0.94）。
结论
在仔细选择患者的情况下，使用 4D PET-CT 进行治疗计划是可行的。使用 4D CT、3D PET-CT 和 4D PET-CT 生成的 PTV 体积相似，但重叠分析表明，约 20%的 PTV 和 PTV 未包含在 PTV 中，导致靶区覆盖不足和潜在的几何遗漏。此外，PTV 和 PTV 之间的差异表明 4D PET-CT 可能具有潜在的益处。
试验注册
ClinicalTrials.gov 标识符-NCT02285660（注册于 2014 年 10 月 21 日）。
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