北京生物醫(yī)學(xué)工程

前列腺癌靶區(qū)位移影響因素分析

Analysis of influence factors of cone beam CT calibration in prostate cancer

作者：田龍閆潔誠(chéng) 胡逸民

單位：河北北方學(xué)院附屬第- -醫(yī)院(河北張家口075000), 中國(guó)醫(yī)學(xué)科學(xué)院腫瘤醫(yī)院(北京100021)  通信作者:田龍。E-mail: 1277473912@ qq. com

關(guān)鍵詞：前列腺癌; 錐形束CT; 剪切波超聲彈性成像; 腹內(nèi)壓; 誤差均方根; 相關(guān)性

分類(lèi)號(hào)：R318; R812

出版年·卷·期（頁(yè)碼）：2021·40·4（406-412）

摘要：

目的深層次探究直腸肌肉張力、腹內(nèi)壓和盆腔骨骼3個(gè)客觀(guān)因素對(duì)前列腺癌放療前錐形束CT校準(zhǔn)數(shù)據(jù)影響,得到影響前列腺靶區(qū)運(yùn)動(dòng)主要因素,為優(yōu)化放療計(jì)劃設(shè)計(jì)和提高圖像引導(dǎo)精度提.供參考。方法依據(jù)試驗(yàn)納排標(biāo)準(zhǔn)，篩選符合條件的10名前列腺癌患者,接受每周兩次隨機(jī)治療前錐形束CT掃描,獲取前列腺靶區(qū)校準(zhǔn)數(shù)據(jù)。掃描之后,分別采用剪切波超聲彈性成像技術(shù)量化患者直腸肌肉張力影響,采用氣囊測(cè)壓表測(cè)量膀胱內(nèi)壓間接量化腹內(nèi)壓影響，采用誤差均方根量化盆腔骨骼影響。回歸分析3個(gè)因素與錐形束CT校準(zhǔn)數(shù)據(jù)之間關(guān)系。結(jié)果所有患者左右、前后、頭腳方向上錐形束CT校準(zhǔn)結(jié)果分別為:0.513 mm+0.072 mm、1. 369 mm+0.162 mm、1.335 mm+0.271 mm;楊氏模量值:8.965kPa+1.391 kPa、10.211 kPa+1. 544 kPa .3.926 kPa+0.693 kPa,腹內(nèi)壓(未分方向) :4.844 mmHg士1.347mmHg( 1 mmHg= 133. 3 Pa) ,誤差均方根:0. 020 mm+0.011 mm、0. 069 mm+0.049 mm .0. 052 mm+0. 029mm;前后方向上直腸肌肉張力( R=0.895)和腹內(nèi)壓( R=0.523)均同錐形束CT校準(zhǔn)數(shù)據(jù)存在統(tǒng)計(jì)學(xué)意義相關(guān)性,頭腳方向上腹內(nèi)壓(R=0.717)存在統(tǒng)計(jì)學(xué)意義相關(guān)性。結(jié)論前后方向上直腸肌肉張力和頭腳方向.上腹內(nèi)壓是造成前列腺癌靶區(qū)位移主要因素,結(jié)果對(duì)優(yōu)化放療計(jì)劃設(shè)計(jì)和提高圖像引導(dǎo)精度具.有重要意義,并為未來(lái)降低靶區(qū)位移提供了方法學(xué)指導(dǎo)。

Objective To deeply explore influence of three objective factors-rectal muscle tension, intra-abdominal pressure and bone in pelvic on cone beam CT calibration data of prostate cancer before radiotherapyand obtain the main factors affecting prostate target movement, so as to provide reference for optimizingradiotherapy plan design and improving image guidance accuracy. Methods Ten eligible patients with prostatecancer were screened according to the inclusion-exclusion criteria for test and scanned twice a week before random treatment using conebeam CT to obtain :prostate target calibration data. After the scanning, the influence of rectal muscle tension was quantified by using shear waveelastography , the influence of intra-abdominal pressure was indirectly quantified by air bag pressure gauge which measured the intra-bladder pressure , and theinfluence of bone in pelvic was quantified by using root mean square. The relationships between the three factorsand cone beam CT calibration data were analyzed by using regression analysis. Results The cone beam CTcalibration result was 0. 513 mm+0. 072 mm, 1. 369 mm+0. 162 mm, 1. 335 mm+0. 271 mm on left-right ,anterior-posterior and superior-inferior direction respectively for all the patients. Young' s modulus value was8. 965 kPat1. 391 kPa,10. 211 kPat1. 544 kPa,3. 926 kPat0. 693 kPa on three directions respectively , intra-abdominal pressure ( without direction) was 4.844 mmHgt 1.347 mmHg ( 1mmHg= 133.3 Pa) and root meansquare was 0. 020 mm # 0.011 mm, 0. 069 mm t 0.049 mm, 0.062 mm t 0.029 mm on three directions ,respectively. Rectal muscle tension ( R = 0. 895 ) and intra-abdominal pressure ( R = 0. 523 ) on anterior-posterior direction were statistically correlated with the cone beam CT calibration data, and intra-abdominalpressure ( R= 0.717) on superior-inferior direction was statistically correlated. Conclusions Rectal muscletension on anterior-posterior direction and intra-abdominal pressure on superior-inferior direction were the mainfactors that caused prostate cancer target movement. The results were of great significance to optimizeradiotherapy plan design and improve image guidance accuracy and provided methodological guidance for futuretarget displacement reduction.

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