北京生物医学工程

前列腺癌靶区位移影响因素分析

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

作者：田龙闫洁诚胡逸民

单位：河北北方学院附属第- -医院(河北张家口075000), 中国医学科学院肿瘤医院(北京100021)  通信作者:田龙。E-mail: 1277473912@ qq. com

关键词：前列腺癌; 锥形束CT; 剪切波超声弹性成像; 腹内压; 误差均方根; 相关性

分类号：R318; R812

出版年·卷·期（页码）：2021·40·4（406-412）

摘要：

目的深层次探究直肠肌肉张力、腹内压和盆腔骨骼3个客观因素对前列腺癌放疗前锥形束CT校准数据影响,得到影响前列腺靶区运动主要因素,为优化放疗计划设计和提高图像引导精度提.供参考。方法依据试验纳排标准，筛选符合条件的10名前列腺癌患者,接受每周两次随机治疗前锥形束CT扫描,获取前列腺靶区校准数据。扫描之后,分别采用剪切波超声弹性成像技术量化患者直肠肌肉张力影响,采用气囊测压表测量膀胱内压间接量化腹内压影响，采用误差均方根量化盆腔骨骼影响。回归分析3个因素与锥形束CT校准数据之间关系。结果所有患者左右、前后、头脚方向上锥形束CT校准结果分别为:0.513 mm+0.072 mm、1. 369 mm+0.162 mm、1.335 mm+0.271 mm;杨氏模量值:8.965kPa+1.391 kPa、10.211 kPa+1. 544 kPa .3.926 kPa+0.693 kPa,腹内压(未分方向) :4.844 mmHg士1.347mmHg( 1 mmHg= 133. 3 Pa) ,误差均方根:0. 020 mm+0.011 mm、0. 069 mm+0.049 mm .0. 052 mm+0. 029mm;前后方向上直肠肌肉张力( R=0.895)和腹内压( R=0.523)均同锥形束CT校准数据存在统计学意义相关性,头脚方向上腹内压(R=0.717)存在统计学意义相关性。结论前后方向上直肠肌肉张力和头脚方向.上腹内压是造成前列腺癌靶区位移主要因素,结果对优化放疗计划设计和提高图像引导精度具.有重要意义,并为未来降低靶区位移提供了方法学指导。

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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