魏佳, 张臻, 于佳琦, 王巍, 王清鑫, 王伟, 刘颖, 叶兆祥, 赵路军. 利用CT影像进行放射性肺损伤客观分级的初步研究[J]. 中国肿瘤临床, 2021, 48(12): 603-608. DOI: 10.3969/j.issn.1000-8179.2021.12.172
引用本文: 魏佳, 张臻, 于佳琦, 王巍, 王清鑫, 王伟, 刘颖, 叶兆祥, 赵路军. 利用CT影像进行放射性肺损伤客观分级的初步研究[J]. 中国肿瘤临床, 2021, 48(12): 603-608. DOI: 10.3969/j.issn.1000-8179.2021.12.172
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Jia Wei, Zhen Zhang, Jiaqi Yu, Wei Wang, Qingxin Wang, Wei Wang, Ying Liu, Zhaoxiang Ye, Lujun Zhao. Preliminary study on the objective grading of radiation-induced lung toxicity using computed tomography images[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2021, 48(12): 603-608. DOI: 10.3969/j.issn.1000-8179.2021.12.172
Citation: Jia Wei, Zhen Zhang, Jiaqi Yu, Wei Wang, Qingxin Wang, Wei Wang, Ying Liu, Zhaoxiang Ye, Lujun Zhao. Preliminary study on the objective grading of radiation-induced lung toxicity using computed tomography images[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2021, 48(12): 603-608. DOI: 10.3969/j.issn.1000-8179.2021.12.172
shu

利用CT影像进行放射性肺损伤客观分级的初步研究

Preliminary study on the objective grading of radiation-induced lung toxicity using computed tomography images

    摘要
  • 摘要:
      目的  探讨放疗后利用随访CT影像学改变范围进行放射性肺损伤（radiation-induced lung toxicity，RILT）定量分级的可行性。
      方法  回顾性分析2017年1月至2019年12月181例于天津医科大学肿瘤医院行胸部放疗的肺癌患者的临床资料。将患者放疗后RILT影像学改变最严重时的随访CT图像融合到定位CT图像中，并勾画RILT影像学改变范围（VRL），结合患者的定位CT图像及治疗计划，获得双肺体积（V双肺）和不同剂量区间的VRL、V双肺。将上述参数代入VRL/V双肺、VRL（不同剂量区间）/VRL、VRL（不同剂量区间）/V双肺（相应剂量区间）、VRL（不同剂量区间）/V双肺共 4项比值，得到定量表示RILT程度的多组比值指标数据。检验各指标与临床RILT分级的关系，确定RILT≥2级的最佳诊断指标。
      结果  除VRL（0～10 Gy）/VRL、VRL（40～50 Gy）/VRL、VRL（0～10 Gy）/V双肺（0～10 Gy）外的各项指标均可用于≥2级RILT的诊断，其中VRL（10～40 Gy）/V双肺和VRL（20～40 Gy）/V双肺两项指标的曲线下面积（area under the curve，AUC）值最高，均为0.821，敏感度分别为0.796和0.741，特异度分别为0.701和0.756。
      结论  根据随访CT影像学改变范围进行RILT定量分级是可行的，VRL（10～40 Gy）/V双肺可以作为RILT≥2级的最佳诊断指标。

     

    Abstract:
      Objective  To explore the feasibility of quantitative grading of radiation-induced lung toxicity (RILT) using the range of imaging changes on computed tomography (CT) after radiotherapy.
      Methods  Data of lung cancer patients who received thoracic radiotherapy in Tianjin Medical University Cancer Institute and Hospital from January 2017 to December 2019 were analyzed retrospectively. Follow-up CT images showing the most RILT-related imaging changes after the end of radiotherapy were fused with localized CT images, delineating the range of RILT-related imaging changes (VRL). Using the patients' localized CT images and treatment plan, the volume of the bilateral lungs (Vbilateral lungs) were obtained, so did VRL and Vbilateral lungs for different dose ranges. To obtain multiple indexes that can be used to quantitatively express the degree of RILT, the aforementioned parameters were substituted into the four ratios: VRL/Vbilateral lungs, VRL(different dose intervals)/VRL, VRL(different dose intervals)/Vbilateral lungs(corresponding dose intervals), and VRL(different dose intervals)/Vbilateral lungs. The relationship between each index and clinical RILT grade was then examined to determine the optimal diagnostic index for grade ≥2 RILT.
      Results  In total, 181 patients were included in this study. All indexes, except VRL(0–10 Gy)/VRL, VRL(40–50 Gy)/VRL, and VRL(0–10 Gy)/Vbilateral lungs(0–10 Gy), can be used in the diagnosis of grade ≥2 RILT. The area under the curve values of VRL(10–40 Gy)/Vbilateral lungs and VRL(20–40 Gy)/Vbilateral lungs were the highest, at 0.821 for both. The sensitivity values of these two indexes were 0.796 and 0.741, respectively, and the specificity values were 0.701 and 0.756, respectively.
      Conclusions  Quantitative grading of RILT is feasible according to the range of imaging changes on CT during follow-up; VRL(10–40 Gy)/Vbilateral lungs can be used as the best diagnostic index for grade ≥2 RILT.

     

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