目的 以四维CT(4DCT)影像量化肺内肿瘤因呼吸导致的运动,分析其影响因素,寻找运动度大的肿瘤特征.方法 在平静呼吸状态下接受4DCT扫描的肺内肿瘤患者43例,肺内可测量病灶44个.由同一位医生在4DCT各时相数据集卜勾画肿瘤GTV,分别测量GTV中心点在上下、左右、前后三维方向上的运动幅度.对与运动度可能相关的临床变量和解剖学因素进行统计学分析.以任意方向运动幅度>5 mm作为分界点,分析此类肿瘤特征.结果 肺内肿瘤运动度与T分期、GTV体积、肺内所处上下位置、与固定组织(如胸壁、纵隔、脊柱)粘连程度相关.10例患者肺内肿瘤的运动幅度>5 mm,均位于胸腔下部及后部,上下方向运动度最大,最大值为14.4 mm.95%肺内肿瘤的运动幅度在上下方向<11.8 mm,前后方向<4.6 mm,左右方向<2.7 mm.结论 呼吸导致的肺内肿瘤运动度受肿瘤位置、体积、T分期及粘连程度等因素影响.下叶肺内孤立肿瘤的运动度最大,主要发生在上下方向,上叶后段肿瘤的运动度次之.%Objective To quantify the amplitudes of lung tumor motion during free-breathing using four dimensional computed tomography (4DCT), and seek the characteristics of tumors with large motion. Methods Respiratory-induced tumor motion was analyzed for 44 tumors from 43 patients. All patients un-derwent 4DCT during free-breathing before treatment. Gross tumor volumes (GTV) on ten respiratory phases were contoured by the same doctor. The eentroids of GTVs were autoplaeed with treatment software (ADAC Pinnacle 7.4f), then the amplitudes of tumor motion were assessed. The various clinical and anatomic fac-tors associated with GTV motion were analyzed. The characteristics of tumors with motion greater than 5 mm in any direction were explored. Results The tumor motion was found to be associated with T stage, GTV size, the superior-inferior (SI) tumor location in the lung, and the attachment to rigid structures such as the chest wall, vertebrae or mediastinum. The motion over 5 mm was observed in ten tumors, which were all lo-cated in the lower or posterior half of the lung, with the greatest motion of 14.4 mm. For 95% of the tumors, the magnitude of motion was less than I 1.8 mm, 4.6 mm and 2.7 mm along the SI, anterior-poste-rior (AP) and lateral directions, respectively. Conclusions Tumor motion due to breathing is associated with tumor location, volume, and T stage. The greatest motion was in the SI direction for unfixed tumor in lower-lobe, followed by tumor in upper-lobe posterior-segment.
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