THR Difference Of Esophageal Cancer Gross Target Volume Contoured Based On CT And MRI Image

Objective:At present,it is still a little difficult to contour esophageal cancer exactly based on CT image,this study explore the value of MRI used in esophageal cancer radiotherapy by comparing of esophageal cancer and metastatic lymph nodes gross target volume on CT image and MRI image,observing the main causes of the differences in gross target volume on CT/MRI fusion images at the same time.Methods:From July 2012 to January 2016,29 patients diagnosed with esophageal cancer by pathology,went with radical radiation therapy at were analyzed.Contouring esophageal cancer and metastatic lymph nodes gross target volume on CT image and MRI image,named GTVCT、GTVndCT and GTVMRI、 GTVndMRI respectively.GTV1=GTVCT+GTVndcT, GTV2=GTVMRI+GTVndMRI. Record the upper and lower bound、the length and thickness of esophageal cancer on CT and MRI image respectively,then compare the CT group with MRI group according to the pathological pattern and the cancer region.Using SPSS 16.0 software package for data processing, testing the difference of the upper and lower bound、the length and thickness of esophageal cancer between CT and MRI image respectively by compare-paired t test, testing the difference between the volume of GTVland GTV2、GTVCT and GTVMRI、 GTVndCT and GTVndMRI,testing the difference of esophageal cancer gross target volume between CT and MRI image according to the pathological pattern、cancer region and the T stage judged by CT. Analysizing the reason of the differences of metastatic lymph nodes gross target volume between CT and MRI image according to the pathological pattern、cancer region and the N stage judged by CT,by stratified analysis.Transfer the CT and MRI image to MIM6.4.7 software,rigid registration with local deformation registration for fusion,evaluate the fused images by Radiology doctor and Radiation doctor.Observed the main difference between GTV1and GTV2 on CT/MRI images fusion, further discusses the value of MRI in esophageal cancer radiotherapy.Results:(1)The volume of GTV1 and GTV2 was 106.9± 13.7cm3、78.7± 9.7cm3, respectively (t=5.05, P=0.00).(2)The volume of GTVCT and GTVMRI was 90.6±12.4cm3、61.3±8.9cm3, respectively (t=4.50, P=0.00).(3) the volume of GTVndCT and GTVnd MRI was 14.2 ± 3.1 cm3、17.4 ± 3.9cm3, respectively (t=-0.82,P=0.419). (4)Esophageal length on CT and MRI images was 9.3±0.6 cm3、8.8±0.7cm3, respectively(t= 1.29,P=1.29).Thickness of esophageal cancer on CT and MRI images was 5.0±0.3cm3、4.3±0.2cm3, respectively (t= 4.41, P= 4.41).(5)The upper bound of esophageal cancer between CT and MRI image was 13.4±1.0cm、12.6± 1.0cm, respectively (t=-2.92,P=0.01),the lower bound of esophageal cancer between CT and MRI image was 9.1 ± 1.0cm、9.0 ± 1.0cm, respectively(t=0.15,P=0.88).(6)According to the cancer region analysis GTVCT and GTVMRI volume:ervical 71.8± 18.9cm3、 57.8± 18.9cm3(t=2.41, P=0.04); middle and upper thoracic:134.1 ± 15.6cm3、 66.1±8.0cm3(t=3.38, P=0.03); whole thoracic、upper thoracic, middle thoracic、middle and lower thoracic did not have significant, P=0.32、0.43, 0.17、0.21, respectively.(7)According to the pathological pattern analysis GTVCT and GTVMRI volume:squamous carcinoma:85.7± 13.8cm3,56.7± 8.7cm3(t=3.95, P=0.00); non-squamous carcinoma:114.2±29.2cm3,83.4± 31.3cm3(t=2.00, P=0.12).(8)According the AJCC seventh edition of T stage judged by CT to analysis GTVCT and GTVMRI volume:T2 23.0±6.4cm3、26.2 ±3.5cm3(t=-1.09, P=0.47); T3 67.3±17.6cm3,53.5±16.6cm3(t=2.16, P=0.06); T4 115.2±16.6cm3、71.0±11.1cm3(t=4.63, P=0.00).(9)According the non-operation therapy of T stage judged by CT to analysis GTVCT and GTVMRI volume:T3 24.8±2.9cm3,25.5±5.4cm3 (t=-0.24, P=0.82); T4 107.8±13.4cm3、70.6±10.3cm3 (t=5.04, P=0.00).(10)According to the cancer region analysis GTVndCT and GTVndMRI volume did not have significant:cervical、whole thoracic、upper thoracic、middle and upper thoracic、middle thoracic、middle and lower thoracic, P=0.68、0.84、 0.76、0.30、0.48、0.43, respectively.(11)According to the pathological pattern analysis GTVndCT and GTVndMRI volume did not have significant:squamous carcinoma、non-squamous carcinoma, P=0.50、0.60, respectively.(12)According the AJCC seventh edition of N stage judged by CT to analysis GTVCT and GTVMRI volume did not have significant:N0、N1、 N2、N2+3, P=0.39、0.48、0.84、0.37, respectively.(13)According the non-operation therapy of N stage judged by CT to analysis GTVCT and GTVMRI volume did not have significant:N0、N、N2, P=0.39、0.49、0.80, respectively. (14) Gross target volume observation of CT/MRI fusion:the reason cause the difference of cervical esophageal cancer is MRI clearly distinguish than CT in the soft tissue (trachea, muscle, pharynx ministry), thoracic esophageal cancer is the soft tissue (azygos vein and aorta, bronchial), and 2,3,4,5,7,8,10 area mediastinal lymph node;CT on thyroid invaded or not compared with MRI are more likely to distinguish.Conclusions:This study by comparing CT and MRI fusion images to find the differences of esophageal cancer gross target volume between contoured based on CT and MRI images.The statistically significant differences factors are:cervical、middle and upper thoracic、squamous carcinoma esophageal cancer, T4 stage esophageal cancer judged by CT non-operation therapy stage and AJCC seventh edition stage;N1 stage esophageal cancer judged by CT non-operation therapy stage for esophageal cancer with metastasis lymph nodes.According to this study,we suggest esophageal cancer patients with those factors had better to undergo MRI before radiotherapy,in order to contour gross target volume accurately.Objective : This study explore the value of DWI used in esophageal cancer radiotherapy by comparing of esophageal cancer gross target volume and length on CT image and MRI image.Methods : From July 2012 to January 2016,29 patients diagnosed with esophageal cancer by pathology,went with radical radiation therapy at were analyzed.Contouring esophageal cancer gro化 target volume on CT image and DWI image ’named GTVct and GTVdw1 ’Kspectively. Record the length of esophageal cancer on CT and MRI image Kspectively.Using SPSS 16.0software package for data processing,testing the difference of between the volume of GTVct and GTVdwi ’testing the difference and analysis the reason of the fferences of esophageal cancer groiss target volume between CT and MRI image according to the pathological pattern、cancer region and the T stage judged by CT,by stratified analysis. Anglicizing the Kason of the differences of esophageal cancer length between CT and MRI image. Discusses the value of MRI in esophageal cancer radiotherapy fiirther.Results : (1)The volume of GTVct and GTVdwi was 92.6± 12.7cm3、44.2±7.5cm3, respectively(f=6.89, P=0.00).(2)the length of esophageal cancer measured by CT and DWI was 9.5±0.6cm3、6.16±0.7cm3, respectively(i=4.20,_P=0.00).(3)According to the cancer region analysis GTVct and GTVDwI volume:cervical71.±18.9cm3、38. 15.1cm3(5.26,/N).00;middle and upper thoracic:134.1±15.6cm 46.9±6.9cm(t=4.24,p=0.01);middleandlowertiioracic:74.7± 8.9cm3、37.9±10.4cm3(t=3.8,P=0.03);whole thoracic upper thoracic middle thoracic did not have significant, P0.25、0.17、0.10, respectively.(4)According to the pathological pattern analysis GTVct and GTVdwi volume : squamous carcinoma: S7.9±14.2cm3、40.3.8cin3(t=5.73, 7).00; non-squamous carcinoma:! 14.2±29.2cm 62.9±22.5cm(t=5.07, P=0.01).(5)According the AJCC seventh edition of Tstage judged by CT to analysis GTVct and GTVdwi volume : T2 23.0±6.4cm 26.2±3.5cm(t=-1.09, P=0.47);T367.3±17.6cm3、53. 16.6cm3(t=2.16, P=0.06);T4 115.2±6.6cm3、71.0±1 cm3(f=4.63, P=0.00).(6)According the non-operation tilierapy of T stage judged by CT to analysis GTVct and GTVdwi volume : T322.7±2.5cm3、9.2±5.9cm3(t=8.24、P=0.00);T4 107.±3.5cm3、6±0.5cm3(t=7.72、P=0.00).Coneclusions : This study analysize the difference of esophageal cancer gross target volume contoured based on CT and DWI image’and showed the factors cause statistically significant are: cervical、middle and upper thoracic’middle and lower thoracic esophageal cancer, T3 and T4 stage esophageal cancer judged by CT non-operation therapy stage and AJCC seventh edition stage.According to this study,we suggesit that esophageal cancer patients withthose factors had better to undergo MRI before radiotherapy in order to contour gross target volume accurately.