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The Role of Motion Measurement of Diaphragm, Liver and Intrahepatic Lesions Using4DCT

Author: LiuZhiKai
Tutor: LiZuoXiong
School: Beijing Union Medical College
Course: Clinical
Keywords: Hepatocellular carcinoma Respiratory motion 4DCT
CLC: R816.5
Type: PhD thesis
Year: 2009
Downloads: 1
Quote: 0
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[Purpose]:To investigate the respiratory motion of diaphragm, liver and intrahepatic lesions using4DCT, and to find the relationship between them.[Materials and Methods]:Eleven patients with markers in liver were scanned using4DCT. Liver and the markers were contoured based on0%to90%images. The motions of diaphragm, liver and markers were measured.[Results]:The motion of diaphragm in the superior-inferior (SI) directions was0.95±0.37cm. The motion of liver in the left-right (LR), anterior-posterior (AP) and superior-inferior (SI) directions were0.19±0.15cm,0.20±0.11cm and0.80±0.32cm. Colinearity of diaphragm and liver in the SI direction was significant, with Correlation coefficient R=0.90(P<0.05). Colinearity of liver and markers in the SI direction was also significant, with Correlation coefficient R=0.92(P<0.05). Liver could be further divided into5parts:the superior part of right lobe, the central part, the hepatic hilar part, the inferior part of right lobe and the left lobe. The former4parts and liver had significant linear correlations, with Correlation coefficient R=0.97,0.98,0.93and0.90(P<0.05) respectively. Data was insufficient for the left lobe. Colinearity of the superior part of right lobe, the central part and diaphragm were significant, with Correlation coefficient R=0.99and0.96(P<0.05) respectively, and it seems no good linearity between the other two parts and diaphragm.[Conclusions]:The respiratory motion of liver in the SI direction was significant compared with the LR and AP direction, and it had strong linear correlation with the motion of diaphragm. For hospitals without4DCT, we recommend a0.5cm CTV-PTV margin in the LR and AP direction. Deformation exists in the respiratory motion of liver. Diaphragm had significant linear correlation with the superior part and the edge part of liver, we recommend to use the motion of diaphragm multiply1.05as the CTV-PTV margin in the SI direction; however, if tumor is in the central part and the inferior part of liver, that margin might cause normal tissue irradiated. The motion of the left lobe need further study.

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