|
The first part: CT images of normal esophageal wall thickness of observation and measurement purposes: observed on CT images the norm under normal esophageal wall morphology, measurement and calculation of normal esophageal wall thickness esophageal wall lesions based on CT images to determine positioning CT images sketched esophageal primary tumor gross tumor target to provide a reference. Materials and Methods: retrospectively collected from 110 cases of normal esophageal CT images, combined with anatomy and CT images on esophageal morphology esophagus divided into cervical, thoracic, cardiac rear section and abdominal segment. Observe the morphology of the esophagus in two states contraction closed and gas expansion, using a magnifying glass on the CT images were measured esophageal wall thickness in both states, with the inner diameter of the esophageal lumen size is measured in the gas state. Analysis of the impact of gender, age, and degree of obesity on the wall thickness. Results: normal esophagus can be in two states of shrinkage closed and the gas expansion in the normal esophagus certain proportion is fully contracted or expanded state, the 47 cases in the esophagus each segment has part or all of the contracted state. Contraction closed and gas expansion state esophagus average wall thickness were 4.70 (95% CI :4.44-4 .95) mm and 2.11 (95% CI 2.00 - 2.23) mm. When esophagus is contraction closed state, abdominal esophagus average wall thickness of 5.68 (95% CI :5.28-6 .09) mm, cervical, thoracic and cardiac posterior segment were 4.67 (95% CI, :4.36-4 .86 ) mm, 4.56 (95% CI :4.31-4 .87) mm, and 4.05 (95% CI :3.71-4 .21) mm; When the esophagus in the gas expanded condition, the fourth member of the average wall thickness of 1.87mm to 2.70mm rooms, all less than 3mm. Male esophageal average wall thickness of 5.26mm, women the esophagus an average wall thickness of 4.34mm, the difference is statistically significant (p <0.001). Age and degree of obesity of the esophageal wall thickness had no significant effect (p = 0.056 and 0.173). Conclusion: CT image observation and measurement of the normal esophageal wall thickness help to help determine abnormal esophageal wall thickening, and esophageal cancer for radiotherapy outline gross tumor target basis. The second part of the purpose of comparison and clinical significance of the lesion length of esophageal cancer in the CT image, esophageal barium meal: by measuring CT images, esophageal barium meal esophageal original lesion length, combined esophagoscopy, general surgery on the length of the specimen, The difference in both length and possible factors affecting the comparative analysis, explore the related results confirm the clinical significance of esophageal three-dimensional radiotherapy target volume. Materials and Methods: A retrospective collection of 79 esophageal cancer cases imaging and pathology diagnostic data. By reading the piece by two of Radiation Oncology doctors to determine the lesion on the chest CT and barium meal length (L CT and Lx), determine and record the X-ray of the lesion classification and lesions in the CT image on violations length (Lq) of the entire circumference of the esophagus, and the CT and X-ray images the lesion length differential (L CT-X ), esophagoscopy displayed tumor length (Le), postoperative substantially specimens showed tumor length (Lp). According to the reported 0.8 the the retraction than projections tumor in the body length [Ls, Ls (cm) = Lp/0.8]. Compare the various parameters difference, and analysis of the lesion stage, type, full perimeter and esophageal contraction and relaxation of state violations of the impact of L CT-X , as well as lesions proximal and distal L CT-X differences. The size of the average number of paired test was used to compare the various lengths, one-way ANOVA test lesions related characteristics affect L CT-X . Results: different ways to measure esophageal length size of the primary tumor followed by CT and barium meal, projections of the tumor in the body length, esophagoscopy, and lesion length, the average length of specimens were 6.39 ± 2.98cm, 4.87 ± 1.99 Cm 4.38 ± 2.03cm, 4.10 ± 1.85cm, 3.50 ± 1.62cm. Mean comparison L CT Lx long 1.5cm (-2 to 7.5cm) compared Ls long 2cm (-1.88 ~ 9.75cm), the difference was statistically significant (p <0.001). In the the esophagoscopy data collected in 53 cases, L CT than Le mean length of 2.3cm, the difference is also statistically significant (p <0.001). Lx Ls, Le mean the difference between statistical significance (t = 2.888, p = 0.005; t = 3.109, p = 0.003). Le and Ls between the mean difference was not statistically significant (t = -0.337, p = 0.738). The different primary lesion (T) staging the the lesion L CT-X different, the difference between the groups was statistically significant (p = 0.020). T1-T4 L CT-X is -0.21 ± 0.81cm, 1.54 ± 1.50cm, 1.76 ± 1.61cm, 1.75 ± 1.19cm. T4 stage (less the number of cases because of the period) combined with stage T3 test shows T3/T4 lesions L CT-X and T2 compared the difference was not statistically significant (p = 0.542 ). Different lesions L parting of the X-ray CT-X . Which the fungating L CT-X , the smallest, the medullary, ulcers, constrictive difference was statistically significant, p values ??were <0.001,0.008,0.030. The the lesion proximal L CT-X is slightly smaller than the remote, the difference was statistically significant (p = 0.033). No significant difference (p = 0.238, p = 0.463) in the expansion or non-expansion the state L CT-X . Pearson correlation analysis showed to Lq with L CT-X were positively correlated (p <0.001), but small correlation coefficient (r = 0.421). Conclusion: CT displayed the esophageal lesion length greater than X-ray barium meal and surgical specimens showed lesion length, and speculated that the tumor in the body length, CT and barium meal differences in lesion length and lesion T stage, lesion type, lesion infringement full weeks long related to the difference in the length of the lesions on CT and barium meal lesions proximal less than remote. CT lesions longer than barium meal part on whether on behalf of the esophageal wall infiltration or metastasis of submucosal esophageal three-dimensional conformal radiotherapy clinical target volume (CTV) set reference value has clinical significance, pending further research confirmed. Improving esophageal sketched consistency of purpose: the length of the primary tumor with intramuscular 654-2 relaxation esophagus enhanced scan after the third part intramuscular 654-2, enhanced scan at the same time, simple plain CT scan (do not use 654-2) image obtained by contrast, comparing different methods outline esophageal primary foci gross tumor target (GTV) consistency, clear whether the methods help to improve CT images esophageal the GTV sketched in length consistency. MATERIALS AND METHODS: A prospective enrolled who have not yet received any treatment and was cytology or tissue pathology confirmed patients with esophageal cancer. Each of the patients were in the same position, a continuous line twice positioning CT scan, first scan (C-), and second intramuscular of 654-2 injections 10mg ,10-15 minutes underwent enhanced scan (C) . By the high, low seniority Radiation Oncology physician three independent outlined in the two sets of positioning on the CT image esophagus tumor primary tumor roughly the tumor target (the GTV), defined as GTV1 GTV6 length denoted L1-L6 volume denoted as V1-V6. CV target length or volume intersection and set the ratio is defined as the conformal index (CI, Conformable Index) target length or volume of the absolute value of the coefficient of variation in mind, CI greater the CV smaller target consistency Vietnam high. The comparison between the two groups CI and CV differences, and different years of physician target delineation impact of CI and CV. Between the two groups were compared using paired test. Results: 15 cases enrolled, intramuscular 654-2 of the lesions in the proximal esophageal dilatation increased 2 cases (13.3%); the remote 6 patients (40%). L CI of the C-group and group C (45 ± 12)% and (59 ± 19)%, respectively, the difference was statistically significant (p = 0.008); GTV length of the C-group and group C the CV were 0.26 ± 0.09,0.18 ± 0.13, the difference was statistically significant (p = 0.015). Whether in the C-group or C group, Dr. Gao Nianzi sketch GTV length L CI lower seniority slightly larger, but the difference is not statistically significant p-value of 0.552 and 0.109, respectively. . Between the C-and C group L CI , whether senior or junior doctors, C group L CI were greater than the average L-C-< sub> CI , the difference between the two tend to be statistically significant p-value of 0.071 and 0.053, respectively. V CI of the C-group and group C, respectively (32 ± 9)% and (35 ± 11)%, the difference was not statistically significant (p = 0.349); GTV volume of the C-group and group C CV were ± 0.09 is 0.206 ± 0.09,0.209, the difference was not statistically significant (p = 0.919). Conclusion: intramuscular 654-2 contribute to expansion of the esophagus, coupled with enhanced scan, can increase the objectivity of judgment lesions, thereby improving different physician outlining the consistency of the target length.
|