MRI和3DCT血管造影在立体定向放射外科动静脉畸形中的病灶描绘和剂量比较。

IF 0.7 Q4 SURGERY Journal of radiosurgery and SBRT Pub Date : 2022-01-01
Deepak Gupta, Venkatesan Kaliyaperumal, Shyam Singh Bisht, Tejinder Kataria, Susovan Banerjee, Shikha Goyal, Kushal Narang, Gaurav Goel, Anshu Mahajan, Karanjit Narang, Sudhir Dubey
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引用次数: 0

摘要

目的/目的:准确描绘靶区是任何放射手术成功的关键。c臂Dyna CT/ 3DCT血管造影(3DCTA)由于血管结构的高时空分辨率,有可能提高颅内动静脉畸形(AVM)病灶描绘的准确性。在这里,我们提出了数字3DCTA和MRI之间病灶描绘和剂量参数的比较。材料/方法:连续10例颅内动静脉畸形患者纳入本研究。所有患者均行MRI/MRA、3DCTA和所有图像联合登记。采用3DCTA (GTV3DCTA)和增强MRI/MRA (GTVMRI)对AVM进行描绘。分析了豪斯多夫距离矩阵和骰子相似系数矩阵。为所有患者制定了立体定向放疗计划,并采用t检验进行统计分析。结果:GTV3DCTA和GTVMRI的平均体积分别为1.771 cc (SD 1.794cc,范围0.124 ~ 4.191cc)和2.183cc (SD 2.16cc,范围0.221 ~ 6.133cc)。以GTVMRI为主诊与GTV3DCTA比较,MD=0.723cc±0.816cc,差异有统计学意义(p=0.018)。GTV3DCTA为原发性,GTVMRI为继发性,结果相似(MD=0.188cc, SD=0.193cc, p=0.024)。最大HD范围为1.71 ~ 7.44mm (mean=4.27mm, SD=1.56)。对于基于GTV3DCTA的方案,GTVMRI与GTV3DCTA在剂量覆盖上存在显著差异,平均差异为22.17% (SD为16.73)。在基于GTVMRI的方案中,GTVMRI和GTV3DCTA的平均CIRTOG分别从1.33下降到2.18。GTVMRI与GTV3DCTA比较,CIRTOG偏差显著(0.005),平均偏差0.86(SD=0.72)。GTVMRI与GTV3DCTA在基于GTVMRI的方案中的CIPaddick差异极显著(p=0.002),平均差值为0.26(SD=0.4, GTVMRI=0.3, GTV3DCTA=0.46)。结论:与MRA/MRI图像相比,使用3DCTA可显著改变病灶体积。多模态成像是准确的目标描绘和成功的放射手术病灶闭塞的关键。
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Nidus delineation and dosimetric comparison in arteriovenous malformation in stereotactic radiosurgery by using MRI and 3DCT angiography.

Purpose/objectives: Accurate delineation of target is key to any successful radiosurgery. C-arm Dyna CT/ 3DCT angiography (3DCTA) has the potential of improving the accuracy of nidus delineation in intracranial arteriovenous malformations (AVM) due to high temporo-spatial resolution of vessel architecture. Here, we present a comparison of nidus delineation and dosimetric parameters between digital 3DCTA and MRI.

Materials/methods: Ten consecutive patients treated for intracranial AVMs were included in this study. All patients underwent MRI/MRA, and 3DCTA and all images were co-registered. AVM were delineated using 3DCTA (GTV3DCTA) and contrast enhanced MRI/MRA (GTVMRI). Hausdorff distance (HD) matrices and dice similarity coefficient (DSC) matrices were analysed. Stereotactic radiosurgery plans were developed for both the volumes for all patients and statistical analysis were performed with T-test.

Results: Mean volumes of GTV3DCTA and GTVMRI were 1.771 cc (SD 1.794cc, range 0.124-4.191cc) and 2.183cc (SD 2.16cc, range 0.221-6.133cc), respectively. Significant deviation (p=0.018) was found when taking GTVMRI as a primary and comparing it to GTV3DCTA (MD=0.723cc±0.816cc). Similar result was observed with GTV3DCTA as primary and GTVMRI as secondary (MD=0.188cc, SD=0.193cc, p=0.024). Maximum HD was in the range of 1.71 to 7.44mm (mean=4.27mm, SD=1.56). For GTV3DCTA based plans, significant deviation was found between GTVMRI and GTV3DCTA in dose coverage and the mean difference was 22.17% (SD 16.73). In GTVMRI based plans, the mean CIRTOG deteriorated from 1.33 to 2.18 for GTVMRI and GTV3DCTA, respectively. Significant deviation was found in CIRTOG (0.005) and mean deviation was 0.86(SD=0.72) when comparing GTVMRI and GTV3DCTA. Highly significant (p=0.002) deviation was found in CIPaddick between GTVMRI and GTV3DCTA for GTVMRI based plans with mean difference of 0.26(SD=0.4, for GTVMRI=0.3, GTV3DCTA=0.46).

Conclusion: Nidus volume was significantly altered with the use of 3DCTA compared to that of MRA/MRI images. Multimodality imaging is crucial for accurate target delineation, and successful radiosurgical obliteration of nidus.

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