【摘要】 目的 评价基于MR多模态成像的脑转移瘤放疗靶区（GTV）勾画的一致性。方法 回顾性分析本院23例经立体定向放射治疗（SRT）的脑转移瘤病例,术前均行常规MRI扫描、增强扫描和扩散加权成像（DWI）的多模态成像。分别在MR增强T₁WI轴位、T₂ FLAIR轴位、表观扩散系数（ADC）轴位图像上手动勾画肿瘤轮廓并以面积求和法计算GTV,再将测量获得的GTV根据MR模态的不同分成T₁WI+C组、T₂ FLAIR组和ADC组。采用Bland-Altman法评价多模态MR图像勾画脑转移瘤GTV结果的一致性,组内相关系数（ICC）和克隆巴赫系数（Cronbach’s alpha）评价观察者间一致性及测量数据的重复性。结果 T₁WI+C与T₂FLAIR组、T₂FLAIR与ADC组、T₁WI+C与ADC组95%一致性界限（95%LOA）分别为:-286.4～275.3 mm³、-284.8～168.5 mm³和-395.4～290.1 mm³。不同测量者所测得脑转移瘤GTV的ICC在0.957～0.976之间,Cronbach’s alpha均>0.8。结论 基于MR多模态的脑转移瘤GTV测量在观测者间具有较好的重复性,MR多模态下测量脑转移瘤GTV的一致性欠佳,不能相互替代,MR增强T₁WI联合T₂ FLAIR、DWI可能有助于脑转移瘤GTV的精准勾画。更多还原

【Abstract】 Objective To investigate the consistency of multiple MR modalities in measurement of gross tumor volume（GTV） in brain metastascs.Methods The clinical datas of 23 patients with brain metastascs treated by stereotactic radio therapy（SRT） in our hospital was analyzed retrospectively.All patients underwent routine MR I scan,enhanced scan and diffusion-weighted imaging（DWI）.The tumor contour was mannully delincated on axial MR enhanced T₁ WI,T₂ FLAIR and ADC images,and GTV was calculated by arca summation methoed.Then the mcasured GTV was divided into T₁WI+C group,T₂ FLAIR group and ADC group according to the different modes of MR.Bland-Altman method was used to evaluate the consistency of GTV results in multiple MR.The correlation coefficients of intra-class correlation cocfficient（ICC） and Cronbach’s alpha cocfficient were used to evaluate inter-observer agreement and reproducibility of mcasurement data.Results The 95% consistency limits（95%LOA）of T₁ WI+C and T₂ FLAIR,T₂ FLAIR and ADC,T₁ WI+C and ADC groups were（-286.4-275.3）mm³,（-284.8-168.5）mm³ and（-395.4-290.1）mm³ respectively.The ICC of brain mctastatic tumor GTV measured by different measurers were between 0.957-0.976,and Cronbach’s alpha coefficient was greater than 0.8.Conclusion The multiple MR modalities has good reproducibility among different observers in measurement of GTV for brain mctastascs.The multiple MR modalities have poor consistency in measurement of GTV for brain metastascs,which can not be replaced by each other.MR enhanced T₁ WI combined with T₂ FLAIR and DWI may contribute to determine a relatively accurate range of the target volume for brain mctastascs.更多还原