脊索瘤质子放疗中能谱CT参数与MRI ADC变化的相关性研究

国际肿瘤学杂志››2025,Vol. 52››Issue (7): 441-447.doi:10.3760/cma.j.cn371439-20250217-00077

脊索瘤质子放疗中能谱CT参数与MRI ADC变化的相关性研究

徐渐¹^,², 段敬豪¹^,², 刘庆增¹^,², 朱健¹^,²()

¹山东省肿瘤防治研究院（山东省肿瘤医院）放射物理技术科，bobapp1中国有限公司（山东省医学科学院），济南 250117
²山东省医药卫生儿童肿瘤精确放疗重点实验室（山东省肿瘤医院），济南 250117

收稿日期:2025-02-17修回日期:2025-04-24出版日期:2025-07-08发布日期:2025-07-23
通讯作者:朱健 E-mail:zhujian@sdfmu.edu.cn
基金资助:
国家科技重大专项(2024ZD0519901);国家自然科学基金(12105160);国家自然科学基金(82172072);山东省重点研发计划(2024CXPT084);山东省自然科学基金(ZR2021QA099);山东省自然科学基金(ZR2022QH188);山东省高等学校青年创新团队发展计划(2024KJJ013);山东省青年科技人才托举工程(SDAST2024QTB034)

Correlation study of spectral CT parameters and MRI ADC changes in proton radiotherapy for chordoma

Xu Jian¹^,², Duan Jinghao¹^,², Liu Qingzeng¹^,², Zhu Jian¹^,²()

¹Department of Radiation Oncology Physics，Shandong Cancer Hospital and Institute，Shandong First Medical University and Shandong Academy of Medical Sciences，Jinan 250117，China
²Shandong Provincial Key Medical and Health Laboratory of Pediatric Cancer Precision Radiotherapy （Shandong Cancer Hospital），Jinan 250117，China

Received:2025-02-17Revised:2025-04-24Online:2025-07-08Published:2025-07-23
Contact:Zhu Jian E-mail:zhujian@sdfmu.edu.cn
Supported by:
National Science and Technology Major Project of China(2024ZD0519901);National Natural Science Foundation of China(12105160);National Natural Science Foundation of China(82172072);Key R&D Program of Shandong Province，China(2024CXPT084);Natural Science Foundation of Shandong Province of China(ZR2021QA099);Natural Science Foundation of Shandong Province of China(ZR2022QH188);Youth Innovation Team Development Plan of Shandong Universities(2024KJJ013);Shandong Provincial Young Science and Technology Talent Support Project(SDAST2024QTB034)

摘要/Abstract

摘要：

目的初步探索脊索瘤患者质子放疗前能谱CT定量参数与放疗前后MRI表观扩散系数（ADC）变化的相关性。方法回顾性分析2022年8月至2024年12月于山东省肿瘤防治研究院（山东省肿瘤医院）行质子放疗的28例脊索瘤患者的影像数据。收集治疗前能谱CT图像中病灶区域的相对碘浓度（RIC）、电子密度（ED）、有效原子序数（Z_eff）及能谱曲线斜率（λHU）4个参数。同时收集放疗前后的MRI-DWI图像中ADC差值，记为ΔADC。通过散点图、一元线性回归、LOWESS曲线、相关性矩阵及Bootstrap等方法评估能谱CT参数与ΔADC之间的相关性。结果28例患者治疗前ADC为1 137.05（921.07，1 643.91），治疗后ADC为1 197.10（994.75，1 785.57），ΔADC为133.18（-36.46，253.04）；RIC为0.45（0.12，0.67），ED为38.01±12.72，Z_eff为8.40±0.64，λHU为-2.20±1.05。散点图结果显示，RIC与ΔADC之间的点状分布呈现正向趋势；λHU与ΔADC之间的点状分布呈现负向趋势。一元线性回归结果显示，RIC与ΔADC的拟合优度最高（R²=0.75），回归系数最大（β=518.34）；其次为λHU（R²=0.64，β=-121.94）；Z_eff与ΔADC的拟合优度较低（R²=0.25）；ED与ΔADC未发现相关关系。LOWESS曲线拟合结果与一元线性回归模型一致，未发现明显偏离趋势。相关性矩阵显示，RIC与ΔADC呈正相关（r=0.88，P<0.001），Z_eff与ΔADC呈中等正相关（r=0.51，P=0.006），λHU与ΔADC呈负相关（r=-0.84，P<0.001）。Bootstrap重抽样分析结果显示，RIC、Z_eff、λHU与ΔADC的r值分别为0.87、0.50、-0.80。结论脊索瘤患者质子放疗前能谱CT参数RIC与ΔADC呈正相关，λHU与ΔADC呈负相关。

关键词:脊索瘤,质子疗法,治疗结果,能谱CT

Abstract:

ObjectiveTo preliminarily explore the correlation between the quantitative parameters of spectral CT before proton radiotherapy and the changes in apparent diffusion coefficient （ADC） of MRI before and after radiotherapy in chordoma patients.MethodsA retrospective analysis was conducted on imaging data from 28 patients with chordoma who underwent proton radiotherapy at Shandong Cancer Hospital and Institute from August 2022 to December 2024. Spectral CT images obtained prior to treatment were used to extract four quantitative parameters of the lesion area： relative iodine concentration （RIC），electron density （ED），effective atomic number （Z_eff），and the slope of spectral attenuation curve （λHU）. In parallel，MRI-DWI scans before and after treatment were collected to compute the ADC difference （ΔADC）. The correlation between spectral CT parameters and ΔADC was assessed using scatter plots，simple linear regression，LOWESS curve fitting，correlation matrix，and bootstrap resampling methods.ResultsThe ADC of 28 patients was 1 137.05 （921.07，1 643.91） before treatment，and 1 197.10 （994.75，1 785.57） after treatment，and the ΔADC was 133.18 （-36.46，253.04）. The RIC was 0.45 （0.12，0.67），the ED was 38.01±12.72，the Z_effwas 8.40±0.64，and the λHU was -2.20±1.05. The scatter plots results indicated a positive distribution trend between RIC and ΔADC，and a negative trend between λHu and ΔADC. Simple linear regression showed that RIC had the highest goodness of fit with ΔADC （R²=0.75） and the largest regression coefficient （β=518.34），followed by λHU （R²=0.64，β=-121.94）. The goodness of fit between Z_effand ΔADC was low （R²=0.25）. No correlation was found between ED and ΔADC. LOWESS curve fitting showed a consistent trend with simple linear regression results，without significant deviation. The correlation matrix indicated that RIC was positively correlated with ΔADC （r=0.88，P<0.001），Z_effwas moderately positively correlated with ΔADC （r=0.51，P=0.006），and λHU was negatively correlated with ΔADC （r=-0.84，P<0.001）. Bootstrap resampling analysis showed that thervalues of RIC，Z_eff，λHU and ΔADC were 0.87，0.50，-0.80，respectively.ConclusionsThe spectral CT parameter RIC of chordoma patients before proton radiotherapy is positively correlated with ΔADC，while λHU exhibits a negative correlation with ΔADC.

Key words:Chordoma,Proton therapy,Treatment outcome,Spectral CT

徐渐, 段敬豪, 刘庆增, 朱健. 脊索瘤质子放疗中能谱CT参数与MRI ADC变化的相关性研究[J]. 国际肿瘤学杂志, 2025, 52(7): 441-447.

Xu Jian, Duan Jinghao, Liu Qingzeng, Zhu Jian. Correlation study of spectral CT parameters and MRI ADC changes in proton radiotherapy for chordoma[J]. Journal of International Oncology, 2025, 52(7): 441-447.

图/表8

表1

28例脊索瘤患者基本情况及能谱CT和MRI参数"

患者序号	性别	年龄（岁）	治疗前ADC	治疗后ADC	ΔADC	RIC	ED	Z_eff	λHU
1	男	48	2 026.61	2 103.38	76.77	0.28	29.20	8.00	-1.47
2	女	43	1 135.47	1 183.61	48.14	0.27	31.30	7.98	-1.38
3	女	47	917.53	1 050.97	133.44	0.68	57.00	9.56	-2.83
4	女	55	1 703.71	2 114.32	410.61	0.67	48.60	8.94	-2.78
5	女	37	540.21	990.76	450.55	0.57	43.77	9.01	-4.59
6	女	39	1 125.49	1 315.15	189.66	0.73	45.90	9.32	-4.38
7	女	35	767.28	900.19	132.91	0.49	36.57	8.65	-2.85
8	女	71	776.14	837.58	61.44	0.23	46.81	8.15	-1.41
9	男	51	1 138.63	1 169.92	31.29	0.08	36.70	6.95	-1.71
10	女	56	1 296.67	1 166.64	-130.03	0.06	4.10	7.65	-1.26
11	女	37	1 675.22	2 023.13	347.91	0.76	32.99	8.97	-1.74
12	男	40	1 045.96	970.66	-75.30	0.05	29.40	7.93	-0.98
13	女	50	1 070.38	1 006.73	-63.65	0.08	20.90	7.48	-0.76
14	男	57	849.22	790.18	-59.04	0.18	11.30	7.32	-1.60
15	男	46	1 734.45	1 816.02	81.57	0.37	50.67	8.04	-1.61
16	男	49	931.69	1 093.04	161.35	0.57	34.26	8.31	-2.81
17	女	46	1 723.22	1 995.74	272.52	0.77	52.89	8.42	-3.36
18	男	52	1 294.84	1 513.38	218.54	0.59	44.54	8.26	-2.69
19	女	63	1 347.96	1 255.26	-92.70	0.15	53.57	8.17	-1.16
20	男	57	1 158.03	1 210.59	52.56	0.41	32.93	8.31	-1.72
21	男	51	1 682.53	1 918.93	236.40	0.66	30.00	8.56	-2.81
22	女	52	810.45	739.82	-70.63	0.05	50.19	8.78	-1.35
23	男	59	1 705.32	1 963.91	258.59	0.67	36.38	8.38	-3.29
24	女	66	729.97	634.21	-95.76	0.08	46.44	9.07	-0.48
25	男	48	1 014.35	1 152.24	137.89	0.11	54.34	9.25	-1.69
26	男	61	1 047.16	1 356.14	308.98	0.79	35.12	9.24	-3.54
27	男	44	1 241.99	1 524.50	282.51	0.71	29.60	8.11	-2.67
28	女	57	1 549.96	1 694.22	144.26	0.49	38.81	8.50	-2.62

表1

影像参数	结果
治疗前ADC	1 137.05（921.07，1 643.91）
治疗后ADC	1 197.10（994.75，1 785.57）
ΔADC	133.18（-36.46，253.04）
RIC	0.45（0.12，0.67）
ED	38.01±12.72
Z_eff	8.40±0.64
λHU	-2.20±1.05

表2

图1

图2

图3

能谱CT参数	截距β₀	回归系数β	拟合优度R²	t值	P值
RIC	-90.57	518.34	0.75	8.75	<0.001
ED	-12.35	3.57	0.08	1.50	0.150
Z_eff	-945.21	127.44	0.25	2.96	0.010
λHU	-144.77	-121.94	0.64	-6.77	<0.001

表3

图4

能谱CT参数	相关系数r	95%CI	P值
RIC	0.87	0.77~0.95	<0.001
ED	0.26	0.16~0.61	0.415
Z_eff	0.50	0.22~0.74	0.006
λHU	-0.80	-0.93~-0.63	<0.001

表4

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