目的:探讨PET－CT 在非小细胞肺癌( Non－small cell lung cancer; NSCLC) 调强放射治疗( Intensitymedulated
radiation therapy; IMRT) 中的应用价值。方法: 分析从2009－04 ～ 2012－09 45 例行IMRT 的NSCLC 病
人，根据其影像学特点将所有病例分为4 组: 12 例中心型无肺不张，12 例中心型伴有肺不张，10 例周围型无胸膜
凹陷，11 例周围型伴有胸膜凹陷。所有病人均进行CT 和PET－CT 检查。通过靶区定义系统比较CT 和PET－CT
勾画的大体肿瘤靶区，通过剂量体积直方图参数比较危及器官剂量分布。结果:所有病例中GTVCT 和GTVPET－CT
都有不同程度的差异。中心型肺癌伴有肺不张和周围型肺癌伴有胸膜凹陷的病人GTV( gross target vdumes;
GTV) CT 均明显大于GTVPET－CT，差异有统计学意义( P＜0． 05) 。而中心型肺癌无肺不张和周围型肺癌无胸膜凹陷
的病人GTVCT 与GTVPET－CT 差异变化不显著( P＞0． 05) 。PlanCT 和PlanPET－CT 计划参数比较在肺V 20、V 30，食管
V 50 和最大剂量，心脏平均剂量显示有显著性差异( P＜0． 05) 。而肺V 5、V 10、平均剂量，心脏V 30 和脊髓最大
剂量，两组差异无统计学意义( P＞0． 05) 。结论: PET－CT 可以提高NSCLC 病人有肺不张和胸膜凹陷的靶区界定
精确性，并减少周围危及器官的损伤。

Objective: To investigate the application value of PET－CT in intensity－modulated radiation
therapy ( IMRT) in patients with non － small cell lung cancer ( NSCLC) ． Methods: Forty five
NSCLC patients who underwent IMRT from April 2009 to September 2012 were included in this study．
All patients were divided into four groups according to image features: 12 cases of central lung cancer
without atelectasis，12 cases of central lung cancer with atelectasis， 10 cases of peripheral lung cancer
without pleural indentation，11 cases of peripheral lung cancer with pleural indentation． CT and PETCT
scanning was performed in these patients． The GTV by CT and by PET－CT( GTVCTand GTVPET－CT)
were compared using a target delineation system，and doses distributions to organs at risk( OARs) were
compared on the basis of dose － volume histogram ( DVH) parameters． Results: The GTVCTand
GTVPET－CThad varying degrees of change in all patients． The GTVCTwere greater than GTVPET－CT in patients
of central lung cancer with atelectasis and peripheral lung cancer with pleural indentation，and
there was statistic difference in two groups( P＜0． 05) ． While there were no significant difference in
GTVCTand GTVPET－CT in patients of central lung cancer without atelectasis and peripheral lung cancer
without pleural indentation ( P ＞0． 05) ． Compared to PlanCTand PlanPET－CTparameters showed varying
degrees of changes in lung V 20，V 30，heart mean heart dose( MHD) ，esophageal V 50 and Dmax were
statistically significant( P＜0． 05) ，while the differences in lung V 5，V 10，mean lung dose( MLD) ，
heart V 30，and spinal cord Dmax were not significant( P＞0． 05) ． Conclusion: PET－CT could improve
the accuracy of target delineation between with atelectasis and pleural indentation，and reduce radiation
damage to the adjacent organs at risk( OARs) in NSCLC patients．

R734． 2

 收稿日期: 2013－04－18; 修回日期: 2013－06－20
基金项目: 内蒙古自然科学基金资助项目( 2013MS11108)
作者简介: 杨昊( 1977－) ，男，内蒙古医科大学附属人民医院放疗科主治医师。
通讯作者: 郁志龙，教授，主任医师，硕士研究生导师，E－mail: richard_yu1961269@ sina． com 内蒙古医科大学附属医院
放疗科， 010050