Korean J Radiol.  2012 Aug;13(4):417-424. 10.3348/kjr.2012.13.4.417.

Measurement of Intra-Fraction Displacement of the Mediastinal Metastatic Lymph Nodes Using Four-Dimensional CT in Non-Small Cell Lung Cancer

• Wang S
• Li J
• Zhang Y
• Wang W
• Li F
• Fan T
• Xu M
• Shao Q

• KMID: 1383853
• DOI: http://doi.org/10.3348/kjr.2012.13.4.417

Abstract

OBJECTIVE
To measure the intra-fraction displacements of the mediastinal metastatic lymph nodes by using four-dimensional CT (4D-CT) in non-small cell lung cancer (NSCLC).
MATERIALS AND METHODS
Twenty-four patients with NSCLC, who were to be treated by using three dimensional conformal radiation therapy (3D-CRT), underwent a 4D-CT simulation during free breathing. The mediastinal metastatic lymph nodes were delineated on the CT images of 10 phases of the breath cycle. The lymph nodes were grouped as the upper, middle and lower mediastinal groups depending on the mediastinal regions. The displacements of the center of the lymph node in the left-right (LR), anterior-posterior (AP), and superior-inferior (SI) directions were measured.
RESULTS
The mean displacements of the center of the mediastinal lymph node in the LR, AP, and SI directions were 2.24 mm, 1.87 mm, and 3.28 mm, respectively. There were statistically significant differences between the displacements in the SI and LR, and the SI and AP directions (p < 0.05). For the middle and lower mediastinal lymph nodes, the displacement difference between the AP and SI was statistically significant (p = 0.005; p = 0.015), while there was no significant difference between the LR and AP directions (p < 0.05).
CONCLUSION
The metastatic mediastinal lymph node movements are different in the LR, AP, and SI directions in patients with NSCLC, particularly for the middle and lower mediastinal lymph nodes. The spatial non-uniform margins should be considered for the metastatic mediastinal lymph nodes in involved-field radiotherapy.

Keyword

Non-small cell lung cancer; Four-dimensional computed tomography; Mediastinal lymph nodes; Displacement measurement

MeSH Terms

Adult
Aged
Aged, 80 and over
Carcinoma, Non-Small-Cell Lung/*radiography/radiotherapy
Contrast Media/diagnostic use
Female
Four-Dimensional Computed Tomography/*methods
Humans
Iohexol/analogs & derivatives/diagnostic use
Lung Neoplasms/*radiography/radiotherapy
Lymphatic Metastasis/*radiography
Male
Mediastinum/radiography
Middle Aged
Radiographic Image Interpretation, Computer-Assisted
Statistics, Nonparametric

Figure

• 

  Fig. 1 Four-dimensional computed tomography image of 0% phase showing contours of 2R lymph node. These contours are drawn in all of 10 phases and mapped to current image. A. Transverse view. B. Sagittal view. C. Coronal view.

• 

  Fig. 2 Correlation between mediastinal lymph node displacement and ipsilateral diaphragm dome movement in superior-inferior direction.

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