目的:探讨基于四维CT(4D-CT)测定纵隔淋巴结与原发肿瘤位移及肺脏、心脏体积变化率的相关性。方法:选择诊断CT显示纵隔淋巴结转移的非小细胞肺癌(NSCLC)患者19例,获得自由呼吸状态下4D-CT模拟定位扫描图像,分别勾画各时相图像中气管左侧组(1L、2L、4L、5区)、右侧组(1R、2R、4R区)、下组(7、9区)纵隔转移淋巴结及肺内原发肿瘤、肺脏和心脏,获得淋巴结及原发肿瘤在左右(LR)、前后(AP)、上下(SI)方向的位移及相应肺脏和心脏体积变化率,比较同一组淋巴结不同方向位移及不同组淋巴结同一方向位移差异性,并分析淋巴结位移与同侧原发肿瘤位移、肺脏及心脏体积变化率的关联性。结果:在LR方向上,左侧淋巴结位移与左肺内原发灶位移有明显相关性,r=0.929,P=0.022;在AP方向上,左侧淋巴结与左肺内原发肿瘤位移亦呈明显正相关,r=0.965,P=0.008。在LR方向上,左侧淋巴结位移与左肺脏体积变化率呈明显正相关,r=0.605,P=0.037;在AP方向上,右侧淋巴结位移与有肺脏体积变化率呈正相关,r=0.614,P=0.044。在LR方向上,左侧淋巴结位移与心脏体积变化率呈明显正相关,r=0.645,P=0.024;在AP方向上,左侧淋巴结位移与心脏体积变化率呈明显正相关,r=0.779,P=0.003;在SI方向上,左侧淋巴结位移与心脏体积变化率呈明显正相关,r=0.609,P=0.035。结论:自由呼吸状态下,左侧淋巴结LR及AP方向位移与同侧肺内原发肿瘤位移有较好的相关性;左侧肺脏和心脏体积变化率大小能预测气管左侧的1L、2L、4L及5区纵隔转移淋巴结位移。 Objective: To investigate the correlation between the mediastinal lymph nodes and the displacement of primary tumors and the changes of lung and heart volume based on 4D-CT (4D-CT). Methods: Nineteen patients with non-small cell lung cancer (NSCLC) diagnosed by mediastinal lymph node dissection (CT) were selected for diagnosis. Four-dimensional CT scans were performed under free-breathing condition. The left trachea of ​​the trachea (1L, 2L, 4L and 5 zones), the right side (1R, 2R and 4R zones) and the lower (7 and 9 zones) mediastinal lymph nodes and primary lung tumors, lung and heart, lymph nodes and primary tumors (AP), up and down (SI) direction and the rate of change of lung and heart volume. The differences of displacement in different directions of the same lymph node group and the same direction of different lymph node groups were compared. The relationship between lymph node metastasis and ipsilateral primary tumor Displacement, lung and heart volume changes in the rate of correlation. Results: In the LR direction, there was a significant correlation between the left lymph node displacement and the left lung primary tumor displacement (r = 0.929, P = 0.022). In the AP direction, the left lymph node and the left lung primary tumor also showed a shift Significantly positive correlation, r = 0.965, P = 0.008. In the LR direction, the left lymph node displacement was positively correlated with the left lung volume change rate (r = 0.605, P = 0.037). In the AP direction, the right lymph node displacement was positively correlated with the lung volume change rate (r = 0.614, P = 0.044. In the LR direction, there was a positive correlation between the left lymph node displacement and the rate of change of the heart volume (r = 0.645, P = 0.024). In the AP direction, the left lymph node displacement was positively correlated with the rate of change of the heart volume P = 0.003; in the SI direction, there was a positive correlation between the left lymph node displacement and the change rate of heart volume (r = 0.609, P = 0.035). CONCLUSION: In free breathing state, the displacement of LR and AP in the left lymph node has a good correlation with the displacement of the primary tumor in the ipsilateral lung. The left lung and heart volume change rate can predict the left tracheal 1L, 2L, 4L and 5 mediastinal lymph node metastasis.