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Hammoudeh L, Abunimer AM, Lee HY, Dee EC, Brennan S V, Yaguang P, Shin KY, Chen YH, Huynh MA, Spektor A, Guenette JP, Balboni T. Spinal Cord Delineation Based on Computed Tomography Myelogram Versus T2 Magnetic Resonance Imaging in Spinal Stereotactic Body Radiation Therapy. Adv Radiat Oncol 2023; 8:101158. [PMID: 36896211 PMCID: PMC9991542 DOI: 10.1016/j.adro.2022.101158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 12/04/2022] [Indexed: 12/28/2022] Open
Abstract
Purpose Spinal cord delineation is critical to the delivery of stereotactic body radiation therapy (SBRT). Although underestimating the spinal cord can lead to irreversible myelopathy, overestimating the spinal cord may compromise the planning target volume coverage. We compare spinal cord contours based on computed tomography (CT) simulation with a myelogram to spinal cord contours based on fused axial T2 magnetic resonance imaging (MRI). Methods and Materials Eight patients with 9 spinal metastases treated with spinal SBRT were contoured by 8 radiation oncologists, neurosurgeons, and physicists, with spinal cord definition based on (1) fused axial T2 MRI and (2) CT-myelogram simulation images, yielding 72 sets of spinal cord contours. The spinal cord volume was contoured at the target vertebral body volume based on both images. The mixed-effect model assessed comparisons of T2 MRI- to myelogram-defined spinal cord in centroid deviations (deviations in the center point of the cord) through the vertebral body target volume, spinal cord volumes, and maximum doses (0.035 cc point) to the spinal cord applying the patient's SBRT treatment plan, in addition to in-between and within-subject variabilities. Results The estimate for the fixed effect from the mixed model showed that the mean difference between 72 CT volumes and 72 MRI volumes was 0.06 cc and was not statistically significant (95% confidence interval, -0.034, 0.153; P = .1832). The mixed model showed that the mean dose at 0.035 cc for CT-defined spinal cord contours was 1.24 Gy lower than that of MRI-defined spinal cord contours and was statistically significant (95% confidence interval, -2.292, -0.180; P = .0271). Also, the mixed model indicated no statistical significance for deviations in any of the axes between MRI-defined spinal cord contours and CT-defined spinal cord contours. Conclusions CT myelogram may not be required when MRI imaging is feasible, although uncertainty at the cord-to-treatment volume interface may result in overcontouring and hence higher estimated cord dose-maximums with axial T2 MRI-based cord definition.
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Affiliation(s)
- Lubna Hammoudeh
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon
| | - Abdullah M Abunimer
- Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Orthopedic Surgery, Hamad General Hospital, Doha, Qatar
| | - Ho Young Lee
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.,Harvard Medical School, Boston, Massachusetts
| | - Victoria Brennan S
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Pei Yaguang
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Kee-Young Shin
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Yu-Hui Chen
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Mai Anh Huynh
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Alexander Spektor
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Jeffrey P Guenette
- Division of Neuroradiology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Tracy Balboni
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
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Shimizu H, Koide Y, Sasaki K, Watanabe Y, Haimoto S, Aoyama T, Tachibana H, Iwata T, Kitagawa T, Kodaira T. Dosimetric analysis on computed tomography myelography based treatment planning in stereotactic body radiotherapy for spinal metastases. Med Dosim 2023:S0958-3947(23)00029-8. [PMID: 37068981 DOI: 10.1016/j.meddos.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/20/2023] [Accepted: 03/20/2023] [Indexed: 04/19/2023]
Abstract
This study aimed to quantitatively evaluate the influence of enhanced contrast on the CT myelography image of the spinal cord and/or cauda equina in addition to the target volume in spine SBRT treatment planning. In total, 19 patients who had previously undergone spine SBRT were randomly selected. The rigid image registration accuracy of CT myelography that aligned with the treatment planning CT was evaluated by calculating the normalized mutual information (NMI) and Pearson's correlation coefficient for the vertebral landmarks. At postregistration, the contrast-enhanced region of the CT myelography image was replaced with water-mass density, and the original treatment plan was recalculated on this image. For comparison, the dose was also recalculated on the contrast-enhanced CT myelography images. The NMI and Pearson's correlation coefficients for landmarks were 0.39 ± 0.12 and 0.97 ± 0.04, respectively. The mean D0.035cc of the spinal cord and/or cauda equina on the CT myelography image with the contrast-enhanced region replaced by water-mass density showed -0.37% ± 0.64% changes compared with that of the treatment planning CT. Conversely, the mean D0.035cc in contrast-enhanced CT myelography changed by -1.39% ± 0.51%. The percentage change in D98% for the planning target volume was confirmed to be small by replacing the contrast-enhanced region with water-mass density (p < 0.01). The dose calculation of the target volume, spinal cord, and/or cauda equina using the CT myelography image that replaced the contrast-enhanced region with water-mass density could be a more appropriate procedure with less dose calculation uncertainty.
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Affiliation(s)
- Hidetoshi Shimizu
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya, Aichi, 464-8681, Japan.
| | - Yutaro Koide
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya, Aichi, 464-8681, Japan
| | - Koji Sasaki
- Graduate School of Radiological Technology, Gunma Prefectural College of Health Sciences, Maebashi, Gunma, 371-0052, Japan
| | - Yui Watanabe
- Radiation Therapy Center, Yachiyo Hospital, Anjyo, Aichi, 446-8510, Japan
| | - Shoichi Haimoto
- Department of Neurosurgery, Aichi Cancer Center Hospital, Nagoya, Aichi, 464-8681, Japan
| | - Takahiro Aoyama
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya, Aichi, 464-8681, Japan; Graduate School of Medicine, Aichi Medical University, Nagakute, Aichi, 480-1195, Japan
| | - Hiroyuki Tachibana
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya, Aichi, 464-8681, Japan
| | - Tohru Iwata
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya, Aichi, 464-8681, Japan
| | - Tomoki Kitagawa
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya, Aichi, 464-8681, Japan
| | - Takeshi Kodaira
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya, Aichi, 464-8681, Japan
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Qualitative Assessment of Titanium versus Carbon Fiber/Polyetheretherketone Pedicle Screw-Related Artifacts: A Cadaveric Study. World Neurosurg 2022; 166:e155-e162. [PMID: 35803562 DOI: 10.1016/j.wneu.2022.06.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/24/2022] [Accepted: 06/25/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Dorsal instrumentation and decompression are the mainstays of spinal tumor treatment. Replacing titanium screws with carbon fiber-reinforced polyetheretherketone (CFRP) screws can reduce imaging artifacts on neural structures and perturbations of radiation dose. Further reduction of metal content in such screws might enhance the benefit. The aim of this study was to assess the artifacts produced by all-titanium screws (Ti-Ti), CFRP thread-titanium screw heads (C-Ti), and all-CFRP screws (C-C). METHODS A cadaveric spine was used to place Ti-Ti, C-Ti, and C-C consecutively from T2 to S1. Computed tomography and 1.5T and 3T magnetic resonance imaging were performed for each screw system. Axial T1- and T2-weighted sequences of representative thoracic and lumbar regions were assessed for artifacts. The artifacts were classified as not relevant, considerable, or severe. RESULTS We evaluated 92 screws and made 178 artifact assessments. The artifacts were clearly visible in computed tomography scans but did not influence the visualization of intraspinal structures. Severe magnetic resonance imaging artifacts were found in 28% (17/60, mostly in the thoracic spine) of Ti-Ti, 2% (1/60, all T1 sequences) of C-Ti, and 0% of C-C, and considerable artifacts were found in 47% (28/60) of Ti-Ti, 10% (6/60, only 1 T2 sequence) of C-Ti, and 0% of C-C screws (P < 0.001). CONCLUSIONS CFRP pedicle screws reduced the artifact intensity in spinal structures compared with titanium screws, and may be beneficial for planning radiotherapy and for follow-up imaging. C-C demonstrated an enhanced effect on dorsal structures.
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Patel DM, Weinberg BD, Hoch MJ. CT Myelography: Clinical Indications and Imaging Findings. Radiographics 2020; 40:470-484. [DOI: 10.1148/rg.2020190135] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Dhruv M. Patel
- From the Division of Neuroradiology, Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga
| | - Brent D. Weinberg
- From the Division of Neuroradiology, Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga
| | - Michael J. Hoch
- From the Division of Neuroradiology, Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga
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Spieler B, Samuels SE, Llorente R, Yechieli R, Ford JC, Mellon EA. Advantages of Radiation Therapy Simulation with 0.35 Tesla Magnetic Resonance Imaging for Stereotactic Ablation of Spinal Metastases. Pract Radiat Oncol 2019; 10:339-344. [PMID: 31783168 DOI: 10.1016/j.prro.2019.10.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/18/2019] [Accepted: 10/29/2019] [Indexed: 11/24/2022]
Abstract
The hybrid 0.35T magnetic resonance imaging (MRI) and radiation therapy system functions in part as a simulation platform for treatment planning. We have found that the images generated are particularly helpful for planning of stereotactic radiation therapy for spinal metastases. Advantages include the following: (1) Low-field MRI mitigates magnetic susceptibility artifacts caused by spinal hardware. (2) Volumetric pulse sequence provides isotropic images for improved target delineation. (3) Wide-bore MRI in the radiation oncology department allows for easy simulation in treatment position for accurate fusion across imaging modalities. (4) When patients are treated on the MRI and radiation therapy hybrid device, adaptive radiation therapy is available for special situations to avoid mobile organs at risk.
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Affiliation(s)
- Benjamin Spieler
- Department of Radiation Oncology, Miller School of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | - Stuart E Samuels
- Department of Radiation Oncology, Miller School of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | - Ricardo Llorente
- Department of Radiation Oncology, Miller School of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | - Raphael Yechieli
- Department of Radiation Oncology, Miller School of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | - John Chetley Ford
- Department of Radiation Oncology, Miller School of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | - Eric A Mellon
- Department of Radiation Oncology, Miller School of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida.
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Wang B, Zhang L, Yang S, Han S, Jiang L, Wei F, Yuan H, Liu X, Liu Z. Atypical Radiographic Features of Aggressive Vertebral Hemangiomas. J Bone Joint Surg Am 2019; 101:979-986. [PMID: 31169574 DOI: 10.2106/jbjs.18.00746] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Vertebral hemangioma (VH) is one of the most common benign spinal tumors and can be aggressive in some cases. While most aggressive VHs have typical radiographic features, including vertical striations, a honeycomb appearance, and/or a "polka-dot sign" in computed tomography (CT) scans, cases with atypical features might complicate diagnosis. This study aimed to determine the range and frequency of these atypical features. METHODS In this retrospective study, to identify the typical and atypical features of aggressive VH, pretreatment CT and magnetic resonance imaging (MRI) were reviewed retrospectively by 1 radiologist and 1 orthopaedic surgeon. Percutaneous biopsies were performed to confirm the VH in atypical cases. RESULTS A total of 95 patients with aggressive VHs were treated in our hospital from January 2005 to December 2017. Thirty-four (36%) of the lesions showed at least 1 atypical radiographic feature: 16 patients (17%) had a vertebral compression fracture, 11 patients (12%) had expansive and/or osteolytic bone destruction without a honeycomb appearance and/or "polka-dot sign", 11 patients (12%) had obvious epidural osseous compression of the spinal cord, 12 patients (13%) had involvement of >1 segment, 9 patients (10%) had a VH centered in the pedicle and/or lamina, and 8 patients (8%) had atypical MRI signals. Forty-three patients underwent percutaneous biopsies, which had an accuracy of 86%. CONCLUSIONS Based on radiographic analysis, aggressive VH can be classified as typical or atypical. More than one-third of aggressive VH lesions may have at least 1 atypical feature. CT-guided biopsies are indicated for these atypical cases.
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Affiliation(s)
- Ben Wang
- Orthopaedic Department (B.W., L.J., F.W., X.L., and Z.L.) and Department of Radiology (L.Z., S.H., and H.Y.), Peking University Third Hospital, Beijing, China.,Department of Pathology (S.Y.), Peking University Health and Science Center (B.W.), Beijing, China
| | - Lihua Zhang
- Orthopaedic Department (B.W., L.J., F.W., X.L., and Z.L.) and Department of Radiology (L.Z., S.H., and H.Y.), Peking University Third Hospital, Beijing, China
| | - Shaomin Yang
- Department of Pathology (S.Y.), Peking University Health and Science Center (B.W.), Beijing, China
| | - Songbo Han
- Orthopaedic Department (B.W., L.J., F.W., X.L., and Z.L.) and Department of Radiology (L.Z., S.H., and H.Y.), Peking University Third Hospital, Beijing, China
| | - Liang Jiang
- Orthopaedic Department (B.W., L.J., F.W., X.L., and Z.L.) and Department of Radiology (L.Z., S.H., and H.Y.), Peking University Third Hospital, Beijing, China
| | - Feng Wei
- Orthopaedic Department (B.W., L.J., F.W., X.L., and Z.L.) and Department of Radiology (L.Z., S.H., and H.Y.), Peking University Third Hospital, Beijing, China
| | - Huishu Yuan
- Orthopaedic Department (B.W., L.J., F.W., X.L., and Z.L.) and Department of Radiology (L.Z., S.H., and H.Y.), Peking University Third Hospital, Beijing, China
| | - Xiaoguang Liu
- Orthopaedic Department (B.W., L.J., F.W., X.L., and Z.L.) and Department of Radiology (L.Z., S.H., and H.Y.), Peking University Third Hospital, Beijing, China
| | - Zhongjun Liu
- Orthopaedic Department (B.W., L.J., F.W., X.L., and Z.L.) and Department of Radiology (L.Z., S.H., and H.Y.), Peking University Third Hospital, Beijing, China
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