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Gill RR, Richards WG, Heiling H, Mazzola E, Hung YP, Seethamraju RT, Chirieac LR, Bueno R. Predictive potential of MRI in differentiating the predominant component in biphasic pleural mesothelioma. Eur J Radiol 2024; 176:111527. [PMID: 38810438 DOI: 10.1016/j.ejrad.2024.111527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/30/2024] [Accepted: 05/23/2024] [Indexed: 05/31/2024]
Abstract
PURPOSE To assess the potential of apparent diffusion coefficient (ADC) values derived from diffusion weighted (DW) MRI preoperatively to predict the predominant histologic component among biphasic pleural mesothelioma (PM) tumors. METHODS ADC maps were generated from DW MRI scans. Histology and predominant component of biphasic PM were confirmed following surgical resection. Statistical analyses were done with R (R Foundation for Statistical Computing, Vienna, Austria). Average ADC values corresponding to epithelioid- and sarcomatoid-predominant tumors were compared. ADC thresholding was accomplished by recursive partitioning and confirmed with ROC analysis. RESULTS Eighty-four patients with biphasic PM's, 69 (82 %) epithelioid-predominant (BE) and 15(18 %) sarcomatoid-predominant (BS) tumors were evaluated. Thirty-eight (45 %) patients underwent extrapleural pneumonectomy (EPP), 39 (46 %) had extended pleural decortication (ePDC) and 7 (8 %) had pleural decortication (PDC). ADC values ranged between 0.696 x 10-3 to 1.921 x 10-3 mm2/s. BE tumors demonstrated significantly higher ADC values than BS tumors (p = 0.026). ADC values above 0.94 x 10-3 mm2/s were associated with a significant increase of relative risk of being in group BE over group BS (relative risk: 1.47, 95 %CI: 1.05-2.06, p = 0.027) CONCLUSION: Average ADC values of BE tumors were higher than BS tumors and the two groups can be separated by a cut off value of 0.94 X 10-3 mm2/s.
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Affiliation(s)
- Ritu R Gill
- Beth Israel Deaconess Medical Center, Boston, MA, United States.
| | | | | | | | - Yin P Hung
- Masschussets General Hospital, Boston, MA, United States
| | | | | | - Raphael Bueno
- Brigham and Women's Hospital, Boston, MA, United States
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2
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McDonald BA, Dal Bello R, Fuller CD, Balermpas P. The Use of MR-Guided Radiation Therapy for Head and Neck Cancer and Recommended Reporting Guidance. Semin Radiat Oncol 2024; 34:69-83. [PMID: 38105096 DOI: 10.1016/j.semradonc.2023.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Although magnetic resonance imaging (MRI) has become standard diagnostic workup for head and neck malignancies and is currently recommended by most radiological societies for pharyngeal and oral carcinomas, its utilization in radiotherapy has been heterogeneous during the last decades. However, few would argue that implementing MRI for annotation of target volumes and organs at risk provides several advantages, so that implementation of the modality for this purpose is widely accepted. Today, the term MR-guidance has received a much broader meaning, including MRI for adaptive treatments, MR-gating and tracking during radiotherapy application, MR-features as biomarkers and finally MR-only workflows. First studies on treatment of head and neck cancer on commercially available dedicated hybrid-platforms (MR-linacs), with distinct common features but also differences amongst them, have also been recently reported, as well as "biological adaptation" based on evaluation of early treatment response via functional MRI-sequences such as diffusion weighted ones. Yet, all of these approaches towards head and neck treatment remain at their infancy, especially when compared to other radiotherapy indications. Moreover, the lack of standardization for reporting MR-guided radiotherapy is a major obstacle both to further progress in the field and to conduct and compare clinical trials. Goals of this article is to present and explain all different aspects of MR-guidance for radiotherapy of head and neck cancer, summarize evidence, as well as possible advantages and challenges of the method and finally provide a comprehensive reporting guidance for use in clinical routine and trials.
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Affiliation(s)
- Brigid A McDonald
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Riccardo Dal Bello
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Panagiotis Balermpas
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
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3
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McDonald BA, Salzillo T, Mulder S, Ahmed S, Dresner A, Preston K, He R, Christodouleas J, Mohamed ASR, Philippens M, van Houdt P, Thorwarth D, Wang J, Shukla Dave A, Boss M, Fuller CD. Prospective evaluation of in vivo and phantom repeatability and reproducibility of diffusion-weighted MRI sequences on 1.5 T MRI-linear accelerator (MR-Linac) and MR simulator devices for head and neck cancers. Radiother Oncol 2023; 185:109717. [PMID: 37211282 PMCID: PMC10527507 DOI: 10.1016/j.radonc.2023.109717] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 05/12/2023] [Accepted: 05/13/2023] [Indexed: 05/23/2023]
Abstract
INTRODUCTION Diffusion-weighted imaging (DWI) on MRI-linear accelerator (MR-linac) systems can potentially be used for monitoring treatment response and adaptive radiotherapy in head and neck cancers (HNC) but requires extensive validation. We performed technical validation to compare six total DWI sequences on an MR-linac and MR simulator (MR sim) in patients, volunteers, and phantoms. METHODS Ten human papillomavirus-positive oropharyngeal cancer patients and ten healthy volunteers underwent DWI on a 1.5 T MR-linac with three DWI sequences: echo planar imaging (EPI), split acquisition of fast spin echo signals (SPLICE), and turbo spin echo (TSE). Volunteers were also imaged on a 1.5 T MR sim with three sequences: EPI, BLADE (vendor tradename), and readout segmentation of long variable echo trains (RESOLVE). Participants underwent two scan sessions per device and two repeats of each sequence per session. Repeatability and reproducibility within-subject coefficient of variation (wCV) of mean ADC were calculated for tumors and lymph nodes (patients) and parotid glands (volunteers). ADC bias, repeatability/reproducibility metrics, SNR, and geometric distortion were quantified using a phantom. RESULTS In vivo repeatability/reproducibility wCV for parotids were 5.41%/6.72%, 3.83%/8.80%, 5.66%/10.03%, 3.44%/5.70%, 5.04%/5.66%, 4.23%/7.36% for EPIMR-linac, SPLICE, TSE, EPIMR sim, BLADE, RESOLVE. Repeatability/reproducibility wCV for EPIMR-linac, SPLICE, TSE were 9.64%/10.28%, 7.84%/8.96%, 7.60%/11.68% for tumors and 7.80%/9.95%, 7.23%/8.48%, 10.82%/10.44% for nodes. All sequences except TSE had phantom ADC biases within ± 0.1x10-3 mm2/s for most vials (EPIMR-linac, SPLICE, and BLADE had 2, 3, and 1 vials out of 13 with larger biases, respectively). SNR of b = 0 images was 87.3, 180.5, 161.3, 171.0, 171.9, 130.2 for EPIMR-linac, SPLICE, TSE, EPIMR sim, BLADE, RESOLVE. CONCLUSION MR-linac DWI sequences demonstrated near-comparable performance to MR sim sequences and warrant further clinical validation for treatment response assessment in HNC.
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Affiliation(s)
| | | | - Samuel Mulder
- The University of Texas MD Anderson Cancer Center, USA
| | - Sara Ahmed
- The University of Texas MD Anderson Cancer Center, USA
| | | | | | - Renjie He
- The University of Texas MD Anderson Cancer Center, USA
| | | | | | | | | | | | - Jihong Wang
- The University of Texas MD Anderson Cancer Center, USA
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4
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Rahbek S, Schakel T, Mahmood F, Madsen KH, Philippens MEP, Hanson LG. Optimized flip angle schemes for the split acquisition of fast spin-echo signals (SPLICE) sequence and application to diffusion-weighted imaging. Magn Reson Med 2023; 89:1469-1480. [PMID: 36420920 PMCID: PMC10099388 DOI: 10.1002/mrm.29545] [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: 04/29/2022] [Revised: 10/21/2022] [Accepted: 11/14/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE The diffusion-weighted SPLICE (split acquisition of fast spin-echo signals) sequence employs split-echo rapid acquisition with relaxation enhancement (RARE) readout to provide images almost free of geometric distortions. However, due to the varying T 2 $$ {}_2 $$ -weighting during k-space traversal, SPLICE suffers from blurring. This work extends a method for controlling the spatial point spread function (PSF) while optimizing the signal-to-noise ratio (SNR) achieved by adjusting the flip angles in the refocusing pulse train of SPLICE. METHODS An algorithm based on extended phase graph (EPG) simulations optimizes the flip angles by maximizing SNR for a flexibly chosen predefined target PSF that describes the desired k-space density weighting and spatial resolution. An optimized flip angle scheme and a corresponding post-processing correction filter which together achieve the target PSF was tested by healthy subject brain imaging using a clinical 1.5 T scanner. RESULTS Brain images showed a clear and consistent improvement over those obtained with a standard constant flip angle scheme. SNR was increased and apparent diffusion coefficient estimates were more accurate. For a modified Hann k-space weighting example, considerable benefits resulted from acquisition weighting by flip angle control. CONCLUSION The presented flexible method for optimizing SPLICE flip angle schemes offers improved MR image quality of geometrically accurate diffusion-weighted images that makes the sequence a strong candidate for radiotherapy planning or stereotactic surgery.
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Affiliation(s)
- Sofie Rahbek
- Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | - Tim Schakel
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, Netherlands
| | - Faisal Mahmood
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Kristoffer H Madsen
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Applied Mathematics and Computer Science, Technical University of Denmark, Lyngby, Denmark
| | | | - Lars G Hanson
- Department of Health Technology, Technical University of Denmark, Lyngby, Denmark.,Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital, Hvidovre, Denmark
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Gurney-Champion OJ, Landry G, Redalen KR, Thorwarth D. Potential of Deep Learning in Quantitative Magnetic Resonance Imaging for Personalized Radiotherapy. Semin Radiat Oncol 2022; 32:377-388. [DOI: 10.1016/j.semradonc.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Target Definition in MR-Guided Adaptive Radiotherapy for Head and Neck Cancer. Cancers (Basel) 2022; 14:cancers14123027. [PMID: 35740691 PMCID: PMC9220977 DOI: 10.3390/cancers14123027] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/14/2022] [Accepted: 06/14/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary Adaptive radiotherapy for head and neck cancer has become more routine due to an increase in imaging quality and improvement in radiation techniques. With the availability of faster adaptive workflows, it is possible to adapt more easily to (daily) changes. MRI offers besides great anatomical imaging, also functional information about the tumor and surrounding tissue. The aim of this review is to provide current state of evidence about target definition on MRI for adaptive strategies in the treatment of head and neck cancer. Abstract In recent years, MRI-guided radiotherapy (MRgRT) has taken an increasingly important position in image-guided radiotherapy (IGRT). Magnetic resonance imaging (MRI) offers superior soft tissue contrast in anatomical imaging compared to computed tomography (CT), but also provides functional and dynamic information with selected sequences. Due to these benefits, in current clinical practice, MRI is already used for target delineation and response assessment in patients with head and neck squamous cell carcinoma (HNSCC). Because of the close proximity of target areas and radiosensitive organs at risk (OARs) during HNSCC treatment, MRgRT could provide a more accurate treatment in which OARs receive less radiation dose. With the introduction of several new radiotherapy techniques (i.e., adaptive MRgRT, proton therapy, adaptive cone beam computed tomography (CBCT) RT, (daily) adaptive radiotherapy ensures radiation dose is accurately delivered to the target areas. With the integration of a daily adaptive workflow, interfraction changes have become visible, which allows regular and fast adaptation of target areas. In proton therapy, adaptation is even more important in order to obtain high quality dosimetry, due to its susceptibility for density differences in relation to the range uncertainty of the protons. The question is which adaptations during radiotherapy treatment are oncology safe and at the same time provide better sparing of OARs. For an optimal use of all these new tools there is an urgent need for an update of the target definitions in case of adaptive treatment for HNSCC. This review will provide current state of evidence regarding adaptive target definition using MR during radiotherapy for HNSCC. Additionally, future perspectives for adaptive MR-guided radiotherapy will be discussed.
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Curcean S, Cheng L, Picchia S, Tunariu N, Collins D, Blackledge M, Popat S, O'Brien M, Minchom A, Leach MO, Koh DM. Early Response to Chemotherapy in Malignant Pleural Mesothelioma Evaluated Using Diffusion-Weighted Magnetic Resonance Imaging: Initial Observations. JTO Clin Res Rep 2021; 2:100253. [PMID: 34870249 PMCID: PMC8626584 DOI: 10.1016/j.jtocrr.2021.100253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/22/2021] [Accepted: 10/27/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction We compared the magnetic resonance imaging total tumor volume (TTV) and median apparent diffusion coefficient (ADC) of malignant pleural mesothelioma (MPM) before and at 4 weeks after chemotherapy, to evaluate whether these are potential early markers of treatment response. Methods Diffusion-weighted magnetic resonance imaging was performed in 23 patients with MPM before and after 4 weeks of chemotherapy. The TTV was measured by semiautomatic segmentation (GrowCut) and transferred onto ADC maps to record the median ADC. Test-retest repeatability of TTV and ADC was evaluated in eight patients. TTV and median ADC changes were compared between responders and nonresponders, defined using modified Response Evaluation Criteria In Solid Tumors on computed tomography (CT) at 12 weeks after treatment. TTV and median ADC were also correlated with CT size measurement and disease survival. Results The test-retest 95% limits of agreement for TTV were -13.9% to 16.2% and for median ADC -1.2% to 3.3%. A significant increase in median ADC in responders was observed at 4 weeks after treatment (p = 0.02). Correlation was found between CT tumor size change at 12 weeks and median ADC changes at 4 weeks post-treatment (r = -0.560, p = 0.006). An increase in median ADC greater than 5.1% at 4 weeks has 100% sensitivity and 90% specificity for responders (area under the curve = 0.933, p < 0.001). There was also moderate correlation between median tumor ADC at baseline and overall survival (r = 0.45, p = 0.03). Conclusions Diffusion-weighted magnetic resonance imaging measurements of TTV and median ADC in MPM have good measurement repeatability. Increase in ADC at 4 weeks post-treatment has the potential to be an early response biomarker.
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Affiliation(s)
- Sebastian Curcean
- Department of Radiation Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Department of Radiation Oncology, Ion Chiricuta Institute of Oncology, Cluj-Napoca, Romania.,Department of Radiology, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Lin Cheng
- Division of Radiotherapy and Imaging, Institute of Cancer Research, London, United Kingdom
| | - Simona Picchia
- Department of Radiology, Bordet Institute, Bruxelles, Belgium
| | - Nina Tunariu
- Department of Radiology, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - David Collins
- Division of Radiotherapy and Imaging, Institute of Cancer Research, London, United Kingdom
| | - Matthew Blackledge
- Division of Radiotherapy and Imaging, Institute of Cancer Research, London, United Kingdom
| | - Sanjay Popat
- Department of Medical Oncology, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Mary O'Brien
- Department of Medical Oncology, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Anna Minchom
- Department of Medical Oncology, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Martin O Leach
- Department of Radiology, Royal Marsden NHS Foundation Trust, London, United Kingdom.,Division of Radiotherapy and Imaging, Institute of Cancer Research, London, United Kingdom
| | - Dow-Mu Koh
- Department of Radiology, Royal Marsden NHS Foundation Trust, London, United Kingdom.,Division of Radiotherapy and Imaging, Institute of Cancer Research, London, United Kingdom
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Christiansen RL, Johansen J, Zukauskaite R, Hansen CR, Bertelsen AS, Hansen O, Mahmood F, Brink C, Bernchou U. Accuracy of automatic structure propagation for daily magnetic resonance image-guided head and neck radiotherapy. Acta Oncol 2021; 60:589-597. [PMID: 33688793 DOI: 10.1080/0284186x.2021.1891282] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Deformable image registration (DIR) and contour propagation are used in daily online adaptation for hybrid MRI linac (MRL) treatments. The accuracy of the propagated contours may vary depending on the chosen workflow (WF), affecting the amount of required manual corrections. This study investigated the impact of three different WFs of contour propagations produced by a clinical treatment planning system for a high-field MRL on head and neck cancer patients. METHODS Seventeen patients referred for curative radiotherapy for oropharyngeal cancer underwent standard CT-based dose planning and MR scans in the treatment position for planning (pMR), and at the 10th (MR10), 20th (MR20) and 30th (MR30) fraction (±2). The primary tumour, a metastatic lymph node and 8 organs at risk were manually delineated on each set of T2 weighted images. Delineations were repeated one month later on the pMR by the same observer to determine the intra-observer variation (IOV). Three WFs were used to deform images in the treatment planning system for the high-field MRL: In WF1, only the planning image and contours were used as a reference for DIR and propagation to MR10,20,30. The most recently acquired image set prior to the daily images was deformed and uncorrected (WF2) versus manually corrected (WF3) structures propagated to the session image. Dice similarity coefficient (DSC), mean surface distance (MSD) and Hausdorff distance (HD) were calculated for each structure in each model. RESULTS Population median DSC, MSD and HD for WF1 and WF3 were similar and slightly better than for WF2. WF3 provided higher accuracy than WF1 for structures that are likely to shrink. All DIR workflows were less accurate than the IOV. CONCLUSIONS WF1 and WF3 provide higher accuracy in structure propagation than WF2. Manual revision and correction of propagated structures are required for all evaluated workflows.
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Affiliation(s)
- Rasmus L. Christiansen
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Odense C, Denmark
| | - Jørgen Johansen
- Department of Oncology, Odense University Hospital, Odense C, Denmark
| | - Ruta Zukauskaite
- Department of Oncology, Odense University Hospital, Odense C, Denmark
| | - Christian R. Hansen
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Odense C, Denmark
| | - Anders S. Bertelsen
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Odense C, Denmark
| | - Olfred Hansen
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Odense C, Denmark
- Department of Oncology, Odense University Hospital, Odense C, Denmark
| | - Faisal Mahmood
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Odense C, Denmark
| | - Carsten Brink
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Odense C, Denmark
| | - Uffe Bernchou
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Odense C, Denmark
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Baidya Kayal E, Kandasamy D, Yadav R, Bakhshi S, Sharma R, Mehndiratta A. Automatic segmentation and RECIST score evaluation in osteosarcoma using diffusion MRI: A computer aided system process. Eur J Radiol 2020; 133:109359. [PMID: 33129104 DOI: 10.1016/j.ejrad.2020.109359] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 09/10/2020] [Accepted: 10/13/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Accuracy and consistency in RECIST (Response evaluation criteria in solid tumors) measurements are crucial for treatment planning. Manual RECIST measurement is tedious, prone-to-error and operator-subjective. Objective was to develop a fully automated system for tumor segmentation and RECIST score estimation with reasonable accuracy, consistency and speed. METHODS Diffusion weight images (DWI) of forty patients (N = 40; Male:Female = 30:10; Age = 17.7 ± 5.9years) with Osteosarcoma was acquired using 1.5 T MRI scanner before (baseline) and after neoadjuvant chemotherapy (follow-up). 3D tumor volume was segmented applying Simple-linear-iterative-clustering Superpixels (SLIC-S) and Fuzzy-c-means-clustering (FCM) separately. Connected-component-analysis was performed to identify image-slice with maximum tumor-burden (Max-burden-sliceno) and measure tumor-sizes (Tumor-diameter(cm) & Tumor-volume(cc)). Relative-percentage-changes in tumor-sizes across time-points were scored using RECIST1.1 and Volumetric-response criterion. Segmentation accuracy was estimated by Dice-coefficient (DC), Jaccard-Index (JI), Precision (P) and Recall (R). Evaluated Apparent-diffusion-coefficient (ADC), Tumor-diameter, Max-burden-sliceno and Tumor-volume in segmented tumor-mask and ground-truth tumor-mask were compared using paired-t-test (p < 0.05), Pearson-correlation-coefficient(PCC) and Bland-Altman plots. Misclassification-error-rate (MER) was evaluated for automated RECIST1.1 and Volumetric-response scoring methods. RESULTS Automated SLIC-S and FCM produced satisfactory tumor segmentation (DC:∼70-83%;JI:∼55-72%;P:∼64-85%;R:∼73-83%) and showed excellent correlation with ground-truth measurements in estimating ADC (p > 0.05; PCC=0.84-0.89), Tumor-diameters (p > 0.05; PCC=0.90-0.95; bias=0.3-2.41), Max-burden-sliceno (p > 0.05; PCC=0.87-0.96) and Tumor-volumes (p > 0.05; PCC=0.89-0.94; bias=15.19-131.81) at baseline and follow-up. MER for SLIC-S and FCM were comparable for RECIST1.1 (15-18 %) and Volumetric-response (18-20 %) scores and assessment times were 2-3s and 4-6s per patient respectively. CONCLUSIONS Proposed method produced promising segmentation and RECIST score measurements in current bone tumor dataset and might be useful as decision-support-tool for response evaluation in other tumors.
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Affiliation(s)
- Esha Baidya Kayal
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, India
| | | | - Richa Yadav
- Department of Radio Diagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, Dr. B.R. Ambedkar Institute-Rotary Cancer Hospital (IRCH), All India Institute of Medical Sciences, New Delhi, India
| | - Raju Sharma
- Department of Radio Diagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Amit Mehndiratta
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, India; Department of Biomedical Engineering, All India Institute of Medical Sciences, New Delhi, India.
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Jensen K, Al-Farra G, Dejanovic D, Eriksen JG, Loft A, Hansen CR, Pameijer FA, Zukauskaite R, Grau C. Imaging for Target Delineation in Head and Neck Cancer Radiotherapy. Semin Nucl Med 2020; 51:59-67. [PMID: 33246540 DOI: 10.1053/j.semnuclmed.2020.07.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The definition of tumor involved volumes in patients with head and neck cancer poses great challenges with the increasing use of highly conformal radiotherapy techniques eg, volumetric modulated arc therapy and intensity modulated proton therapy. The risk of underdosing the tumor might increase unless great care is taken in the process. The information gained from imaging is increasing with both PET and MRI becoming readily available for the definition of targets. The information gained from these techniques is indeed multidimensional as one often acquire data on eg, metabolism, diffusion, and hypoxia together with anatomical and structural information. Nevertheless, much work remains to fully exploit the available information on a patient-specific level. Multimodality target definition in radiotherapy is a chain of processes that must be individually scrutinized, optimized and quality assured. Any uncertainties or errors in image acquisition, reconstruction, interpretation, and delineation are systematic errors and hence will potentially have a detrimental effect on the entire radiotherapy treatment and hence; the chance of cure or the risk of unnecessary side effects. Common guidelines and procedures create a common minimum standard and ground for evaluation and development. In Denmark, the treatment of head and neck cancer is organized within the multidisciplinary Danish Head and Neck Cancer Group (DAHANCA). The radiotherapy quality assurance group of DAHANCA organized a workshop in January 2020 with participants from oncology, radiology, and nuclear medicine from all centers in Denmark, treating patients with head and neck cancer. The participants agreed on a national guideline on imaging for target delineation in head and neck cancer radiotherapy, which has been approved by the DAHANCA group. The guidelines are available in the Supplementary. The use of multimodality imaging is being recommended for the planning of all radical treatments with a macroscopic tumor. 2-[18F]FDG-PET/CT should be available, preferable in the treatment position. The recommended MRI sequences are T1, T2 with and without fat suppression, and T1 with contrast enhancement, preferable in the treatment position. The interpretation of clinical information, including thorough physical examination as well as imaging, should be done in a multidisciplinary setting with an oncologist, radiologist, and nuclear medicine specialist.
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Affiliation(s)
- Kenneth Jensen
- Danish Center for Particle Therapy. Aarhus University Hospital, Denmark.
| | - Gina Al-Farra
- Department of Radiology, Herlev and Gentofte Hospital, Denmark
| | - Danijela Dejanovic
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Denmark
| | | | - Annika Loft
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Christian R Hansen
- Laboratory of Radiation Physics, Odense University Hospital, Denmark; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark; Danish Center for Particle Therapy. Aarhus University Hospital, Denmark
| | - Frank A Pameijer
- Department of Radiology, University Medical Center Utrecht, the Netherlands
| | - Ruta Zukauskaite
- Department of Oncology, Odense University Hospital, Denmark; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Cai Grau
- Danish Center for Particle Therapy. Aarhus University Hospital, Denmark
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11
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Touska P, Connor SEJ. Recent advances in MRI of the head and neck, skull base and cranial nerves: new and evolving sequences, analyses and clinical applications. Br J Radiol 2019; 92:20190513. [PMID: 31529977 PMCID: PMC6913354 DOI: 10.1259/bjr.20190513] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 09/09/2019] [Accepted: 09/12/2019] [Indexed: 12/14/2022] Open
Abstract
MRI is an invaluable diagnostic tool in the investigation and management of patients with pathology of the head and neck. However, numerous technical challenges exist, owing to a combination of fine anatomical detail, complex geometry (that is subject to frequent motion) and susceptibility effects from both endogenous structures and exogenous implants. Over recent years, there have been rapid developments in several aspects of head and neck imaging including higher resolution, isotropic 3D sequences, diffusion-weighted and diffusion-tensor imaging as well as permeability and perfusion imaging. These have led to improvements in anatomic, dynamic and functional imaging. Further developments using contrast-enhanced 3D FLAIR for the delineation of endolymphatic structures and black bone imaging for osseous structures are opening new diagnostic avenues. Furthermore, technical advances in compressed sensing and metal artefact reduction have the capacity to improve imaging speed and quality, respectively. This review explores novel and evolving MRI sequences that can be employed to evaluate diseases of the head and neck, including the skull base.
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Affiliation(s)
- Philip Touska
- Department of Radiology, Guy’s and St. Thomas’ NHS Foundation Trust, Guy’s Hospital, Great Maze Pond, London, SE1 9RT, United Kingdom
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Thorwarth D. Imaging science and development in modern high-precision radiotherapy. Phys Imaging Radiat Oncol 2019; 12:63-66. [PMID: 33458297 PMCID: PMC7807660 DOI: 10.1016/j.phro.2019.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Daniela Thorwarth
- Section for Biomedical Physics, Department of Radiation Oncology, University of Tübingen, Germany
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