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El-Habashy DM, Wahid KA, He R, McDonald B, Mulder SJ, Ding Y, Salzillo T, Lai SY, Christodouleas J, Dresner A, Wang J, Naser MA, Fuller CD, Mohamed ASR. Dataset of weekly intra-treatment diffusion weighted imaging in head and neck cancer patients treated with MR-Linac. Sci Data 2024; 11:487. [PMID: 38734679 PMCID: PMC11088675 DOI: 10.1038/s41597-024-03217-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 04/03/2024] [Indexed: 05/13/2024] Open
Abstract
Radiation therapy (RT) is a crucial treatment for head and neck squamous cell carcinoma (HNSCC); however, it can have adverse effects on patients' long-term function and quality of life. Biomarkers that can predict tumor response to RT are being explored to personalize treatment and improve outcomes. While tissue and blood biomarkers have limitations, imaging biomarkers derived from magnetic resonance imaging (MRI) offer detailed information. The integration of MRI and a linear accelerator in the MR-Linac system allows for MR-guided radiation therapy (MRgRT), offering precise visualization and treatment delivery. This data descriptor offers a valuable repository for weekly intra-treatment diffusion-weighted imaging (DWI) data obtained from head and neck cancer patients. By analyzing the sequential DWI changes and their correlation with treatment response, as well as oncological and survival outcomes, the study provides valuable insights into the clinical implications of DWI in HNSCC.
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Affiliation(s)
- Dina M El-Habashy
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Department of Clinical Oncology and Nuclear Medicine, Menoufia University, Shebin Elkom, Egypt.
| | - Kareem A Wahid
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Renjie He
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Brigid McDonald
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Samuel J Mulder
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yao Ding
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Travis Salzillo
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stephen Y Lai
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Molecular and Cellular Oncology, Division of Basic Science Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Alex Dresner
- Philips Healthcare MR Oncology, Cleveland, Ohio, USA
| | - Jihong Wang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mohamed A Naser
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Abdallah Sherif Radwan Mohamed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Department of Radiation Oncology, Baylor College of Medicine, Houston, TX, USA.
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2
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Shen M, Lin X, Yang C, Zhou Z, Chen S, Yin Y, Long L, Huang L, Yang Z, Wang R, Kang M. Potential predictive value of IVIM MR for xerostomia in nasopharyngeal carcinoma. Radiother Oncol 2024; 197:110323. [PMID: 38734144 DOI: 10.1016/j.radonc.2024.110323] [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: 08/08/2023] [Revised: 04/24/2024] [Accepted: 04/28/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND AND PURPOSE Xerostomia, caused by radiation-induced parotid damage, is the most commonly reported radiotherapy (RT) complication for nasopharyngeal carcinoma (NPC). The purpose of this study was to evaluate the value of intravoxel incoherent motion (IVIM) MR in monitoring radiation-induced parotid gland damage and predicting the risk of xerostomia. METHODS Fifty-four NPC patients were enrolled and underwent at least three IVIM MR scans: before (pre-RT), after 5 fractions of (5th-RT), halfway through (mid-RT), and after RT (post-RT). The degree of xerostomia patients was assessed before each MR examination. Furthermore, the time when patients first reported xerostomia symptoms was recorded. The changes in IVIM parameters throughout RT, as well as the relationships between IVIM parameters and xerostomia, were analysed. RESULT All IVIM parameters increased significantly from pre-RT to post-RT (p < 0.001). The rates of D, D* and f increase increased significantly from pre-RT to mid-RT (p < 0.001), indicating that cell necrosis mainly occurs in the first half of RT. In multivariate analysis, N3 (p = 0.014), pre-D (p = 0.007) and pre-D* (p = 0.003) were independent factors influencing xerostomia. D and f were significantly higher at 5th-RT than at pre-RT (both p < 0.05). IVIM detected parotid gland injury at 5th-RT at an average scanning time of 6.18 ± 1.07 days, earlier than the 11.94 ± 2.61 days when the patient first complained of xerostomia according to the RTOG scale (p < 0.001). CONCLUSIONS IVIM MR can dynamically monitor radiation-induced parotid gland damage and assess it earlier and more objectively than RTOG toxicity. Moreover, IVIM can screen people at risk of more severe xerostomia early.
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Affiliation(s)
- Mingjun Shen
- Department of Radiation Oncology, the First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China; Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education, Nanning, 530021, Guangxi, China; Guangxi Key Laboratory of Immunology and Metabolism for Liver Diseases, Nanning, 530021, Guangxi, China; Guangxi Medical University, Nanning, 530021, Guangxi, China; Department of Radiation Oncology, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, 533000, Guangxi, China
| | - Xiangying Lin
- Department of Radiation Oncology, the First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China; Department of Radiation Oncology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, 570311,Hainan, China
| | - Chaolin Yang
- Department of Radiation Oncology, the First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China; Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education, Nanning, 530021, Guangxi, China; Guangxi Key Laboratory of Immunology and Metabolism for Liver Diseases, Nanning, 530021, Guangxi, China; Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Ziyan Zhou
- Department of Radiation Oncology, the First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China; Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education, Nanning, 530021, Guangxi, China; Guangxi Key Laboratory of Immunology and Metabolism for Liver Diseases, Nanning, 530021, Guangxi, China; Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Sixia Chen
- Department of Radiation Oncology, the First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China; Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education, Nanning, 530021, Guangxi, China; Guangxi Key Laboratory of Immunology and Metabolism for Liver Diseases, Nanning, 530021, Guangxi, China; Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Yuanxiu Yin
- Department of Radiation Oncology, the First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China; Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education, Nanning, 530021, Guangxi, China; Guangxi Key Laboratory of Immunology and Metabolism for Liver Diseases, Nanning, 530021, Guangxi, China; Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Liling Long
- Guangxi Medical University, Nanning, 530021, Guangxi, China; Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Lixuan Huang
- Guangxi Medical University, Nanning, 530021, Guangxi, China; Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Zongxiang Yang
- Guangxi Medical University, Nanning, 530021, Guangxi, China; Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Rensheng Wang
- Department of Radiation Oncology, the First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China; Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education, Nanning, 530021, Guangxi, China; Guangxi Key Laboratory of Immunology and Metabolism for Liver Diseases, Nanning, 530021, Guangxi, China; Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Min Kang
- Department of Radiation Oncology, the First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China; Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education, Nanning, 530021, Guangxi, China; Guangxi Key Laboratory of Immunology and Metabolism for Liver Diseases, Nanning, 530021, Guangxi, China; Guangxi Medical University, Nanning, 530021, Guangxi, China.
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Yan Q, Yan X, Yang X, Li S, Song J. The use of PET/MRI in radiotherapy. Insights Imaging 2024; 15:63. [PMID: 38411742 PMCID: PMC10899128 DOI: 10.1186/s13244-024-01627-6] [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: 09/19/2023] [Accepted: 01/21/2024] [Indexed: 02/28/2024] Open
Abstract
Positron emission tomography/magnetic resonance imaging (PET/MRI) is a hybrid imaging technique that quantitatively combines the metabolic and functional data from positron emission tomography (PET) with anatomical and physiological information from MRI. As PET/MRI technology has advanced, its applications in cancer care have expanded. Recent studies have demonstrated that PET/MRI provides unique advantages in the field of radiotherapy and has become invaluable in guiding precision radiotherapy techniques. This review discusses the rationale and clinical evidence supporting the use of PET/MRI for radiation positioning, target delineation, efficacy evaluation, and patient surveillance.Critical relevance statement This article critically assesses the transformative role of PET/MRI in advancing precision radiotherapy, providing essential insights into improved radiation positioning, target delineation, efficacy evaluation, and patient surveillance in clinical radiology practice.Key points• The emergence of PET/MRI will be a key bridge for precise radiotherapy.• PET/MRI has unique advantages in the whole process of radiotherapy.• New tracers and nanoparticle probes will broaden the use of PET/MRI in radiation.• PET/MRI will be utilized more frequently for radiotherapy.
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Affiliation(s)
- Qi Yan
- Cancer Center, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences Tongji Shanxi Hospital, Taiyuan, China
| | - Xia Yan
- Cancer Center, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
- Shanxi Provincial Key Laboratory for Translational Nuclear Medicine and Precision Protection, Taiyuan, China
| | - Xin Yang
- Cancer Center, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Sijin Li
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Shanxi Medical University, Taiyuan, China.
| | - Jianbo Song
- Cancer Center, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences Tongji Shanxi Hospital, Taiyuan, China.
- Shanxi Provincial Key Laboratory for Translational Nuclear Medicine and Precision Protection, Taiyuan, China.
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Paudyal R, Jiang J, Han J, Diplas BH, Riaz N, Hatzoglou V, Lee N, Deasy JO, Veeraraghavan H, Shukla-Dave A. Auto-segmentation of neck nodal metastases using self-distilled masked image transformer on longitudinal MR images. BJR ARTIFICIAL INTELLIGENCE 2024; 1:ubae004. [PMID: 38476956 PMCID: PMC10928808 DOI: 10.1093/bjrai/ubae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 03/14/2024]
Abstract
Objectives Auto-segmentation promises greater speed and lower inter-reader variability than manual segmentations in radiation oncology clinical practice. This study aims to implement and evaluate the accuracy of the auto-segmentation algorithm, "Masked Image modeling using the vision Transformers (SMIT)," for neck nodal metastases on longitudinal T2-weighted (T2w) MR images in oropharyngeal squamous cell carcinoma (OPSCC) patients. Methods This prospective clinical trial study included 123 human papillomaviruses (HPV-positive [+]) related OSPCC patients who received concurrent chemoradiotherapy. T2w MR images were acquired on 3 T at pre-treatment (Tx), week 0, and intra-Tx weeks (1-3). Manual delineations of metastatic neck nodes from 123 OPSCC patients were used for the SMIT auto-segmentation, and total tumor volumes were calculated. Standard statistical analyses compared contour volumes from SMIT vs manual segmentation (Wilcoxon signed-rank test [WSRT]), and Spearman's rank correlation coefficients (ρ) were computed. Segmentation accuracy was evaluated on the test data set using the dice similarity coefficient (DSC) metric value. P-values <0.05 were considered significant. Results No significant difference in manual and SMIT delineated tumor volume at pre-Tx (8.68 ± 7.15 vs 8.38 ± 7.01 cm3, P = 0.26 [WSRT]), and the Bland-Altman method established the limits of agreement as -1.71 to 2.31 cm3, with a mean difference of 0.30 cm3. SMIT model and manually delineated tumor volume estimates were highly correlated (ρ = 0.84-0.96, P < 0.001). The mean DSC metric values were 0.86, 0.85, 0.77, and 0.79 at the pre-Tx and intra-Tx weeks (1-3), respectively. Conclusions The SMIT algorithm provides sufficient segmentation accuracy for oncological applications in HPV+ OPSCC. Advances in knowledge First evaluation of auto-segmentation with SMIT using longitudinal T2w MRI in HPV+ OPSCC.
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Affiliation(s)
- Ramesh Paudyal
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Jue Jiang
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - James Han
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Bill H Diplas
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Nadeem Riaz
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Vaios Hatzoglou
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Nancy Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Joseph O Deasy
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Harini Veeraraghavan
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Amita Shukla-Dave
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
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5
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El-Habashy DM, Wahid KA, Renjie H, McDonald B, Mulder SJ, Ding Y, Salzillo T, Stephen L, Christodouleas J, Dresner A, Wang J, Naser MA, Fuller CD, Mohamed ASR. Weekly Intra-Treatment Diffusion Weighted Imaging Dataset for Head and Neck Cancer Patients Undergoing MR-linac Treatment. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.18.23294280. [PMID: 37645931 PMCID: PMC10462225 DOI: 10.1101/2023.08.18.23294280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Radiation therapy (RT) is a crucial treatment for head and neck squamous cell carcinoma (HNSCC), however it can have adverse effects on patients' long-term function and quality of life. Biomarkers that can predict tumor response to RT are being explored to personalize treatment and improve outcomes. While tissue and blood biomarkers have limitations, imaging biomarkers derived from magnetic resonance imaging (MRI) offer detailed information. The integration of MRI and a linear accelerator in the MR-Linac system allows for MR-guided radiation therapy (MRgRT), offering precise visualization and treatment delivery. This data descriptor offers a valuable repository for weekly intra-treatment diffusion-weighted imaging (DWI) data obtained from head and neck cancer patients. By analyzing the sequential DWI changes and their correlation with treatment response, as well as oncological and survival outcomes, the study provides valuable insights into the clinical implications of DWI in HNSCC. [Table: see text].
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Affiliation(s)
- Dina M El-Habashy
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Clinical Oncology and Nuclear Medicine, Menoufia University, Shebin Elkom, Egypt
| | - Kareem A Wahid
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - He Renjie
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Brigid McDonald
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Samuel J. Mulder
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yao Ding
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Travis Salzillo
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lai Stephen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Molecular and Cellular Oncology, Division of Basic Science Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Alex Dresner
- Philips Healthcare MR Oncology, Cleveland, Ohio, USA
| | - Jihong Wang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mohamed A Naser
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Abdallah Sherif Radwan Mohamed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Radiation Oncology, Baylor College of Medicine, Houston, TX, USA
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6
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Li T, Wang J, Yang Y, Glide-Hurst CK, Wen N, Cai J. Multi-parametric MRI for radiotherapy simulation. Med Phys 2023; 50:5273-5293. [PMID: 36710376 PMCID: PMC10382603 DOI: 10.1002/mp.16256] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 09/10/2022] [Accepted: 12/06/2022] [Indexed: 01/31/2023] Open
Abstract
Magnetic resonance imaging (MRI) has become an important imaging modality in the field of radiotherapy (RT) in the past decade, especially with the development of various novel MRI and image-guidance techniques. In this review article, we will describe recent developments and discuss the applications of multi-parametric MRI (mpMRI) in RT simulation. In this review, mpMRI refers to a general and loose definition which includes various multi-contrast MRI techniques. Specifically, we will focus on the implementation, challenges, and future directions of mpMRI techniques for RT simulation.
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Affiliation(s)
- Tian Li
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China
| | - Jihong Wang
- Department of Radiation Physics, Division of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Yingli Yang
- Department of Radiology, Ruijin Hospital, Shanghai Jiaotong Univeristy School of Medicine, Shanghai, China
- SJTU-Ruijing-UIH Institute for Medical Imaging Technology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Carri K Glide-Hurst
- Department of Radiation Oncology, University of Wisconsin, Madison, Wisconsin, USA
| | - Ning Wen
- Department of Radiology, Ruijin Hospital, Shanghai Jiaotong Univeristy School of Medicine, Shanghai, China
- SJTU-Ruijing-UIH Institute for Medical Imaging Technology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- The Global Institute of Future Technology, Shanghai Jiaotong University, Shanghai, China
| | - Jing Cai
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China
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7
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Adjogatse D, Petkar I, Reis Ferreira M, Kong A, Lei M, Thomas C, Barrington SF, Dudau C, Touska P, Guerrero Urbano T, Connor SEJ. The Impact of Interactive MRI-Based Radiologist Review on Radiotherapy Target Volume Delineation in Head and Neck Cancer. AJNR Am J Neuroradiol 2023; 44:192-198. [PMID: 36702503 PMCID: PMC9891322 DOI: 10.3174/ajnr.a7773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 12/31/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND PURPOSE Peer review of head and neck cancer radiation therapy target volumes by radiologists was introduced in our center to optimize target volume delineation. Our aim was to assess the impact of MR imaging-based radiologist peer review of head and neck radiation therapy gross tumor and nodal volumes, through qualitative and quantitative analysis. MATERIALS AND METHODS Cases undergoing radical radiation therapy with a coregistered MR imaging, between April 2019 and March 2020, were reviewed. The frequency and nature of volume changes were documented, with major changes classified as per the guidance of The Royal College of Radiologists. Volumetric alignment was assessed using the Dice similarity coefficient, Jaccard index, and Hausdorff distance. RESULTS Fifty cases were reviewed between April 2019 and March 2020. The median age was 59 years (range, 29-83 years), and 72% were men. Seventy-six percent of gross tumor volumes and 41.5% of gross nodal volumes were altered, with 54.8% of gross tumor volume and 66.6% of gross nodal volume alterations classified as "major." Undercontouring of soft-tissue involvement and unidentified lymph nodes were predominant reasons for change. Radiologist review significantly altered the size of both the gross tumor volume (P = .034) and clinical target tumor volume (P = .003), but not gross nodal volume or clinical target nodal volume. The median conformity and surface distance metrics were the following: gross tumor volume Dice similarity coefficient = 0.93 (range, 0.82-0.96), Jaccard index = 0.87 (range, 0.7-0.94), Hausdorff distance = 7.45 mm (range, 5.6-11.7 mm); and gross nodular tumor volume Dice similarity coefficient = 0.95 (0.91-0.97), Jaccard index = 0.91 (0.83-0.95), and Hausdorff distance = 20.7 mm (range, 12.6-41.6). Conformity improved on gross tumor volume-to-clinical target tumor volume expansion (Dice similarity coefficient = 0.93 versus 0.95, P = .003). CONCLUSIONS MR imaging-based radiologist review resulted in major changes to most radiotherapy target volumes and significant changes in volume size of both gross tumor volume and clinical target tumor volume, suggesting that this is a fundamental step in the radiotherapy workflow of patients with head and neck cancer.
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Affiliation(s)
- D Adjogatse
- From the Departments of Oncology (D.A., I.P., M.R.F., A.K., M.L., T.G.U.)
- School of Biomedical Engineering and Imaging Sciences (D.A., C.T., S.E.J.C.)
| | - I Petkar
- From the Departments of Oncology (D.A., I.P., M.R.F., A.K., M.L., T.G.U.)
| | - M Reis Ferreira
- From the Departments of Oncology (D.A., I.P., M.R.F., A.K., M.L., T.G.U.)
| | - A Kong
- From the Departments of Oncology (D.A., I.P., M.R.F., A.K., M.L., T.G.U.)
| | - M Lei
- From the Departments of Oncology (D.A., I.P., M.R.F., A.K., M.L., T.G.U.)
| | - C Thomas
- Medical Physics (C.T.)
- School of Biomedical Engineering and Imaging Sciences (D.A., C.T., S.E.J.C.)
| | - S F Barrington
- King's College London and Guy's and St Thomas' PET Centre (S.F.B.), School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, UK
| | - C Dudau
- Radiology (C.D., P.T., S.E.J.C.), Guy's and St Thomas' National Health Service Foundation Trust, London, UK
- Department of Neurororadiology (C.D., S.E.J.C.), King's College Hospital, London, UK
| | - P Touska
- Radiology (C.D., P.T., S.E.J.C.), Guy's and St Thomas' National Health Service Foundation Trust, London, UK
| | - T Guerrero Urbano
- From the Departments of Oncology (D.A., I.P., M.R.F., A.K., M.L., T.G.U.)
- Faculty of Dentistry, Oral and Craniofacial Sciences (T.G.U.), King's College London, London, UK
| | - S E J Connor
- Radiology (C.D., P.T., S.E.J.C.), Guy's and St Thomas' National Health Service Foundation Trust, London, UK
- School of Biomedical Engineering and Imaging Sciences (D.A., C.T., S.E.J.C.)
- Department of Neurororadiology (C.D., S.E.J.C.), King's College Hospital, London, UK
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8
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Hu J, Xie X, Zhou W, Hu X, Sun X. The emerging potential of quantitative MRI biomarkers for the early prediction of brain metastasis response after stereotactic radiosurgery: a scoping review. Quant Imaging Med Surg 2023; 13:1174-1189. [PMID: 36819250 PMCID: PMC9929394 DOI: 10.21037/qims-22-412] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 11/23/2022] [Indexed: 01/05/2023]
Abstract
Background At present, the simple prognostic models based on clinical information for predicting the treatment outcomes of brain metastases (BMs) are subjective and delayed. Thus, we performed this systematic review of multiple studies to assess the potential of quantitative magnetic resonance imaging (MRI) biomarkers for the early prediction of treatment outcomes of brain metastases with stereotactic radiosurgery (SRS). Methods We systematically searched the PubMed, Embase, Cochrane, Web of Science, and Clinical Trials.gov databases for articles published between February 1, 1991, and April 11, 2022, with no language restrictions. We included studies involving patients with BMs receiving SRS; the included patients were required to have definite pathology of a primary tumor and complete imaging data (pre- and post-SRS). We excluded the articles that included patients who had undergone previous surgery and those that did not include regular follow-up or corresponding MRI scans. Results We identified 2,162 studies, of which 26 were included in our analysis, involving a total of 1,362 participants. All 26 studies explored the relevant MRI parameters to predict the prognosis of patients with BMs who received SRS. The outcomes were generalized according to the relationships between the anatomical/morphological, microstructural, vascular, and metabolic changes and SRS. Generally, with traditional MRI, there are several quantitative prognostic models based on preradiosurgical radiomics that predict the outcome of SRS treatment in local BM control. With the implementation of advanced MRI, the relative apparent diffusion coefficient (ADC), perfusion fraction (f), relative cerebral blood volume (rCBV), relative regional cerebral blood flow (rrCBF), interstitial fluid pressure (IFP), quadratic of time-dependent leakage (Ktrans 2), extracellular extravascular volume (ve), choline/creatine (Cho/Cr), nuclear Overhauser effect (NOE) peak, and intraextracellular water exchange rate constant (kIE ) were confirmed to be indicative of the therapeutic effect of SRS for BMs. Conclusions Quantitative MRI biomarkers extracted from traditional or advanced MRI at different time points, which can represent the anatomical/morphological, microstructural, vascular, and metabolic changes, respectively, have been proposed as promising markers for the early prediction of SRS response in those with BMs. There are some limitations in this review, including the risk of selection bias, the limited number of study objects, the incomparability of the total data, and the subjectivity of the review process.
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Affiliation(s)
- Jiamiao Hu
- Department of Radiation Oncology, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Xuyun Xie
- Department of Radiation Oncology, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Weiwen Zhou
- Department of Radiation Oncology, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Xiao Hu
- Department of Radiation Oncology, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Xiaonan Sun
- Department of Radiation Oncology, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, Hangzhou, China
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9
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Romeo V, Stanzione A, Ugga L, Cuocolo R, Cocozza S, Quarantelli M, Chawla S, Farina D, Golay X, Parker G, Shukla-Dave A, Thoeny H, Vidiri A, Brunetti A, Surlan-Popovic K, Bisdas S. Clinical indications and acquisition protocol for the use of dynamic contrast-enhanced MRI in head and neck cancer squamous cell carcinoma: recommendations from an expert panel. Insights Imaging 2022; 13:198. [PMID: 36528678 PMCID: PMC9759606 DOI: 10.1186/s13244-022-01317-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/19/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The clinical role of perfusion-weighted MRI (PWI) in head and neck squamous cell carcinoma (HNSCC) remains to be defined. The aim of this study was to provide evidence-based recommendations for the use of PWI sequence in HNSCC with regard to clinical indications and acquisition parameters. METHODS Public databases were searched, and selected papers evaluated applying the Oxford criteria 2011. A questionnaire was prepared including statements on clinical indications of PWI as well as its acquisition technique and submitted to selected panelists who worked in anonymity using a modified Delphi approach. Each panelist was asked to rate each statement using a 7-point Likert scale (1 = strongly disagree, 7 = strongly agree). Statements with scores equal or inferior to 5 assigned by at least two panelists were revised and re-submitted for the subsequent Delphi round to reach a final consensus. RESULTS Two Delphi rounds were conducted. The final questionnaire consisted of 6 statements on clinical indications of PWI and 9 statements on the acquisition technique of PWI. Four of 19 (21%) statements obtained scores equal or inferior to 5 by two panelists, all dealing with clinical indications. The Delphi process was considered concluded as reasons entered by panelists for lower scores were mainly related to the lack of robust evidence, so that no further modifications were suggested. CONCLUSIONS Evidence-based recommendations on the use of PWI have been provided by an independent panel of experts worldwide, encouraging a standardized use of PWI across university and research centers to produce more robust evidence.
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Affiliation(s)
- Valeria Romeo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Arnaldo Stanzione
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Lorenzo Ugga
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Renato Cuocolo
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy.,Interdepartmental Research Center on Management and Innovation in Healthcare - CIRMIS, University of Naples Federico II, Naples, Italy
| | - Sirio Cocozza
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Mario Quarantelli
- Biostructure and Bioimaging Institute, National Research Council, Naples, Italy
| | - Sanjeev Chawla
- Department of Radiology, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, PA, USA
| | - Davide Farina
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Xavier Golay
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, UK.,Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, University College Hospitals NHS Trust, London, UK
| | - Geoff Parker
- Department of Computer Science, Centre for Medical Image Computing, Queen Square Institute of Neurology, University College London, London, UK
| | - Amita Shukla-Dave
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Departments of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Harriet Thoeny
- Department of Radiology, Cantonal Hospital Fribourg, University of Fribourg, Fribourg, Switzerland
| | - Antonello Vidiri
- Department of Radiology and Diagnostic Imaging, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Arturo Brunetti
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | | | - Sotirios Bisdas
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, UK. .,Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, University College Hospitals NHS Trust, London, UK.
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10
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Kaza E, Guenette JP, Guthier CV, Hatch S, Marques A, Singer L, Schoenfeld JD. Image quality comparisons of coil setups in 3T MRI for brain and head and neck radiotherapy simulations. J Appl Clin Med Phys 2022; 23:e13794. [PMID: 36285814 PMCID: PMC9797171 DOI: 10.1002/acm2.13794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/11/2022] [Accepted: 09/06/2022] [Indexed: 01/01/2023] Open
Abstract
PURPOSE MRI is increasingly used for brain and head and neck radiotherapy treatment planning due to its superior soft tissue contrast. Flexible array coils can be arranged to encompass treatment immobilization devices, which do not fit in diagnostic head/neck coils. Selecting a flexible coil arrangement to replace a diagnostic coil should rely on image quality characteristics and patient comfort. We compared image quality obtained with a custom UltraFlexLarge18 (UFL18) coil setup against a commercial FlexLarge4 (FL4) coil arrangement, relative to a diagnostic Head/Neck20 (HN20) coil at 3T. METHODS The large American College of Radiology (ACR) MRI phantom was scanned monthly in the UFL18, FL4, and HN20 coil setup over 2 years, using the ACR series and three clinical sequences. High-contrast spatial resolution (HCSR), image intensity uniformity (IIU), percent-signal ghosting (PSG), low-contrast object detectability (LCOD), signal-to-noise ratio (SNR), and geometric accuracy were calculated according to ACR recommendations for each series and coil arrangement. Five healthy volunteers were scanned with the clinical sequences in all three coil setups. SNR, contrast-to-noise ratio (CNR) and artifact size were extracted from regions-of-interest along the head for each sequence and coil setup. For both experiments, ratios of image quality parameters obtained with UFL18 or FL4 over those from HN20 were formed for each coil setup, grouping the ACR and clinical sequences. RESULTS Wilcoxon rank-sum tests revealed significantly higher (p < 0.001) LCOD, IIU and SNR, and lower PSG ratios with UFL18 than FL4 on the phantom for the clinical sequences, with opposite PSG and SNR trends for the ACR series. Similar statistical tests on volunteer data corroborated that SNR ratios with UFL18 (0.58 ± 0.19) were significantly higher (p < 0.001) than with FL4 (0.51 ± 0.18) relative to HN20. CONCLUSIONS The custom UFL18 coil setup was selected for clinical application in MR simulations due to the superior image quality demonstrated on a phantom and volunteers for clinical sequences and increased volunteer comfort.
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Affiliation(s)
- Evangelia Kaza
- Radiation Oncology, Brigham and Women's HospitalDana‐Farber Cancer Institute, Harvard Medical SchoolBostonMassachusettsUSA
| | - Jeffrey P. Guenette
- Division of Neuroradiology, Brigham and Women's HospitalDana‐Farber Cancer Institute, Harvard Medical SchoolBostonMassachusettsUSA
| | - Christian V. Guthier
- Radiation Oncology, Brigham and Women's HospitalDana‐Farber Cancer Institute, Harvard Medical SchoolBostonMassachusettsUSA
| | - Steven Hatch
- Radiation Oncology, Brigham and Women's HospitalDana‐Farber Cancer Institute, Harvard Medical SchoolBostonMassachusettsUSA
| | - Alexander Marques
- Radiation Oncology, Brigham and Women's HospitalDana‐Farber Cancer Institute, Harvard Medical SchoolBostonMassachusettsUSA
| | - Lisa Singer
- Radiation Oncology, Brigham and Women's HospitalDana‐Farber Cancer Institute, Harvard Medical SchoolBostonMassachusettsUSA,Radiation OncologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Jonathan D. Schoenfeld
- Radiation Oncology, Brigham and Women's HospitalDana‐Farber Cancer Institute, Harvard Medical SchoolBostonMassachusettsUSA
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11
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Yuan J, Kam MKM, Poon DMC. Editorial for "MRI-Based Metastatic Nodal Number and Associated Nomogram Improve Stratification of Nasopharyngeal Carcinoma Patients: Potential Indications for Individual Induction Chemotherapy". J Magn Reson Imaging 2022; 57:1803-1804. [PMID: 36149087 DOI: 10.1002/jmri.28436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/08/2022] Open
Affiliation(s)
- Jing Yuan
- Research Department, Hong Kong Sanatorium & Hospital, Happy Valley, Hong Kong SAR, China
| | - Michael Koon-Ming Kam
- Comprehensive Oncology Centre, Hong Kong Sanatorium & Hospital, Happy Valley, Hong Kong SAR, China
| | - Darren M C Poon
- Comprehensive Oncology Centre, Hong Kong Sanatorium & Hospital, Happy Valley, Hong Kong SAR, China
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12
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Guha A, Anjari M, Cook G, Goh V, Connor S. Radiomic Analysis of Tumour Heterogeneity Using MRI in Head and Neck Cancer Following Chemoradiotherapy: A Feasibility Study. Front Oncol 2022; 12:784693. [PMID: 35242703 PMCID: PMC8886142 DOI: 10.3389/fonc.2022.784693] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/13/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives To evaluate interval changes in heterogeneity on diffusion-weighted apparent diffusion coefficient (ADC) maps and T1-weighted post-gadolinium (T1w post gad) MRI in head and neck carcinoma (HNSCC), with and without chemo-radiotherapy (CRT) response. Methods This prospective observational cohort study included 24 participants (20 men, age 62.9 ± 8.8 years) with stage III and IV HNSCC. The primary tumour (n = 23) and largest lymph node (n = 22) dimensions, histogram parameters and grey-level co-occurrence matrix (GLCM) parameters were measured on ADC maps and T1w post gad sequences, performed pretreatment and 6 and 12 weeks post CRT. The 2-year treatment response at primary and nodal sites was recorded. The Wilcoxon signed-rank test was used to compare interval changes in parameters after stratifying for treatment response and failure (p < 0.001 statistical significance). Results 23/23 primary tumours and 18/22 nodes responded to CRT at 2 years. Responding HNSCC demonstrated a significant interval change in ADC histogram parameters (kurtosis, coefficient of variation, entropy, energy for primary tumour; kurtosis for nodes) and T1w post gad GLCM (entropy and contrast in the primary tumour and nodes) by 6 weeks post CRT (p < 0.001). Lymph nodes with treatment failure did not demonstrate an interval alteration in heterogeneity parameters. Conclusions ADC maps and T1w post gad MRI demonstrate the evolution of heterogeneity parameters in successfully treated HNSCC by 6 weeks post CRT; however, this is not observed in lymph nodes failing treatment. Advances in Knowledge Early reduction in heterogeneity is demonstrated on MRI when HNSCC responds to CRT.
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Affiliation(s)
- Amrita Guha
- Department of Radio-Diagnosis, Tata Memorial Hospital, Mumbai, India.,Training School Complex, Homi Bhabha National Institute, Mumbai, India.,School of Biomedical Engineering & Imaging Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Mustafa Anjari
- Department of Radiology, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Gary Cook
- School of Biomedical Engineering & Imaging Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom.,King's College London & Guy's and St Thomas' Positron Emission Tomography (PET) Centre, London, United Kingdom
| | - Vicky Goh
- School of Biomedical Engineering & Imaging Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom.,Department of Radiology, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Steve Connor
- School of Biomedical Engineering & Imaging Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom.,Department of Radiology, Guy's and St Thomas' Hospital, London, United Kingdom.,Department of Neuroradiology, King's College Hospital, London, United Kingdom
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13
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Chiu K, Hoskin P, Gupta A, Butt R, Terparia S, Codd L, Tsang Y, Bhudia J, Killen H, Kane C, Ghoshray S, Lemon C, Megias D. The quantitative impact of joint peer review with a specialist radiologist in head and neck cancer radiotherapy planning. Br J Radiol 2022; 95:20211219. [PMID: 34918547 PMCID: PMC8822559 DOI: 10.1259/bjr.20211219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES Radiologist input in peer review of head and neck radiotherapy has been introduced as a routine departmental approach. The aim was to evaluate this practice and to quantitatively analyse the changes made. METHODS Patients treated with radical-dose radiotherapy between August and November 2020 were reviewed. The incidence of major and minor changes, as defined by The Royal College of Radiologists guidance, was prospectively recorded. The amended radiotherapy volumes were compared with the original volumes using Jaccard Index (JI) to assess conformity; Geographical Miss Index (GMI) for undercontouring; and Hausdorff Distance (HD) between the volumes. RESULTS In total, 73 out of 87 (84%) patients were discussed. Changes were recommended in 38 (52%) patients: 30 had ≥1 major change, eight had minor changes only. There were 99 amended volumes: The overall median JI, GMI and HD was 0.91 (interquartile range [IQR]=0.80-0.97), 0.06 (IQR = 0.02-0.18) and 0.42 cm (IQR = 0.20-1.17 cm), respectively. The nodal gross-tumour-volume (GTVn) and therapeutic high-dose nodal clinical-target-volume (CTVn) had the biggest magnitude of changes: The median JI, GMI and HD of GTVn was 0.89 (IQR = 0.44-0.95), 0.11 (IQR = 0.05-0.51), 3.71 cm (IQR = 0.31-6.93 cm); high-dose CTVn was 0.78 (IQR = 0.59-0.90), 0.20 (IQR = 0.07-0.31) and 3.28 cm (IQR = 1.22-6.18 cm), respectively. There was no observed difference in the quantitative indices of the 85 'major' and 14 'minor' volumes (p = 0.5). CONCLUSIONS Routine head and neck radiologist input in radiotherapy peer review is feasible and can help avoid gross error in contouring. ADVANCES IN KNOWLEDGE The major and minor classifications may benefit from differentiation with quantitative indices but requires correlation from clinical outcomes.
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Affiliation(s)
- Kevin Chiu
- Department of Head & Neck Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - Peter Hoskin
- Department of Clinical Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - Amit Gupta
- Department of Head & Neck Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - Roeum Butt
- Department of Clinical Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - Samsara Terparia
- Department of Clinical Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - Louise Codd
- Department of Clinical Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - Yatman Tsang
- Department of Clinical Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - Jyotsna Bhudia
- Department of Head & Neck Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - Helen Killen
- Department of Head & Neck Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - Clare Kane
- Department of Head & Neck Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | | | - Catherine Lemon
- Department of Head & Neck Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - Daniel Megias
- Department of Clinical Oncology, Mount Vernon Cancer Centre, Northwood, UK
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14
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Gupta A, Dunlop A, Mitchell A, McQuaid D, Nill S, Barnes H, Newbold K, Nutting C, Bhide S, Oelfke U, Harrington KJ, Wong KH. Online adaptive radiotherapy for head and neck cancers on the MR linear Accelerator: Introducing a novel modified Adapt-to-Shape approach. Clin Transl Radiat Oncol 2022; 32:48-51. [PMID: 34849412 PMCID: PMC8608651 DOI: 10.1016/j.ctro.2021.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 11/02/2021] [Accepted: 11/04/2021] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION The Elekta Unity MR-Linac (MRL) has enabled adaptive radiotherapy (ART) for patients with head and neck cancers (HNC). Adapt-To-Shape-Lite (ATS-Lite) is a novel Adapt-to-Shape strategy that provides ART without requiring daily clinician presence to perform online target and organ at risk (OAR) delineation. In this study we compared the performance of our clinically-delivered ATS-Lite strategy against three Adapt-To-Position (ATP) variants: Adapt Segments (ATP-AS), Optimise Weights (ATP-OW), and Optimise Shapes (ATP-OS). METHODS Two patients with HNC received radical-dose radiotherapy on the MRL. For each fraction, an ATS-Lite plan was generated online and delivered and additional plans were generated offline for each ATP variant. To assess the clinical acceptability of a plan for every fraction, twenty clinical goals for targets and OARs were assessed for all four plans. RESULTS 53 fractions were analysed. ATS-Lite passed 99.9% of mandatory dose constraints. ATP-AS and ATP-OW each failed 7.6% of mandatory dose constraints. The Planning Target Volumes for 54 Gy (D95% and D98%) were the most frequently failing dose constraint targets for ATP. ATS-Lite median fraction times for Patient 1 and 2 were 40 mins 9 s (range 28 mins 16 s - 47 mins 20 s) and 32 mins 14 s (range 25 mins 33 s - 44 mins 27 s), respectively. CONCLUSIONS Our early data show that the novel ATS-Lite strategy produced plans that fulfilled 99.9% of clinical dose constraints in a time frame that is tolerable for patients and comparable to ATP workflows. Therefore, ATS-Lite, which bridges the gap between ATP and full ATS, will be further utilised and developed within our institute and it is a workflow that should be considered for treating patients with HNC on the MRL.
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Affiliation(s)
- Amit Gupta
- The Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, Head & Neck Unit, 15 Cotswold Road, Sutton, London SM2 5NG, United Kingdom
| | - Alex Dunlop
- The Joint Department of Physics, The Royal Marsden Hospital and the Institute of Cancer Research; Downs Road, Sutton SM2 5PT, United Kingdom
| | - Adam Mitchell
- The Joint Department of Physics, The Royal Marsden Hospital and the Institute of Cancer Research; Downs Road, Sutton SM2 5PT, United Kingdom
| | - Dualta McQuaid
- The Joint Department of Physics, The Royal Marsden Hospital and the Institute of Cancer Research; Downs Road, Sutton SM2 5PT, United Kingdom
| | - Simeon Nill
- The Joint Department of Physics, The Royal Marsden Hospital and the Institute of Cancer Research; Downs Road, Sutton SM2 5PT, United Kingdom
| | - Helen Barnes
- The Royal Marsden NHS Foundation Trust; Downs Road, Sutton SM2 5PT, United Kingdom
| | - Kate Newbold
- The Royal Marsden NHS Foundation Trust; Downs Road, Sutton SM2 5PT, United Kingdom
| | - Chris Nutting
- The Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, Head & Neck Unit, 15 Cotswold Road, Sutton, London SM2 5NG, United Kingdom
| | - Shreerang Bhide
- The Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, Head & Neck Unit, 15 Cotswold Road, Sutton, London SM2 5NG, United Kingdom
| | - Uwe Oelfke
- The Joint Department of Physics, The Royal Marsden Hospital and the Institute of Cancer Research; Downs Road, Sutton SM2 5PT, United Kingdom
| | - Kevin Joseph Harrington
- The Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, Head & Neck Unit, 15 Cotswold Road, Sutton, London SM2 5NG, United Kingdom
| | - Kee Howe Wong
- The Royal Marsden NHS Foundation Trust; Downs Road, Sutton SM2 5PT, United Kingdom
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15
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The Role of Patient- and Treatment-Related Factors and Early Functional Imaging in Late Radiation-Induced Xerostomia in Oropharyngeal Cancer Patients. Cancers (Basel) 2021; 13:cancers13246296. [PMID: 34944916 PMCID: PMC8699504 DOI: 10.3390/cancers13246296] [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: 10/30/2021] [Revised: 12/05/2021] [Accepted: 12/10/2021] [Indexed: 11/22/2022] Open
Abstract
Simple Summary In the present prospective study, we assessed the role of various Magnetic Resonance Imaging biomarkers combined with self-assessed xerostomia questionnaires and patient- and treatment-related factors, in predicting xerostomia at 12 months after chemoradiotherapy for oropharyngeal squamous cell carcinoma. We hypothesized that the integration of pre-treatment imaging biomarkers, which addresses the tissue heterogeneity and individual variations among patients, could improve the accuracy of conventional prediction models that are based only on dose information, ultimately providing a better understanding of the pathophysiological mechanisms underlying radiation induced salivary dysfunction. The implementation of multifactorial models, driven by machine learning algorithms, may improve prediction accuracy of radiation-induced toxicity and tailor individual treatment options for patients. Abstract The advent of quantitative imaging in personalized radiotherapy (RT) has offered the opportunity for a better understanding of individual variations in intrinsic radiosensitivity. We aimed to assess the role of magnetic resonance imaging (MRI) biomarkers, patient-related factors, and treatment-related factors in predicting xerostomia 12 months after RT (XER12) in patients affected by oropharyngeal squamous cell carcinoma (OSCC). Patients with locally advanced OSCC underwent diffusion-weighted imaging (DWI) and dynamic-contrast enhanced MRI at baseline; DWI was repeated at the 10th fraction of RT. The Radiation Therapy Oncology Group (RTOG) toxicity scale was used to evaluate salivary gland toxicity. Xerostomia-related questionnaires (XQs) were administered weekly during and after RT. RTOG toxicity ≥ grade 2 at XER12 was considered as endpoint to build prediction models. A Decision Tree classification learner was applied to build the prediction models following a five-fold cross-validation. Of the 89 patients enrolled, 63 were eligible for analysis. Thirty-six (57.1%) and 21 (33.3%) patients developed grade 1 and grade 2 XER12, respectively. Including only baseline variables, the model based on DCE-MRI and V65 (%) (volume of both glands receiving doses ≥ 65 Gy) had a fair accuracy (77%, 95% CI: 66.5–85.4%). The model based on V65 (%) and XQ-Intmid (integral of acute XQ scores from the start to the middle of RT) reached the best accuracy (81%, 95% CI: 71–88.7%). In conclusion, non-invasive biomarkers from DCE-MRI, in combination with dosimetric variables and self-assessed acute XQ scores during treatment may help predict grade 2 XER12 with a fair to good accuracy.
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16
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Using Black Bone Magnetic Resonance Imaging for Fibula Free Flap Surgical Planning: A Means to Reduce Radiation Exposure with Accurate Surgical Outcomes. Plast Reconstr Surg 2021; 148:77e-82e. [PMID: 34076611 DOI: 10.1097/prs.0000000000008090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SUMMARY Advances in virtual surgical planning and three-dimensionally-printed guides have enabled increased precision in vascularized free fibula flap reconstruction of the mandible and valuable preoperative planning. However, virtual surgical planning currently requires high-resolution computed tomographic scans, exposing patients to ionizing radiation. The aim of this study was to determine whether black bone magnetic resonance imaging can be used for accurate surgical planning and three-dimensionally-printed guide creation, thus reducing patient radiation exposure. This study included 10 cadaver heads and 10 cadaver lower extremities. A mock fibula free flap for mandible reconstruction was performed. Five operations were planned with guides created using black bone magnetic resonance imaging, whereas the other five were planned and performed using guides created with computed tomographic scan data. All specimens underwent a postoperative computed tomographic scan, and three-dimensional reconstruction of scans was performed and surgical accuracy to the planned surgery was assessed. Guides created from black bone magnetic resonance imaging demonstrated high accuracy to the surgical plan. There was no statistically significant difference in postoperative deviation from the plan when black bone magnetic resonance imaging versus computed tomographic scanning was used for virtual surgical planning and guide creation. Both modalities led to a postoperative positive or negative deviation from the virtual plan within 0.8 mm. This study demonstrates that virtual surgical planning and three-dimensionally-printed guide creation for free fibula flaps for mandible reconstruction can be performed using black bone magnetic resonance imaging with comparable accuracy to computed tomographic scanning. This could reduce radiation exposure for patients and enable a more streamlined imaging process for head and neck cancer patients.
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17
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Kieselmann JP, Fuller CD, Gurney-Champion OJ, Oelfke U. Cross-modality deep learning: Contouring of MRI data from annotated CT data only. Med Phys 2021; 48:1673-1684. [PMID: 33251619 PMCID: PMC8058228 DOI: 10.1002/mp.14619] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 08/03/2020] [Accepted: 11/02/2020] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Online adaptive radiotherapy would greatly benefit from the development of reliable auto-segmentation algorithms for organs-at-risk and radiation targets. Current practice of manual segmentation is subjective and time-consuming. While deep learning-based algorithms offer ample opportunities to solve this problem, they typically require large datasets. However, medical imaging data are generally sparse, in particular annotated MR images for radiotherapy. In this study, we developed a method to exploit the wealth of publicly available, annotated CT images to generate synthetic MR images, which could then be used to train a convolutional neural network (CNN) to segment the parotid glands on MR images of head and neck cancer patients. METHODS Imaging data comprised 202 annotated CT and 27 annotated MR images. The unpaired CT and MR images were fed into a 2D CycleGAN network to generate synthetic MR images from the CT images. Annotations of axial slices of the synthetic images were generated by propagating the CT contours. These were then used to train a 2D CNN. We assessed the segmentation accuracy using the real MR images as test dataset. The accuracy was quantified with the 3D Dice similarity coefficient (DSC), Hausdorff distance (HD), and mean surface distance (MSD) between manual and auto-generated contours. We benchmarked the approach by a comparison to the interobserver variation determined for the real MR images, as well as to the accuracy when training the 2D CNN to segment the CT images. RESULTS The determined accuracy (DSC: 0.77±0.07, HD: 18.04±12.59mm, MSD: 2.51±1.47mm) was close to the interobserver variation (DSC: 0.84±0.06, HD: 10.85±5.74mm, MSD: 1.50±0.77mm), as well as to the accuracy when training the 2D CNN to segment the CT images (DSC: 0.81±0.07, HD: 13.00±7.61mm, MSD: 1.87±0.84mm). CONCLUSIONS The introduced cross-modality learning technique can be of great value for segmentation problems with sparse training data. We anticipate using this method with any nonannotated MRI dataset to generate annotated synthetic MR images of the same type via image style transfer from annotated CT images. Furthermore, as this technique allows for fast adaptation of annotated datasets from one imaging modality to another, it could prove useful for translating between large varieties of MRI contrasts due to differences in imaging protocols within and between institutions.
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Affiliation(s)
- Jennifer P. Kieselmann
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London SM2 5NG, UK
| | - Clifton D. Fuller
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA
| | - Oliver J. Gurney-Champion
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London SM2 5NG, UK
| | - Uwe Oelfke
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London SM2 5NG, UK
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Boeke S, Mönnich D, van Timmeren JE, Balermpas P. MR-Guided Radiotherapy for Head and Neck Cancer: Current Developments, Perspectives, and Challenges. Front Oncol 2021; 11:616156. [PMID: 33816247 PMCID: PMC8017313 DOI: 10.3389/fonc.2021.616156] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 02/01/2021] [Indexed: 02/06/2023] Open
Abstract
Based on the development of new hybrid machines consisting of an MRI and a linear accelerator, magnetic resonance image guided radiotherapy (MRgRT) has revolutionized the field of adaptive treatment in recent years. Although an increasing number of studies have been published, investigating technical and clinical aspects of this technique for various indications, utilizations of MRgRT for adaptive treatment of head and neck cancer (HNC) remains in its infancy. Yet, the possible benefits of this novel technology for HNC patients, allowing for better soft-tissue delineation, intra- and interfractional treatment monitoring and more frequent plan adaptations appear more than obvious. At the same time, new technical, clinical, and logistic challenges emerge. The purpose of this article is to summarize and discuss the rationale, recent developments, and future perspectives of this promising radiotherapy modality for treating HNC.
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Affiliation(s)
- Simon Boeke
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Tübingen, Germany
| | - David Mönnich
- Section for Biomedical Physics, Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Tübingen, Germany
| | | | - Panagiotis Balermpas
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
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Flaus A, Nevesny S, Guy JB, Sotton S, Magné N, Prévot N. Positron emission tomography for radiotherapy planning in head and neck cancer: What impact? Nucl Med Commun 2021; 42:234-243. [PMID: 33252513 DOI: 10.1097/mnm.0000000000001329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PET-computed tomography (CT) plays a growing role to guide target volume delineation for head and neck cancer in radiation oncology. Pretherapeutic [18F]FDG PET-CT adds information to morphological imaging. First, as a whole-body imaging modality, it reveals regional or distant metastases that induce major therapeutic changes in more than 10% of the cases. Moreover, it allows better pathological lymph node selection which improves overall regional control and overall survival. Second, locally, it allows us to define the metabolic tumoral volume, which is a reliable prognostic feature for survival outcome. [18F]FDG PET-CT-based gross tumor volume (GTV) is on average significantly smaller than GTV based on CT. Nevertheless, the overlap is incomplete and more evaluation of composite GTV based on PET and GTV based on CT are needed. However, in clinical practice, the study showed that using GTV PET alone for treatment planning was similar to using GTVCT for local control and dose distribution was better as a dose to organs at risk significantly decreased. In addition to FDG, pretherapeutic PET could give access to different biological tumoral volumes - thanks to different tracers - guiding heterogeneous dose delivery (dose painting concept) to resistant subvolumes. During radiotherapy treatment, follow-up [18F]FDG PET-CT revealed an earlier and more important diminution of GTV than other imaging modality. It may be a valuable support for adaptative radiotherapy as a new treatment plan with a significant impact on dose distribution became possible. Finally, additional studies are required to prospectively validate long-term outcomes and lower toxicity resulting from the use of PET-CT in treatment planning.
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Affiliation(s)
- Anthime Flaus
- Service de Médecine Nucléaire, Centre Hospitalier Universitaire de Saint-Etienne, St Etienne
| | - Stéphane Nevesny
- Département de Radiothérapie, Institut de Cancérologie de la Loire-Lucien Neuwirth, St Priest en Jarez
| | - Jean-Baptiste Guy
- Département de Radiothérapie, Institut de Cancérologie de la Loire-Lucien Neuwirth, St Priest en Jarez
- UMR CNRS 5822/IN2P3, IPNL, PRISME, Laboratoire de Radiobiologie Cellulaire et Moléculaire, Faculté de Médecine Lyon-Sud, Université Lyon 1, Oullins Cedex
| | - Sandrine Sotton
- Department of Research and Teaching, Lucien Neuwirth Cancer Institute, Saint-Priest-en-Jarez, University Departement of Research and Teaching
| | - Nicolas Magné
- Département de Radiothérapie, Institut de Cancérologie de la Loire-Lucien Neuwirth, St Priest en Jarez
- UMR CNRS 5822/IN2P3, IPNL, PRISME, Laboratoire de Radiobiologie Cellulaire et Moléculaire, Faculté de Médecine Lyon-Sud, Université Lyon 1, Oullins Cedex
| | - Nathalie Prévot
- Service de Médecine Nucléaire, Centre Hospitalier Universitaire de Saint-Etienne, St Etienne
- INSERM U 1059 Sainbiose, Université Jean Monnet, Saint-Etienne, France
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20
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Transoral robotic surgery in Ireland: the beginning. Ir J Med Sci 2021; 191:361-365. [PMID: 33559869 DOI: 10.1007/s11845-021-02539-w] [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: 12/05/2020] [Accepted: 02/01/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Transoral robotic surgery (TORS) has shown promising results in the treatment of myriad head and neck pathologies but is now most commonly used in the investigation and management of oropharyngeal squamous cell carcinoma. AIMS The aim of this study was to report our cases of the newly introduced TORS, particularly its role in identifying primary of unknown origin and the potential implications for patients. A literature review and our early experience should begin to debunk some of the criticisms of TORS including setup times and cost. METHODS Prospective data was collected from all patients undergoing transoral robotic surgery including demographics, indication, histology results in primary of unknown origin and complications. RESULTS We have performed 36 TORS procedures in total ranging from intermediate to major complex. Our complication rate is low, and this has improved with the passage of time. Haemorrhage rates remain at 5.6% (n = 2), and the average length of stay is 1 day. Successful identification of a primary tumour in cancer of unknown primary was 80% (n = 8). CONCLUSIONS We anticipate the integration of TORS into routine practice in the investigation and management of a number of ENT pathologies following robust clinical trials.
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21
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Mahieu R, de Maar JS, Nieuwenhuis ER, Deckers R, Moonen C, Alic L, ten Haken B, de Keizer B, de Bree R. New Developments in Imaging for Sentinel Lymph Node Biopsy in Early-Stage Oral Cavity Squamous Cell Carcinoma. Cancers (Basel) 2020; 12:cancers12103055. [PMID: 33092093 PMCID: PMC7589685 DOI: 10.3390/cancers12103055] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/03/2020] [Accepted: 10/15/2020] [Indexed: 12/18/2022] Open
Abstract
Sentinel lymph node biopsy (SLNB) is a diagnostic staging procedure that aims to identify the first draining lymph node(s) from the primary tumor, the sentinel lymph nodes (SLN), as their histopathological status reflects the histopathological status of the rest of the nodal basin. The routine SLNB procedure consists of peritumoral injections with a technetium-99m [99mTc]-labelled radiotracer followed by lymphoscintigraphy and SPECT-CT imaging. Based on these imaging results, the identified SLNs are marked for surgical extirpation and are subjected to histopathological assessment. The routine SLNB procedure has proven to reliably stage the clinically negative neck in early-stage oral squamous cell carcinoma (OSCC). However, an infamous limitation arises in situations where SLNs are located in close vicinity of the tracer injection site. In these cases, the hotspot of the injection site can hide adjacent SLNs and hamper the discrimination between tracer injection site and SLNs (shine-through phenomenon). Therefore, technical developments are needed to bring the diagnostic accuracy of SLNB for early-stage OSCC to a higher level. This review evaluates novel SLNB imaging techniques for early-stage OSCC: MR lymphography, CT lymphography, PET lymphoscintigraphy and contrast-enhanced lymphosonography. Furthermore, their reported diagnostic accuracy is described and their relative merits, disadvantages and potential applications are outlined.
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Affiliation(s)
- Rutger Mahieu
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, University of Utrecht, 3584 CX Utrecht, The Netherlands;
| | - Josanne S. de Maar
- Division of Imaging and Oncology, University Medical Center Utrecht, University of Utrecht, 3584 CX Utrecht, The Netherlands; (J.S.d.M.); (R.D.); (C.M.)
| | - Eliane R. Nieuwenhuis
- Department of Magnetic Detection & Imaging, University of Twente, 7522 NB Enschede, The Netherlands; (E.R.N.); (L.A.); (B.t.H.)
| | - Roel Deckers
- Division of Imaging and Oncology, University Medical Center Utrecht, University of Utrecht, 3584 CX Utrecht, The Netherlands; (J.S.d.M.); (R.D.); (C.M.)
| | - Chrit Moonen
- Division of Imaging and Oncology, University Medical Center Utrecht, University of Utrecht, 3584 CX Utrecht, The Netherlands; (J.S.d.M.); (R.D.); (C.M.)
| | - Lejla Alic
- Department of Magnetic Detection & Imaging, University of Twente, 7522 NB Enschede, The Netherlands; (E.R.N.); (L.A.); (B.t.H.)
| | - Bennie ten Haken
- Department of Magnetic Detection & Imaging, University of Twente, 7522 NB Enschede, The Netherlands; (E.R.N.); (L.A.); (B.t.H.)
| | - Bart de Keizer
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands;
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, University of Utrecht, 3584 CX Utrecht, The Netherlands;
- Correspondence: ; Tel.: +31-88-7550819
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Liu Y, Lei Y, Fu Y, Wang T, Zhou J, Jiang X, McDonald M, Beitler JJ, Curran WJ, Liu T, Yang X. Head and neck multi-organ auto-segmentation on CT images aided by synthetic MRI. Med Phys 2020; 47:4294-4302. [PMID: 32648602 DOI: 10.1002/mp.14378] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 06/22/2020] [Accepted: 06/30/2020] [Indexed: 11/03/2023] Open
Abstract
PURPOSE Because the manual contouring process is labor-intensive and time-consuming, segmentation of organs-at-risk (OARs) is a weak link in radiotherapy treatment planning process. Our goal was to develop a synthetic MR (sMR)-aided dual pyramid network (DPN) for rapid and accurate head and neck multi-organ segmentation in order to expedite the treatment planning process. METHODS Forty-five patients' CT, MR, and manual contours pairs were included as our training dataset. Nineteen OARs were target organs to be segmented. The proposed sMR-aided DPN method featured a deep attention strategy to effectively segment multiple organs. The performance of sMR-aided DPN method was evaluated using five metrics, including Dice similarity coefficient (DSC), Hausdorff distance 95% (HD95), mean surface distance (MSD), residual mean square distance (RMSD), and volume difference. Our method was further validated using the 2015 head and neck challenge data. RESULTS The contours generated by the proposed method closely resemble the ground truth manual contours, as evidenced by encouraging quantitative results in terms of DSC using the 2015 head and neck challenge data. Mean DSC values of 0.91 ± 0.02, 0.73 ± 0.11, 0.96 ± 0.01, 0.78 ± 0.09/0.78 ± 0.11, 0.88 ± 0.04/0.88 ± 0.06 and 0.86 ± 0.08/0.85 ± 0.1 were achieved for brain stem, chiasm, mandible, left/right optic nerve, left/right parotid, and left/right submandibular, respectively. CONCLUSIONS We demonstrated the feasibility of sMR-aided DPN for head and neck multi-organ delineation on CT images. Our method has shown superiority over the other methods on the 2015 head and neck challenge data results. The proposed method could significantly expedite the treatment planning process by rapidly segmenting multiple OARs.
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Affiliation(s)
- Yingzi Liu
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
| | - Yang Lei
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
| | - Yabo Fu
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
| | - Tonghe Wang
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
| | - Jun Zhou
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
| | - Xiaojun Jiang
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
| | - Mark McDonald
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
| | - Jonathan J Beitler
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
| | - Walter J Curran
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
| | - Tian Liu
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
| | - Xiaofeng Yang
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
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Thureau S, Briens A, Decazes P, Castelli J, Barateau A, Garcia R, Thariat J, de Crevoisier R. PET and MRI guided adaptive radiotherapy: Rational, feasibility and benefit. Cancer Radiother 2020; 24:635-644. [PMID: 32859466 DOI: 10.1016/j.canrad.2020.06.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 02/07/2023]
Abstract
Adaptive radiotherapy (ART) corresponds to various replanning strategies aiming to correct for anatomical variations occurring during the course of radiotherapy. The goal of the article was to report the rational, feasibility and benefit of using PET and/or MRI to guide this ART strategy in various tumor localizations. The anatomical modifications defined by scanner taking into account tumour mobility and volume variation are not always sufficient to optimise treatment. The contribution of functional imaging by PET or the precision of soft tissue by MRI makes it possible to consider optimized ART. Today, the most important data for both PET and MRI are for lung, head and neck, cervical and prostate cancers. PET and MRI guided ART appears feasible and safe, however in a very limited clinical experience. Phase I/II studies should be therefore performed, before proposing cost-effectiveness comparisons in randomized trials and before using the approach in routine practice.
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Affiliation(s)
- S Thureau
- Département de radiothérapie et de physique médicale, centre Henri-Becquerel, QuantIF EA 4108, université de Rouen, 76000 Rouen, France.
| | - A Briens
- Département de radiothérapie, centre Eugène-Marquis, rue de la Bataille-Flandres-Dunkerque, CS 44229, 35042 Rennes cedex, France
| | - P Decazes
- Département de médecine nucléaire, center Henri-Becquerel, QuantIF EA 4108, université de Rouen, Rouen, France
| | - J Castelli
- Département de radiothérapie, centre Eugène Marquis, rue de la Bataille-Flandres-Dunkerque, CS 44229, 35042 Rennes cedex, France; CLCC Eugène Marquis, Inserm, LTSI-UMR 1099, université de Rennes, 35000 Rennes, France
| | - A Barateau
- Département de radiothérapie, centre Eugène Marquis, rue de la Bataille-Flandres-Dunkerque, CS 44229, 35042 Rennes cedex, France; CLCC Eugène Marquis, Inserm, LTSI-UMR 1099, université de Rennes, 35000 Rennes, France
| | - R Garcia
- Service de physique médicale, institut Sainte-Catherine, 84918 Avignon, France
| | - J Thariat
- Department of radiation oncology, centre François-Baclesse, 14000 Caen, France; Laboratoire de physique corpusculaire IN2P3/ENSICAEN-UMR6534-Unicaen-Normandie université, 14000 Caen, France; ARCHADE Research Community, 14000 Caen, France
| | - R de Crevoisier
- Département de radiothérapie, centre Eugène-Marquis, rue de la Bataille-Flandres-Dunkerque, CS 44229, 35042 Rennes cedex, France; CLCC Eugène Marquis, Inserm, LTSI-UMR 1099, université de Rennes, 35000 Rennes, France
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24
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Shukla M, Forghani R, Agarwal M. Patient-Centric Head and Neck Cancer Radiation Therapy: Role of Advanced Imaging. Neuroimaging Clin N Am 2020; 30:341-357. [PMID: 32600635 DOI: 10.1016/j.nic.2020.04.005] [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] [Indexed: 12/24/2022]
Abstract
The traditional 'one-size-fits-all' approach to H&N cancer therapy is archaic. Advanced imaging can identify radioresistant areas by using biomarkers that detect tumor hypoxia, hypercellularity etc. Highly conformal radiotherapy can target resistant areas with precision. The critical information that can be gleaned about tumor biology from these advanced imaging modalities facilitates individualized radiotherapy. The tumor imaging world is pushing its boundaries. Molecular imaging can now detect protein expression and genotypic variations across tumors that can be exploited for tailoring treatment. The exploding field of radiomics and radiogenomics extracts quantitative, biologic and genetic information and further expands the scope of personalized therapy.
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Affiliation(s)
- Monica Shukla
- Department of Radiation Oncology, Froedtert and Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI 53226, USA
| | - Reza Forghani
- Augmented Intelligence & Precision Health Laboratory, Department of Radiology, Research Institute of McGill University Health Centre, 1001 Decarie Boulevard, Montreal, Quebec H4A 3J1, Canada
| | - Mohit Agarwal
- Department of Radiology, Section of Neuroradiology, Froedtert and Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
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25
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Jonsson J, Nyholm T, Söderkvist K. The rationale for MR-only treatment planning for external radiotherapy. Clin Transl Radiat Oncol 2019; 18:60-65. [PMID: 31341977 PMCID: PMC6630106 DOI: 10.1016/j.ctro.2019.03.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 03/28/2019] [Accepted: 03/29/2019] [Indexed: 12/12/2022] Open
Abstract
•MR-only treatment planning could improve the spatial accuracy of radiotherapy.•The benefit compared to a mixed MR-CT workflow will vary between patient groups.•Further development of QA tools is needed before the procedure will save resources.
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Affiliation(s)
| | - Tufve Nyholm
- Department of Radiation Sciences, Umeå University, 90187 Umeå, Sweden
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Blanchard P, Biau J, Castelli J, Tao Y, Graff P, Nguyen F. [Individualization of dose and fractionation of radiotherapy for head and neck cancers]. Cancer Radiother 2019; 23:784-788. [PMID: 31420129 DOI: 10.1016/j.canrad.2019.07.131] [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: 06/12/2019] [Revised: 07/04/2019] [Accepted: 07/05/2019] [Indexed: 10/26/2022]
Abstract
Head and neck cancers comprise a variety of tumours depending on the sub-site, for which target volumes and the prescribed doses need to be individualized according to each patient's history and presentation. This article aims at describing the main factors involved in decision-making regarding dose and volume, as well as ongoing research. Contouring and treatment guidelines, use of altered fractionation, major prognostic factors, the role of Human papillomavirus and of functional imaging will be presented and discussed.
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Affiliation(s)
- P Blanchard
- Département de radiothérapie oncologie, Gustave-Roussy Cancer Campus, 114, rue Édouard-Vaillant, 94800 Villejuif, France; Inserm, U1018 « Centre de recherche en épidémiologie et santé des populations » (CESP), 94800 Villejuif, France; Université Paris-Saclay, 94800 Villejuif, France.
| | - J Biau
- Département de radiothérapie oncologie, centre Jean-Perrin, 63000 Clermont-Ferrand, France; Université Clermont-Auvergne, 63000 Clermont-Ferrand, France; Inserm, U1240 « Imagerie moléculaire et stratégies théranostiques » (Imost), 63000 Clermont-Ferrand, France
| | - J Castelli
- Département de radiothérapie, centre Eugène-Marquis, 35000 Rennes, France; Inserm, U1099 « Laboratoire traitement du signal et de l'image » (LTSI), 35000 Rennes, France; Université Rennes 1, 35000 Rennes, France
| | - Y Tao
- Département de radiothérapie oncologie, Gustave-Roussy Cancer Campus, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - P Graff
- Département de radiothérapie, IUCT Oncopole, 31000 Toulouse, France
| | - F Nguyen
- Département de radiothérapie oncologie, Gustave-Roussy Cancer Campus, 114, rue Édouard-Vaillant, 94800 Villejuif, France
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Zhou Y, Wong OL, Cheung KY, Yu SK, Yuan J. A pilot study of highly accelerated 3D MRI in the head and neck position verification for MR-guided radiotherapy. Quant Imaging Med Surg 2019; 9:1255-1269. [PMID: 31448211 DOI: 10.21037/qims.2019.06.18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background To evaluate the performance of a highly accelerated 3D MRI on inter-fractional positional measurement for MR-guided radiotherapy (MRgRT) in the head and neck (HN). Methods Fourteen healthy volunteers received 159 scans on a 1.5 T MR-sim to simulate MRgRT fractions. MRI acquisition included a high-resolution (HQI-MRI, voxel-size =1.05×1.05×1.05 mm3, duration =5 min) and a highly-accelerated low-resolution (true-LQI-MRI, acceleration-factor =9, voxel-size =1.4×1.4×1.4 mm3, duration =86 s) T1w spin-echo sequence (TR/TE =420/7.2 ms). The first session HQI-MRI was used as the reference to mimic planning MRI. Other HQI-MRI was also retrospectively down-sampled in K-space and GRAPPA reconstructed to generate pseudo-LQI-MRI. Inter-sessional positional shift calculated from HQI-MRI, true-LQI-MRI and pseudo-LQI-MRI rigidly registering to the reference were analyzed and compared in the overall HN and the sub-regions of brain, nasopharynx, oropharynx and hypopharynx. Results The calculated SD of systematic errors (Σ) from HQI-MRI/pseudo-LQI-MRI/true-LQI-MRI images for overall HN were 1.11/1.14/1.08, 0.28/0.26/0.29, 0.43/0.44/0.60, and 0.77/0.79/0.74 mm for translation in LR, AP, SI and 3D, respectively; The corresponding RMS of random errors (σ) were 0.97/0.98/0.96, 0.28/0.27/0.26, 0.77/0.77/0.72, and 0.85/0.87/0.85 mm. For all sub-regions, brain showed the smallest Σ and σ in 3D. Other sub-regions showed direction-dependent error patterns, but the positioning results were consistent, independent of the datasets used for registration. Conclusions A highly-accelerated 3D-MRI could be used for MR-guided HN radiotherapy without compromising position verification accuracy.
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Affiliation(s)
- Yihang Zhou
- Medical Physics and Research Department, Hong Kong Sanatorium & Hospital, Hong Kong, China
| | - Oi Lei Wong
- Medical Physics and Research Department, Hong Kong Sanatorium & Hospital, Hong Kong, China
| | - Kin Yin Cheung
- Medical Physics and Research Department, Hong Kong Sanatorium & Hospital, Hong Kong, China
| | - Siu Ki Yu
- Medical Physics and Research Department, Hong Kong Sanatorium & Hospital, Hong Kong, China
| | - Jing Yuan
- Medical Physics and Research Department, Hong Kong Sanatorium & Hospital, Hong Kong, China
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Soisson E, Guerrieri P, Balasubramanian S, Ahamad A, Moran JM, Joiner MC, Dominello M, Burmeister J. Three discipline collaborative radiation therapy special debate: All head and neck cancer patients with intact tumors/nodes should have scheduled adaptive replanning performed at least once during the course of radiotherapy. J Appl Clin Med Phys 2019; 20:7-11. [PMID: 30983132 PMCID: PMC6523017 DOI: 10.1002/acm2.12587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 03/28/2019] [Accepted: 03/28/2019] [Indexed: 11/07/2022] Open
Affiliation(s)
- Emilie Soisson
- Department of RadiologyUniversity of VermontBurlingtonVTUSA
- Medical Physics UnitMcGill UniversityMontrealQCCanada
| | | | | | - Anesa Ahamad
- Department of Radiation OncologyUniversity of Miami Miller School of MedicineSylvester Comprehensive Cancer CenterMiamiFLUSA
| | - Jean M. Moran
- Department of Radiation OncologyUniversity of MichiganAnn ArborMIUSA
| | - Michael C. Joiner
- Department of OncologyWayne State University School of MedicineDetroitMIUSA
| | - Michael Dominello
- Department of OncologyWayne State University School of MedicineDetroitMIUSA
| | - Jay Burmeister
- Department of OncologyWayne State University School of MedicineDetroitMIUSA
- Gershenson Radiation Oncology CenterBarbara Ann Karmanos Cancer InstituteDetroitMIUSA
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Maffei C, Sarubbo S, Jovicich J. A Missing Connection: A Review of the Macrostructural Anatomy and Tractography of the Acoustic Radiation. Front Neuroanat 2019; 13:27. [PMID: 30899216 PMCID: PMC6416820 DOI: 10.3389/fnana.2019.00027] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 02/15/2019] [Indexed: 12/13/2022] Open
Abstract
The auditory system of mammals is dedicated to encoding, elaborating and transporting acoustic information from the auditory nerve to the auditory cortex. The acoustic radiation (AR) constitutes the thalamo-cortical projection of this system, conveying the auditory signals from the medial geniculate nucleus (MGN) of the thalamus to the transverse temporal gyrus on the superior temporal lobe. While representing one of the major sensory pathways of the primate brain, the currently available anatomical information of this white matter bundle is quite limited in humans, thus constituting a notable omission in clinical and general studies on auditory processing and language perception. Tracing procedures in humans have restricted applications, and the in vivo reconstruction of this bundle using diffusion tractography techniques remains challenging. Hence, a more accurate and reliable reconstruction of the AR is necessary for understanding the neurobiological substrates supporting audition and language processing mechanisms in both health and disease. This review aims to unite available information on the macroscopic anatomy and topography of the AR in humans and non-human primates. Particular attention is brought to the anatomical characteristics that make this bundle difficult to reconstruct using non-invasive techniques, such as diffusion-based tractography. Open questions in the field and possible future research directions are discussed.
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Affiliation(s)
- Chiara Maffei
- Harvard Medical School, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, United States.,Center for Mind/Brain Sciences - CIMeC, University of Trento, Trento, Italy
| | - Silvio Sarubbo
- Division of Neurosurgery, Structural and Functional Connectivity Lab Project, S. Chiara Hospital, Trento Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Jorge Jovicich
- Center for Mind/Brain Sciences - CIMeC, University of Trento, Trento, Italy.,Department of Psychology and Cognitive Sciences, University of Trento, Trento, Italy
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Obuchowski NA, Mozley PD, Matthews D, Buckler A, Bullen J, Jackson E. Statistical Considerations for Planning Clinical Trials with Quantitative Imaging Biomarkers. J Natl Cancer Inst 2018; 111:19-26. [DOI: 10.1093/jnci/djy194] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 10/04/2018] [Indexed: 12/26/2022] Open
Affiliation(s)
- Nancy A Obuchowski
- Cleveland Clinic Foundation, Quantitative Health Sciences/JJN3, Cleveland, OH
| | | | | | | | | | - Edward Jackson
- University of Wisconsin School of Medicine and Public Health, Madison, WI
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Ruiz-Drebing M, Dennis R, Sparkes A, Dominguez E. MRI features of presumed normal palatine tonsils in dogs. J Small Anim Pract 2018; 60:231-238. [PMID: 30488445 DOI: 10.1111/jsap.12967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 09/24/2018] [Accepted: 09/26/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the MRI characteristics of normal palatine tonsils in dogs. MATERIALS AND METHODS Retrospective study of 95 dogs with presumed normal tonsils. Tonsillar margination, shape and signal intensity in pre- and postcontrast studies were assessed and the cross-sectional area was measured at the point of maximal size on transverse images. RESULTS In all cases the tonsils were located with their largest transverse cross-section at the level of the temporomandibular joints. Their margins were well-defined in all dogs; in 57 (60%) the borders were smooth and in 38 (40%) slightly irregular. The majority (96%) of the tonsils were rounded to oval in cross-section and the remainder were elongated. All tonsils were hyperintense to the medial pterygoid muscles in T1-weighted, T2-weighted, FLAIR and T2* gradient echo images and they showed either homogeneous (53%) or heterogeneous (47%) signal intensity. Contrast enhancement was marked (65%) or moderate (33%) in the majority of animals. Median tonsillar cross-sectional area was approximately 29 mm2 (90% confidence interval: 10.0 to 64.4 mm2 ). There was significant positive correlation between bodyweight and tonsillar cross-sectional area and a weak negative correlation between age and tonsillar cross-sectional area. CLINICAL SIGNIFICANCE MRI is of value in assessing normal palatine tonsils in dogs. This study could be used as a baseline for the investigation of the value of MRI in assessment of tonsillar disease in dogs.
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Affiliation(s)
| | - R Dennis
- Animal Health Trust, Newmarket, CB8 7UU, UK
| | - A Sparkes
- International Cat Care, Tisbury, SP3 6LW, UK
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Shukla-Dave A, Obuchowski NA, Chenevert TL, Jambawalikar S, Schwartz LH, Malyarenko D, Huang W, Noworolski SM, Young RJ, Shiroishi MS, Kim H, Coolens C, Laue H, Chung C, Rosen M, Boss M, Jackson EF. Quantitative imaging biomarkers alliance (QIBA) recommendations for improved precision of DWI and DCE-MRI derived biomarkers in multicenter oncology trials. J Magn Reson Imaging 2018; 49:e101-e121. [PMID: 30451345 DOI: 10.1002/jmri.26518] [Citation(s) in RCA: 219] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/06/2018] [Accepted: 09/06/2018] [Indexed: 12/14/2022] Open
Abstract
Physiological properties of tumors can be measured both in vivo and noninvasively by diffusion-weighted imaging and dynamic contrast-enhanced magnetic resonance imaging. Although these techniques have been used for more than two decades to study tumor diffusion, perfusion, and/or permeability, the methods and studies on how to reduce measurement error and bias in the derived imaging metrics is still lacking in the literature. This is of paramount importance because the objective is to translate these quantitative imaging biomarkers (QIBs) into clinical trials, and ultimately in clinical practice. Standardization of the image acquisition using appropriate phantoms is the first step from a technical performance standpoint. The next step is to assess whether the imaging metrics have clinical value and meet the requirements for being a QIB as defined by the Radiological Society of North America's Quantitative Imaging Biomarkers Alliance (QIBA). The goal and mission of QIBA and the National Cancer Institute Quantitative Imaging Network (QIN) initiatives are to provide technical performance standards (QIBA profiles) and QIN tools for producing reliable QIBs for use in the clinical imaging community. Some of QIBA's development of quantitative diffusion-weighted imaging and dynamic contrast-enhanced QIB profiles has been hampered by the lack of literature for repeatability and reproducibility of the derived QIBs. The available research on this topic is scant and is not in sync with improvements or upgrades in MRI technology over the years. This review focuses on the need for QIBs in oncology applications and emphasizes the importance of the assessment of their reproducibility and repeatability. Level of Evidence: 5 Technical Efficacy Stage: 1 J. Magn. Reson. Imaging 2019;49:e101-e121.
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Affiliation(s)
- Amita Shukla-Dave
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Nancy A Obuchowski
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Thomas L Chenevert
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Sachin Jambawalikar
- Department of Radiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Lawrence H Schwartz
- Department of Radiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Dariya Malyarenko
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Wei Huang
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Susan M Noworolski
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Robert J Young
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Mark S Shiroishi
- Division of Neuroradiology, Department of Radiology, University of Southern California, Los Angeles, California, USA
| | - Harrison Kim
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Catherine Coolens
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Canada
| | | | - Caroline Chung
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Mark Rosen
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael Boss
- Applied Physics Division, National Institute of Standards and Technology, Boulder, Colorado, USA
| | - Edward F Jackson
- Departments of Medical Physics, Radiology, and Human Oncology, University of Wisconsin School of Medicine, Madison, Wisconsin, USA
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Marzi S, Minosse S, Vidiri A, Piludu F, Giannelli M. Diffusional kurtosis imaging in head and neck cancer: On the use of trace-weighted images to estimate indices of non-Gaussian water diffusion. Med Phys 2018; 45:5411-5419. [PMID: 30317646 DOI: 10.1002/mp.13238] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 10/02/2018] [Accepted: 10/03/2018] [Indexed: 12/11/2022] Open
Abstract
PURPOSE While previous studies have demonstrated the feasibility and potential usefulness of quantitative non-Gaussian diffusional kurtosis imaging (DKI) of the brain, more recent research has focused on oncological application of DKI in various body regions such as prostate, breast, and head and neck (HN). Given the need to minimize scan time during most routine magnetic resonance imaging (MRI) acquisitions of body regions, diffusion-weighted imaging (DWI) with only three orthogonal diffusion weighting directions (x, y, z) is usually performed. Moreover, as water diffusion within malignant tumors is generically thought to be almost isotropic, DWI with only three diffusion weighting directions is considered sufficient for oncological application and it represents the de facto standard in body DKI. In this context, since the kurtosis tensor and diffusion tensor cannot be obtained, the averages of the three directional (Kx , Ky , Kz ) and (Dx , Dy , Dz ) - namely K and D, respectively - represent the best-possible surrogates of directionless DKI-derived indices of kurtosis and diffusivity, respectively. This would require fitting the DKI model to the diffusion-weighted images acquired along each direction (x, y, z) prior to averaging. However, there is a growing tendency to perform only a single fit of the DKI model to the geometric means of the images acquired with diffusion-sensitizing gradient along (x, y, z), referred to as trace-weighted (TW) images. To the best of our knowledge, no in vivo studies have evaluated how TW images affect estimates of DKI-derived indices of K and D. Thus, the aim of this study was to assess the potential bias and error introduced in estimated K and D by fitting the DKI model to the TW images in HN cancer patients. METHODS Eighteen patients with histologically proven malignant tumors of the HN were enrolled in the study. They underwent pretreatment 3 T MRI, including DWI (b-values: 0, 500, 1000, 1500, 2000 s/mm2 ). Some patients had multiple lesions, and thus a total of 34 lesions were analyzed. DKI-derived indices were estimated, voxel-by-voxel, using single diffusion-weighted images along (x, y, z) as well as TW images. A comparison between the two estimation methods was performed by calculating the percentage error in D (Derr ) and K (Kerr ). Also, diffusivity anisotropy (Danis ) and diffusional kurtosis anisotropy (Kanis ) were estimated. Agreements between the two estimation methods were assessed by Bland-Altman plots. The Spearman rank correlation test was used to study the correlations between Kerr /Derr and Danis /Kanis. RESULTS: The median (95% confidence interval) Kerr and Derr were 5.1% (0.8%, 32.6%) and 1.7% (-2.5%, 5.3%), respectively. A significant relationship was observed between Kerr and Danis (correlation coefficient R = 0.694, P < 0.0001), as well as between Kerr and Kanis (R = 0.848, P < 0.0001). CONCLUSIONS In HN cancer, the fit of the DKI model to TW images can introduce bias and error in the estimation of K and D, which may be non-negligible for single lesions, and should hence be adopted with caution.
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Affiliation(s)
- Simona Marzi
- Medical Physics Laboratory, IRCCS Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Silvia Minosse
- Medical Physics Laboratory, IRCCS Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Antonello Vidiri
- Radiology and Diagnostic Imaging Department, IRCCS Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Francesca Piludu
- Radiology and Diagnostic Imaging Department, IRCCS Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Marco Giannelli
- Unit of Medical Physics, Pisa University Hospital "Azienda Ospedaliero-Universitaria Pisana", 56126, Pisa, Italy
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Arterial spin labelling and diffusion-weighted magnetic resonance imaging in differentiation of recurrent head and neck cancer from post-radiation changes. The Journal of Laryngology & Otology 2018; 132:923-928. [DOI: 10.1017/s0022215118001743] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AbstractObjectiveTo assess arterial spin labelling and diffusion-weighted imaging in the differentiation of recurrent head and neck cancer from post-radiation changes.MethodsA retrospective study was conducted of 47 patients with head and neck cancer, treated with radiotherapy, who underwent magnetic resonance arterial spin labelling and diffusion-weighted magnetic resonance imaging. Tumour blood flow and apparent diffusion co-efficient of the lesion were calculated.ResultsThere was significant difference (p= 0.001) in tumour blood flow between patients with recurrent head and neck cancer (n= 31) (47.37 ± 16.3 ml/100 g/minute) and those with post-radiation changes (n= 16) (18.80 ± 2.9 ml/100 g/minute). The thresholds of tumour blood flow and apparent diffusion co-efficient used for differentiating recurrence from post-radiation changes were more than 24.0 ml/100 g/minute and 1.21 × 10−3mm2/second or less, with area under the curve values of 0.94 and 0.90, and accuracy rates of 88.2 per cent and 88.2 per cent, respectively. The combined tumour blood flow and apparent diffusion co-efficient values used for differentiating recurrence from post-radiation changes had an area under the curve of 0.96 and an accuracy of 90.2 per cent.ConclusionCombined tumour blood flow and apparent diffusion co-efficient can differentiate recurrence from post-radiation changes.
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Payabvash S. Quantitative diffusion magnetic resonance imaging in head and neck tumors. Quant Imaging Med Surg 2018; 8:1052-1065. [PMID: 30598882 DOI: 10.21037/qims.2018.10.14] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In patients with head and neck cancer, conventional anatomical magnetic resonance imaging (MRI) scans are commonly used for identification of primary lesion, assessment of structural distortion, and presence of metastatic lymph nodes. However, quantitative analysis of diffusion MRI can provide added value to structural and anatomical evaluation of head and neck tumors (HNT), by differentiation of primary malignant process, prognostic prediction, and treatment monitoring. In this article, we will review the applications of quantitative diffusion MRI in identification of primary malignant tissue, differentiation of tumor pathology, prediction of molecular phenotype, monitoring of treatment response, and evaluation of posttreatment changes in patient with HNT.
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Affiliation(s)
- Seyedmehdi Payabvash
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
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Marzi S, Farneti A, Vidiri A, Di Giuliano F, Marucci L, Spasiano F, Terrenato I, Sanguineti G. Radiation-induced parotid changes in oropharyngeal cancer patients: the role of early functional imaging and patient-/treatment-related factors. Radiat Oncol 2018; 13:189. [PMID: 30285893 PMCID: PMC6167883 DOI: 10.1186/s13014-018-1137-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 09/24/2018] [Indexed: 02/08/2023] Open
Abstract
Background Functional magnetic resonance imaging may provide several quantitative indices strictly related to distinctive tissue signatures with radiobiological relevance, such as tissue cellular density and vascular perfusion. The role of Intravoxel Incoherent Motion Diffusion Weighted Imaging (IVIM-DWI) and Dynamic Contrast-Enhanced (DCE) MRI in detecting/predicting radiation-induced volumetric changes of parotids both during and shortly after (chemo)radiotherapy of oropharyngeal squamous cell carcinoma (SCC) was explored. Methods Patients with locally advanced oropharyngeal SCC were accrued within a prospective study offering both IVIM-DWI and DCE-MRI at baseline; IVIM-DWI was repeated at the 10th fraction of treatment. Apparent diffusion coefficient (ADC), tissue diffusion coefficient Dt, perfusion fraction f and perfusion-related diffusion coefficient D* were estimated both at baseline and during RT. Semi-quantitative and quantitative parameters, including the transfer constant Ktrans, were calculated from DCE-MRI. Parotids were contoured on T2-weighted images at baseline, 10th fraction and 8th weeks after treatment end and the percent change of parotid volume between baseline/10th fr (∆Vol10fr) and baseline/8th wk. (∆Volpost) computed. Correlations among volumetric changes and patient-, treatment- and imaging-related features were investigated at univariate analysis (Spearman’s Rho). Results Eighty parotids (40 patients) were analyzed. Percent changes were 18.2 ± 10.7% and 31.3 ± 15.8% for ∆Vol10fr and ∆Volpost, respectively. Among baseline characteristics, ∆Vol10fr was correlated to body mass index, patient weight as well as the initial parotid volume. A weak correlation was present between parotid shrinkage after the first 2 weeks of treatment and dosimetric variables, while no association was found after radiotherapy. Percent changes of both ADC and Dt at the 10th fraction were also correlated to ∆Vol10fr. Significant relationships were found between ∆Volpost and baseline DCE-MRI parameters. Conclusions Both IVIM-DWI and DCE-MRI can help to detect/predict early (during treatment) and shortly after treatment completion the parotid shrinkage. They may contribute to clarify the correlations between volumetric changes of parotid glands and patient−/treatment-related variables by assessing individual microcapillary perfusion and tissue diffusivity. Electronic supplementary material The online version of this article (10.1186/s13014-018-1137-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Simona Marzi
- Medical Physics Laboratory, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
| | - Alessia Farneti
- Department of Radiotherapy, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Antonello Vidiri
- Radiology and Diagnostic Imaging Department, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Francesca Di Giuliano
- Radiology and Diagnostic Imaging Department, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.,Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Laura Marucci
- Department of Radiotherapy, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Filomena Spasiano
- Department of Radiotherapy, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Irene Terrenato
- Biostatistics-Scientific Direction, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Giuseppe Sanguineti
- Department of Radiotherapy, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
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Luo H, He Y, Jin F, Yang D, Liu X, Ran X, Wang Y. Impact of CT slice thickness on volume and dose evaluation during thoracic cancer radiotherapy. Cancer Manag Res 2018; 10:3679-3686. [PMID: 30288099 PMCID: PMC6159785 DOI: 10.2147/cmar.s174240] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Introduction Accurate delineation of targets and organs at risk (OAR) is required to ensure treatment efficacy and minimize risk of normal tissue toxicity with radiotherapy. Therefore, we evaluated the impacts of computed tomography (CT) slice thickness and reconstruction methods on the volume and dose evaluations of targets and OAR. Patients and methods Eleven CT datasets from patients with thoracic cancer were included. 3D images with a slice thickness of 2 mm (2–CT) were created automatically. Images of other slice thickness (4–CT, 6–CT, 8–CT, 10–CT) were reconstructed manually by the selected 2D images using two methods; internal tumor information and external CT Reference markers. Structures and plans on 2–CT images, as a reference data, were copied to the reconstructed images. Results The maximum error of volume was 84.6% for the smallest target in 10–CT, and the maximum error (≥20 cm3) was 10.1%, 14.8% for the two reconstruction methods, internal tumor information and external CT Reference, respectively. Changes in conformity index for a target of <20 cm3 were 5.4% and 17.5% in 8–CT. Changes on V30 and V40 of the heart were considerable. In the internal tumor information method, volumes of hearts decreased by 3.2% in 6–CT, while V30 and V40 increased by 18.4% and 46.6%. Conclusion The image reconstruction method by internal tumor information was less affected by slice thickness than the image reconstruction method by external CT Reference markers. This study suggested that before positioning scanning, the largest section through the target should be determined and the optimal slice thickness should be estimated.
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Affiliation(s)
- Huanli Luo
- Department of Radiation Oncology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, 400030, China,
| | - Yanan He
- Department of Radiation Oncology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, 400030, China,
| | - Fu Jin
- Department of Radiation Oncology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, 400030, China,
| | - Dingyi Yang
- Department of Radiation Oncology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, 400030, China,
| | - Xianfeng Liu
- Department of Radiation Oncology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, 400030, China,
| | - Xueqi Ran
- Department of Radiation Oncology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, 400030, China,
| | - Ying Wang
- Department of Radiation Oncology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, 400030, China,
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Marcu LG, Reid P, Bezak E. The Promise of Novel Biomarkers for Head and Neck Cancer from an Imaging Perspective. Int J Mol Sci 2018; 19:E2511. [PMID: 30149561 PMCID: PMC6165113 DOI: 10.3390/ijms19092511] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 08/18/2018] [Accepted: 08/23/2018] [Indexed: 01/25/2023] Open
Abstract
It is an agreed fact that overall survival among head and neck cancer patients has increased over the last decade. Several factors however, are still held responsible for treatment failure requiring more in-depth evaluation. Among these, hypoxia and proliferation-specific parameters are the main culprits, along with the more recently researched cancer stem cells. This paper aims to present the latest developments in the field of biomarkers for hypoxia, stemness and tumour proliferation, from an imaging perspective that includes both Positron Emission Tomography (PET) and Single Photon Emission Computed Tomography (SPECT) as well as functional magnetic resonance imaging (MRI). Quantitative imaging of biomarkers is a prerequisite for accurate treatment response assessment, bringing us closer to the highly needed personalised therapy.
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Affiliation(s)
- Loredana G Marcu
- Faculty of Science, University of Oradea, 410087 Oradea, Romania.
- Cancer Research Institute and School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia.
| | - Paul Reid
- Cancer Research Institute and School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia.
| | - Eva Bezak
- Cancer Research Institute and School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia.
- Department of Physics, University of Adelaide, Adelaide, SA 5005, Australia.
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Emerging Magnetic Resonance Imaging Technologies for Radiation Therapy Planning and Response Assessment. Int J Radiat Oncol Biol Phys 2018; 101:1046-1056. [DOI: 10.1016/j.ijrobp.2018.03.028] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 03/12/2018] [Accepted: 03/22/2018] [Indexed: 12/27/2022]
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40
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Chen X, Dai J. Quantitative analysis of image quality for acceptance and commissioning of an MRI simulator with a semiautomatic method. J Appl Clin Med Phys 2018; 19:326-335. [PMID: 29573140 PMCID: PMC5978956 DOI: 10.1002/acm2.12311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 01/09/2018] [Accepted: 02/06/2018] [Indexed: 11/28/2022] Open
Abstract
Magnetic Resonance Imaging (MRI) simulation differs from diagnostic MRI in purpose, technical requirements, and implementation. We propose a semiautomatic method for image acceptance and commissioning for the scanner, the radiofrequency (RF) coils, and pulse sequences for an MRI simulator. The ACR MRI accreditation large phantom was used for image quality analysis with seven parameters. Standard ACR sequences with a split head coil were adopted to examine the scanner's basic performance. The performance of simulation RF coils were measured and compared using the standard sequence with different clinical diagnostic coils. We used simulation sequences with simulation coils to test the quality of image and advanced performance of the scanner. Codes and procedures were developed for semiautomatic image quality analysis. When using standard ACR sequences with a split head coil, image quality passed all ACR recommended criteria. The image intensity uniformity with a simulation RF coil decreased about 34% compared with the eight‐channel diagnostic head coil, while the other six image quality parameters were acceptable. Those two image quality parameters could be improved to more than 85% by built‐in intensity calibration methods. In the simulation sequences test, the contrast resolution was sensitive to the FOV and matrix settings. The geometric distortion of simulation sequences such as T1‐weighted and T2‐weighted images was well‐controlled in the isocenter and 10 cm off‐center within a range of ±1% (2 mm). We developed a semiautomatic image quality analysis method for quantitative evaluation of images and commissioning of an MRI simulator. The baseline performances of simulation RF coils and pulse sequences have been established for routine QA.
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Affiliation(s)
- Xinyuan Chen
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianrong Dai
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Lee HJ, Kadbi M, Bosco G, Ibbott GS. Real-time volumetric relative dosimetry for magnetic resonance-image-guided radiation therapy (MR-IGRT). Phys Med Biol 2018; 63:045021. [PMID: 29384731 DOI: 10.1088/1361-6560/aaac22] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The integration of magnetic resonance imaging (MRI) with linear accelerators (linac) has enabled the use of 3D MR-visible gel dosimeters for real-time verification of volumetric dose distributions. Several iron-based radiochromic 3D gels were created in-house then imaged and irradiated in a pre-clinical 1.5 T-7 MV MR-Linac. MR images were acquired using a range of balanced-fast field echo (b-FFE) sequences during irradiation to assess the contrast and dose response in irradiated regions and to minimize the presence of MR artifacts. Out of four radiochromic 3D gel formulations, the FOX 3D gel was found to provide superior MR contrast in the irradiated regions. The FOX gels responded linearly with respect to real-time dose and the signal remained stable post-irradiation for at least 20 min. The response of the FOX gel also was found to be unaffected by the radiofrequency and gradient fields created by the b-FFE sequence during irradiation. A reusable version of the FOX gel was used for b-FFE sequence optimization to reduce artifacts by increasing the number of averages at the expense of temporal resolution. Regardless of the real-time MR sequence used, the FOX 3D gels responded linearly to dose with minimal magnetic field effects due to the strong 1.5 T field or gradient fields present during imaging. These gels can easily be made in-house using non-reusable and reusable formulations depending on the needs of the clinic, and the results of this study encourage further applications of 3D gels for MR-IGRT applications.
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Affiliation(s)
- Hannah J Lee
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America. The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, United States of America. The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX 77030, United States of America
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Diffusion-kurtosis imaging predicts early radiotherapy response in nasopharyngeal carcinoma patients. Oncotarget 2017; 8:66128-66136. [PMID: 29029498 PMCID: PMC5630398 DOI: 10.18632/oncotarget.19820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 06/28/2017] [Indexed: 12/17/2022] Open
Abstract
In this prospective study, we analyzed diffusion kurtosis imaging (DKI) parameters to predict the early response to radiotherapy in 23 nasopharyngeal carcinoma (NPC) patients. All patients underwent conventional magnetic resonance imaging (MRI) and DKI before and after radiotherapy. The patients were divided into response (RG; no residual tumors; 16/23 patients) and no-response (NRG; residual tumors; 7/23 patients) groups, based on MRI and biopsy results 3 months after radiotherapy. The maximum diameter of tumors in RG and NRG patients were similar prior to radiotherapy (p=0.103). The pretreatment diffusion coefficient (D) parameters (Daxis, Dmean and Drad) were higher in RG than NRG patients (p=0.022, p=0.027 and p=0.027). Conversely, the pre-treatment fractional anisotropy (FA) and kurtosis coefficient (K) parameters (Kaxis, Kfa, Kmean, Krad and Mkt) were lower in RG than NRG patients (p=0.015, p=0.022, p=0.008, p=0.004, p=0.001, p=0.002). The Krad coefficient (0.76) was the best parameter to predict the radiotherapy response. Based on receiver operating characteristic curve analysis Krad showed 71.4% sensitivity and 93.7% specificity (AUC: 0.897, 95% CI, 0.756-1). Multivariate analysis indicated DKI parameters were independent prognostic factors for the short-term effect in NPC. Thus, DKI predicts the early response to radiotherapy in NPC patients.
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