Clinical evaluation of 4D MRI in the delineation of gross and internal tumor volumes in comparison with 4DCT

Jingjing Zhang; Shreya Srivastava; Chunyu Wang; Thomas Beckham; Christopher Johnson; Pinaki Dutta; Annemarie Shepherd; James Mechalakos; Margie Hunt; Abraham Wu; Andreas Rimner; Guang Li

doi:10.1002/acm2.12699

Clinical evaluation of 4D MRI in the delineation of gross and internal tumor volumes in comparison with 4DCT

Jingjing Zhang, Shreya Srivastava, Chunyu Wang, Thomas Beckham, Christopher Johnson, Pinaki Dutta, Annemarie Shepherd, James Mechalakos, Margie Hunt, Abraham Wu, Andreas Rimner, Guang Li

Research output: Contribution to journal › Article › peer-review

19 Scopus citations

Abstract

Purpose: To evaluate clinical utility of respiratory-correlated (RC) four-dimensional magnetic resonance imaging (4DMRI) for lung tumor delineation and motion assessment, in comparison with the current clinical standard of 4D computed tomography (4DCT). Methods and Materials: A prospective T2-weighted (T2w) RC-4DMRI technique was applied to acquire coronal 4DMRI images for 14 lung cancer patients (16 lesions) during free breathing (FB) under an IRB-approved protocol, together with a breath-hold (BH) T1w 3DMRI and axial 4DMRI. Clinical simulation CT and 4DCT were acquired within 2 h. An internal navigator was applied to trigger amplitude-binned 4DMRI acquisition whereas a bellows or real-time position management (RPM) was used in the 4DCT reconstruction. Six radiation oncologists manually delineated the gross and internal tumor volumes (GTV and ITV) in 399 3D images using programmed clinical workflows under a tumor delineation guideline. The ITV was the union of GTVs within the breathing cycle without margin. Average GTV and motion range were assessed and ITV variation between 4DMRI and 4DCT was evaluated using the Dice similarity index, mean distance agreement (MDA), and volume difference. Results: The mean tumor volume is similar between 4DCT (GTV^4DCT = 1.0, as the reference) and T2w-4DMRI (GTV^T2wMR = 0.97), but smaller in T1w MRI (GTV^T1wMR = 0.76), suggesting possible peripheral edema around the tumor. Average GTV variation within the breathing cycle (22%) in 4DMRI is slightly greater than 4DCT (17%). GTV motion variation (−4 to 12 mm) and ITV variation (∆V^ITV=−25 to 95%) between 4DCT and 4DMRI are large, confirmed by relatively low ITV similarity (Dice = 0.72 ± 0.11) and large MDA = 2.9 ± 1.5 mm. Conclusion: Average GTVs are similar between T2w-4DMRI and 4DCT, but smaller by 25% in T1w BH MRI. Physician training and breathing coaching may be necessary to reduce ITV variability between 4DMRI and 4DCT. Four-dimensional magnetic resonance imaging is a promising and viable technique for clinical lung tumor delineation and motion assessment.

Original language	English
Pages (from-to)	51-60
Number of pages	10
Journal	Journal of Applied Clinical Medical Physics
Volume	20
Issue number	9
DOIs	https://doi.org/10.1002/acm2.12699
State	Published - 1 Sep 2019
Externally published	Yes

Keywords

magnetic resonance imaging
motion artifacts
respiratory motion simulation
treatment planning
tumor delineation

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10.1002/acm2.12699

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@article{b4fe7bbaefb3449292d42128a868ab93,

title = "Clinical evaluation of 4D MRI in the delineation of gross and internal tumor volumes in comparison with 4DCT",

abstract = "Purpose: To evaluate clinical utility of respiratory-correlated (RC) four-dimensional magnetic resonance imaging (4DMRI) for lung tumor delineation and motion assessment, in comparison with the current clinical standard of 4D computed tomography (4DCT). Methods and Materials: A prospective T2-weighted (T2w) RC-4DMRI technique was applied to acquire coronal 4DMRI images for 14 lung cancer patients (16 lesions) during free breathing (FB) under an IRB-approved protocol, together with a breath-hold (BH) T1w 3DMRI and axial 4DMRI. Clinical simulation CT and 4DCT were acquired within 2 h. An internal navigator was applied to trigger amplitude-binned 4DMRI acquisition whereas a bellows or real-time position management (RPM) was used in the 4DCT reconstruction. Six radiation oncologists manually delineated the gross and internal tumor volumes (GTV and ITV) in 399 3D images using programmed clinical workflows under a tumor delineation guideline. The ITV was the union of GTVs within the breathing cycle without margin. Average GTV and motion range were assessed and ITV variation between 4DMRI and 4DCT was evaluated using the Dice similarity index, mean distance agreement (MDA), and volume difference. Results: The mean tumor volume is similar between 4DCT (GTV4DCT = 1.0, as the reference) and T2w-4DMRI (GTVT2wMR = 0.97), but smaller in T1w MRI (GTVT1wMR = 0.76), suggesting possible peripheral edema around the tumor. Average GTV variation within the breathing cycle (22%) in 4DMRI is slightly greater than 4DCT (17%). GTV motion variation (−4 to 12 mm) and ITV variation (∆VITV=−25 to 95%) between 4DCT and 4DMRI are large, confirmed by relatively low ITV similarity (Dice = 0.72 ± 0.11) and large MDA = 2.9 ± 1.5 mm. Conclusion: Average GTVs are similar between T2w-4DMRI and 4DCT, but smaller by 25% in T1w BH MRI. Physician training and breathing coaching may be necessary to reduce ITV variability between 4DMRI and 4DCT. Four-dimensional magnetic resonance imaging is a promising and viable technique for clinical lung tumor delineation and motion assessment.",

keywords = "magnetic resonance imaging, motion artifacts, respiratory motion simulation, treatment planning, tumor delineation",

author = "Jingjing Zhang and Shreya Srivastava and Chunyu Wang and Thomas Beckham and Christopher Johnson and Pinaki Dutta and Annemarie Shepherd and James Mechalakos and Margie Hunt and Abraham Wu and Andreas Rimner and Guang Li",

note = "Funding Information: This research is supported in part by the MSK Cancer Center Support Grant/Core Grant (P30 CA008748) and the MSK fellowship program (R25CA020449). The authors would like to thank Drs. Kadbi (Philips Healthcare), Tyagi and Zakian (MSKCC) for their efforts in supporting this study and the MRI simulation technologists and therapists for their assistance. Publisher Copyright: {\textcopyright} 2019 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.",

year = "2019",

month = sep,

day = "1",

doi = "10.1002/acm2.12699",

language = "English",

volume = "20",

pages = "51--60",

journal = "Journal of Applied Clinical Medical Physics",

issn = "1526-9914",

publisher = "American Institute of Physics",

number = "9",

}

TY - JOUR

T1 - Clinical evaluation of 4D MRI in the delineation of gross and internal tumor volumes in comparison with 4DCT

AU - Zhang, Jingjing

AU - Srivastava, Shreya

AU - Wang, Chunyu

AU - Beckham, Thomas

AU - Johnson, Christopher

AU - Dutta, Pinaki

AU - Shepherd, Annemarie

AU - Mechalakos, James

AU - Hunt, Margie

AU - Wu, Abraham

AU - Rimner, Andreas

AU - Li, Guang

N1 - Funding Information: This research is supported in part by the MSK Cancer Center Support Grant/Core Grant (P30 CA008748) and the MSK fellowship program (R25CA020449). The authors would like to thank Drs. Kadbi (Philips Healthcare), Tyagi and Zakian (MSKCC) for their efforts in supporting this study and the MRI simulation technologists and therapists for their assistance. Publisher Copyright: © 2019 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.

PY - 2019/9/1

Y1 - 2019/9/1

N2 - Purpose: To evaluate clinical utility of respiratory-correlated (RC) four-dimensional magnetic resonance imaging (4DMRI) for lung tumor delineation and motion assessment, in comparison with the current clinical standard of 4D computed tomography (4DCT). Methods and Materials: A prospective T2-weighted (T2w) RC-4DMRI technique was applied to acquire coronal 4DMRI images for 14 lung cancer patients (16 lesions) during free breathing (FB) under an IRB-approved protocol, together with a breath-hold (BH) T1w 3DMRI and axial 4DMRI. Clinical simulation CT and 4DCT were acquired within 2 h. An internal navigator was applied to trigger amplitude-binned 4DMRI acquisition whereas a bellows or real-time position management (RPM) was used in the 4DCT reconstruction. Six radiation oncologists manually delineated the gross and internal tumor volumes (GTV and ITV) in 399 3D images using programmed clinical workflows under a tumor delineation guideline. The ITV was the union of GTVs within the breathing cycle without margin. Average GTV and motion range were assessed and ITV variation between 4DMRI and 4DCT was evaluated using the Dice similarity index, mean distance agreement (MDA), and volume difference. Results: The mean tumor volume is similar between 4DCT (GTV4DCT = 1.0, as the reference) and T2w-4DMRI (GTVT2wMR = 0.97), but smaller in T1w MRI (GTVT1wMR = 0.76), suggesting possible peripheral edema around the tumor. Average GTV variation within the breathing cycle (22%) in 4DMRI is slightly greater than 4DCT (17%). GTV motion variation (−4 to 12 mm) and ITV variation (∆VITV=−25 to 95%) between 4DCT and 4DMRI are large, confirmed by relatively low ITV similarity (Dice = 0.72 ± 0.11) and large MDA = 2.9 ± 1.5 mm. Conclusion: Average GTVs are similar between T2w-4DMRI and 4DCT, but smaller by 25% in T1w BH MRI. Physician training and breathing coaching may be necessary to reduce ITV variability between 4DMRI and 4DCT. Four-dimensional magnetic resonance imaging is a promising and viable technique for clinical lung tumor delineation and motion assessment.

AB - Purpose: To evaluate clinical utility of respiratory-correlated (RC) four-dimensional magnetic resonance imaging (4DMRI) for lung tumor delineation and motion assessment, in comparison with the current clinical standard of 4D computed tomography (4DCT). Methods and Materials: A prospective T2-weighted (T2w) RC-4DMRI technique was applied to acquire coronal 4DMRI images for 14 lung cancer patients (16 lesions) during free breathing (FB) under an IRB-approved protocol, together with a breath-hold (BH) T1w 3DMRI and axial 4DMRI. Clinical simulation CT and 4DCT were acquired within 2 h. An internal navigator was applied to trigger amplitude-binned 4DMRI acquisition whereas a bellows or real-time position management (RPM) was used in the 4DCT reconstruction. Six radiation oncologists manually delineated the gross and internal tumor volumes (GTV and ITV) in 399 3D images using programmed clinical workflows under a tumor delineation guideline. The ITV was the union of GTVs within the breathing cycle without margin. Average GTV and motion range were assessed and ITV variation between 4DMRI and 4DCT was evaluated using the Dice similarity index, mean distance agreement (MDA), and volume difference. Results: The mean tumor volume is similar between 4DCT (GTV4DCT = 1.0, as the reference) and T2w-4DMRI (GTVT2wMR = 0.97), but smaller in T1w MRI (GTVT1wMR = 0.76), suggesting possible peripheral edema around the tumor. Average GTV variation within the breathing cycle (22%) in 4DMRI is slightly greater than 4DCT (17%). GTV motion variation (−4 to 12 mm) and ITV variation (∆VITV=−25 to 95%) between 4DCT and 4DMRI are large, confirmed by relatively low ITV similarity (Dice = 0.72 ± 0.11) and large MDA = 2.9 ± 1.5 mm. Conclusion: Average GTVs are similar between T2w-4DMRI and 4DCT, but smaller by 25% in T1w BH MRI. Physician training and breathing coaching may be necessary to reduce ITV variability between 4DMRI and 4DCT. Four-dimensional magnetic resonance imaging is a promising and viable technique for clinical lung tumor delineation and motion assessment.

KW - magnetic resonance imaging

KW - motion artifacts

KW - respiratory motion simulation

KW - treatment planning

KW - tumor delineation

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DO - 10.1002/acm2.12699

M3 - Article

C2 - 31538719

AN - SCOPUS:85072391797

SN - 1526-9914

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SP - 51

EP - 60

JO - Journal of Applied Clinical Medical Physics

JF - Journal of Applied Clinical Medical Physics

IS - 9

ER -

Clinical evaluation of 4D MRI in the delineation of gross and internal tumor volumes in comparison with 4DCT

Abstract

Keywords

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