A prospective study of DWI, DCE-MRI and FDG PET imaging for target delineation in brachytherapy for cervical cancer

Han, Kathy; Croke, Jennifer; Foltz, Warren D.; Metser, Ur; Xie, Jiawen; Shek, Tina; Driscoll, Brandon; Ménard, Cynthia; Vines, Doug; Coolens, Catherine; Simeonov, Anna; Beiki-Ardakani, Akbar; Leung, Eric; Levin, Wilfred; Fyles, Anthony; Milosevic, Michael

doi:10.1016/j.radonc.2016.08.002

Cited by 48 publications

(23 citation statements)

References 34 publications

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“…The conformity index for GTV was significantly improved, thanks to the incorporation of functional imaging, from 0.54 (obtained on T2 imaging) to 0.65 (p=0.003). Both readers adapted the high-risk clinical target volume in three and eight cases, reporting a better concordance with the addition of functional imaging (conformity index from 0.71 to 0.76, p=0.06) (26). The authors concluded that supplementing T2-MRI with DCE-MRI/DWI/FDG-PET imaging leads to a significant reduction in interobserver variability.…”

Section: Discussionmentioning

confidence: 92%

“…In this scenario, it could be of interest to include all the information resulting from these different modalities (25). T2-MRI, DWI-MRI and PET-CT imaging have been studied for target delineation in patients with LACC (26). In this scenario, we investigated the potential of DWI-MRI and the corresponding ADC maps in order to study the possibility of having more information on tumor volume.…”

Section: Discussionmentioning

confidence: 99%

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Volume Delineation in Cervical Cancer With T2 and Diffusion-weighted MRI: Agreement on Volumes Between Observers

Rosa

Pizzi

Augurio

et al. 2020

In Vivo

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Aim: To delineate cervical cancer gross tumor volume (GTV) on T2-magnetic resonance imaging (MRI) and apparent diffusion coefficient (ADC) maps, assessing volumes and inter-observer agreement between two observers. Patients and Methods: A radiologist and a radiation oncologist delineated GTV on T2 (T2 GTV) and ADC (ADC GTV) sequences. Dice similarity index (DICE) and Bland-Altman analysis were used to estimated concordance. Results: Mean T2 GTV and ADC GTV volumes were 43.84±71.47 cc and 37.28±68.92 cc according to the radiologist, and 43.4±70.44 cc and 36.65±69.21 cc according to the radiation oncologist. ADC led to statistically significantly smaller volumes compared to T2. The mean DICE index was 0.86 for T2 GTV and 0.84 for ADC GTV. The Bland-Altman plots globally showed concordance. Conclusion: GTV delineation was smaller in the ADC maps compared to T2-MRI, reaching an almost perfect agreement between observers. Thanks to this acceptable variability, adding functional imaging might provide more information for tumor delineation, improving reproducibility for image-guided adaptive radiotherapy. Nowadays, the mainstay of treatment for locally advanced cervical cancer (LACC) includes external beam radiotherapy (EBRT), concomitant chemotherapy and brachytherapy. T2weighted magnetic resonance imaging (MRI) is the imaging modality to be preferred for careful and accurate primary staging of the tumor (1, 2). Despite the extensive use of MRI, recent studies reported significant uncertainties in T2-weighted MRI delineation, describing a poor interobserver variability in brachytherapy target volume, represented by conformity indices of 0.58-0.60 for gross tumor volume (GTV) at brachytherapy, and 0.39-0.79 (mostly between 0.70-0.79) for high-risk clinical target volume (3, 4). Considering this aspect and the possible advantages of improved diagnostic techniques in a dose-intensification strategy, in particular in patients with higher risk of local relapse, its integration with diffusion-weighted MRI (DWI) might improve tumor volume definition in addition to patient outcome. In this way, a recent study demonstrated the accuracy of the apparent diffusion coefficient (ADC) map obtained at 2 weeks during radiotherapy in allowing an early prediction of treatment response (5). DWI-MRI is considered an encouraging functional imaging mode in the definition of a biological target volume, thanks to its capability for detecting highly metabolic regions. DWI-MRI evaluates the random motion of water molecules, mostly present in the extracellular space: compared to normal tissue, in cervical cancer, as in other neoplasms, tumor is densely cellular, showing restricted diffusion. This distribution is quantitatively well measured by ADC. In DWI, cancer has an increased signal intensity, which results in a reduction of the corresponding ADC map. It is well established that both DWI techniques as well as ADC measurement improves cervical cancer clinical assessment, regarding both tumor and nodal status, and histology (6). Few studies hav...

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Volume Delineation in Cervical Cancer With T2 and Diffusion-weighted MRI: Agreement on Volumes Between Observers

Rosa

Pizzi

Augurio

et al. 2020

In Vivo

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“…But up to now, there is no definitional judgment that one image technique can completely replace another (15,16). MRI DWI is an imaging technique developed on the basis of MRI (13), and PET/CT is the most advanced and the best molecular imaging technique for early diagnosis, clinical staging and monitoring of curative effect of tumors and it has been widely used in clinical practice (17). However, there are still some differences in the indications, advantages and disadvantages of these two medical imaging techniques in tumor examination (18).…”

Section: Discussionmentioning

confidence: 99%

Application value of MRI diffuse weighted imaging combined with PET/CT in the diagnosis of stomach cancer at different stages

Sui

Zou

et al. 2019

Oncol Lett

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Value of MRI diffusion-weighted imaging (MRI DWI) combined with PET/CT in the diagnosis and staging of stomach cancer (SC) was investigated. A retrospective analysis was performed on 160 patients with SC diagnosed by pathological biopsy in The Affiliated Yantai Yuhuangding Hospital of Qingdao University from March 2015 to April 2018. The values of MRI DWI, PET/CT and combined diagnosis in the diagnosis and staging of SC were compared according to the criteria of diagnosis of postoperative pathological or clinical comprehensive evaluation. The sensitivity, specificity and diagnostic coincidence rate of MRI DWI in the diagnosis of SC at stage I–II were 61.05, 64.62 and 62.50%, respectively, which were significantly lower than those of PET/CT (P<0.05). Sensitivity, specificity and diagnostic coincidence rate of MRI DWI in the diagnosis of SC at stage III–IV were lower than those of PET/CT (P<0.05). Sensitivity and diagnostic coincidence rate of MRI DWI combined with PET/CT in the diagnosis of SC at stage I–II were significantly higher than those of MRI DWI or PET/CT alone (P<0.05). Specificity and diagnostic coincidence rate of MRI DWI combined with PET/CT in the diagnosis of SC at stage III–IV were significantly higher than those of MRI DWI or PET/CT alone (P<0.05). PET/CT is superior to MRI DWI in SC staging, whereas the diagnostic efficiency of combined scan is much higher than that of PET/CT or MRI DWI alone. In order to obtain more accurate preoperative staging and to avoid diagnostic exploratory laparotomy, the combination of MRI DWI and PET/CT techniques should be used in the comprehensive analysis of the disease to improve the accuracy of clinical diagnosis.

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“…Accurate contouring of target volumes can benefit from quantitative imaging approaches that give high contrast-to-noise ratio between the tumour and the adjacent tissue structures, such as PET [4,60], DCE MRI [61] and DW-MRI [61]. The raw data images (pre-modelling) can have a higher contrast-to-noise ratio than the derived parameter maps.…”

Section: Contouringmentioning

confidence: 99%

Quantitative imaging for radiotherapy purposes

Gurney‐Champion

Mahmood

Schie

et al. 2020

Radiotherapy and Oncology

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Quantitative imaging biomarkers show great potential for use in radiotherapy. Quantitative images based on microscopic tissue properties and tissue function can be used to improve contouring of the radiotherapy targets. Furthermore, quantitative imaging biomarkers might be used to predict treatment response for several treatment regimens and hence be used as a tool for treatment stratification, either to determine which treatment modality is most promising or to determine patient-specific radiation dose. Finally, patient-specific radiation doses can be further tailored to a tissue/voxel specific radiation dose when quantitative imaging is used for dose painting. In this review, published standards, guidelines and recommendations on quantitative imaging assessment using CT, PET and MRI are discussed. Furthermore, critical issues regarding the use of quantitative imaging for radiation oncology purposes and resultant pending research topics are identified.

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A prospective study of DWI, DCE-MRI and FDG PET imaging for target delineation in brachytherapy for cervical cancer

Cited by 48 publications

References 34 publications

Volume Delineation in Cervical Cancer With T2 and Diffusion-weighted MRI: Agreement on Volumes Between Observers

Volume Delineation in Cervical Cancer With T2 and Diffusion-weighted MRI: Agreement on Volumes Between Observers

Application value of MRI diffuse weighted imaging combined with PET/CT in the diagnosis of stomach cancer at different stages

Quantitative imaging for radiotherapy purposes

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