Rectal tumour volume (GTV) delineation using T2-weighted and diffusion-weighted MRI: Implications for radiotherapy planning

Regini, Francesco; Gourtsoyianni, Sofia; Melo, R. Cardoso De; Charles‐Edwards, Geoffrey; Griffin, Nyree; Parikh, Jyoti; Rottenberg, Giles; Leslie, M.D.; Gaya, Andrew; Goh, Vicky

doi:10.1016/j.ejrad.2014.02.007

Cited by 26 publications

(19 citation statements)

References 26 publications

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“…Given the high soft tissue contrast, MRI is often considered superior to CT in providing information regarding local extent and depth, or invasion of close organs and vascular structure. GTV delineation based on MRI is then actually recommended and used for RT planning in several cancer treatment as neurological, including spine metastases [31], and pelvic malignancies [32][33][34]. Moreover, MRI is acquiring an emerging role in adaptive real time strategies with on-board imaging guidance [11].…”

Section: Discussionmentioning

confidence: 99%

Magnetic resonance imaging (MRI) compared with computed tomography (CT) for interobserver agreement of gross tumor volume delineation in pancreatic cancer: a multi-institutional contouring study on behalf of the AIRO group for gastrointestinal cancers

et al. 2019

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Genovesi (2019) Magnetic resonance imaging (MRI) compared with computed tomography (CT) for interobserver agreement of gross tumor volume delineation in pancreatic cancer: a multiinstitutional contouring study on behalf of the AIRO group for gastrointestinal cancers, Acta Oncologica, 58:4, 439-447, ABSTRACT Background: Due to the high soft tissue resolution, magnetic resonance imaging (MRI) could improve the accuracy of pancreatic tumor delineation in radiation treatment planning. A multi-institutional study was proposed to evaluate the impact of MRI on inter-observer agreement in gross tumor volume (GTV) and duodenum delineation for pancreatic cancer compared with computer tomography (CT). Material and Methods: Two clinical cases of borderline resectable (Case 1) and unresectable (Case 2) pancreatic cancer were selected. In two sequential steps, diagnostic contrast-enhanced CT scan and MRI sequences were sent to the participating centers. CT-GTVs were contoured while blinded to MRI data sets. DICE index was used to evaluate the spatial overlap accuracy. Results: Thirty-one radiation oncologists from different Institutions submitted the delineated volumes. CT-and MRI-GTV mean volumes were 21.6 ± 9.0 cm 3 and 17.2 ± 6.0 cm 3 , respectively for Case 1, and 31.3 ± 15.6 cm 3 and 33.2 ± 20.2 cm 3 , respectively for Case 2. Resulting MRI-GTV mean volume was significantly smaller than CT-GTV in the borderline resectable case (p < .05). A substantial agreement was shown by the median DICE index for CT-and MRI-GTV resulting as 0.74 (IQR: 0.67-0.75) and 0.61 (IQR: 0.57-0.67) for Case 1; a moderate agreement was instead reported for Case 2: 0.59 (IQR:0.52-0.66) and 0.53 (IQR:0.42-0.62) for CT-and MRI-GTV, respectively. Conclusion: Diagnostic MRI resulted in smaller GTV in borderline resectable case with a substantial agreement between observers, and was comparable to CT scan in interobserver variability, in both cases. The greater variability in the unresectable case underlines the critical issues related to the outlining when vascular structures are more involved. The integration of MRI with contrast-enhancement CT, thanks to its high definition of tumor relationship with neighboring vessels, could offer a greater accuracy of target delineation.

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Section: Discussionmentioning

confidence: 99%

Magnetic resonance imaging (MRI) compared with computed tomography (CT) for interobserver agreement of gross tumor volume delineation in pancreatic cancer: a multi-institutional contouring study on behalf of the AIRO group for gastrointestinal cancers

et al. 2019

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“…However, Regini et al . presented completely different results in their recent study 14 . In addition, diffusion-weighted intravoxel incoherent motion (IVIM) imaging with multiple b values fitted to a bi-exponential model has been widely studied for its capability of characterizing diffusion and perfusion effects in normal and diseased tissues 15 16 .…”

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confidence: 74%

“…In addition to the controversy over MRI sequences for GTV measurements, the imaging segmentation method is another confounding factor. Typically, tumour volume is calculated via the manual segmentation method in MRI studies 13 14 . However, this method is time-consuming and has large inter-observer variability because no recognized criteria exist to delineate tumour boundaries 17 .…”

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confidence: 99%

MR diffusion-weighted imaging-based subcutaneous tumour volumetry in a xenografted nude mouse model using 3D Slicer: an accurate and repeatable method

Chen

Huang

et al. 2015

Sci Rep

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Accurate and repeatable measurement of the gross tumour volume(GTV) of subcutaneous xenografts is crucial in the evaluation of anti-tumour therapy. Formula and image-based manual segmentation methods are commonly used for GTV measurement but are hindered by low accuracy and reproducibility. 3D Slicer is open-source software that provides semiautomatic segmentation for GTV measurements. In our study, subcutaneous GTVs from nude mouse xenografts were measured by semiautomatic segmentation with 3D Slicer based on morphological magnetic resonance imaging(mMRI) or diffusion-weighted imaging(DWI)(b = 0,20,800 s/mm2) . These GTVs were then compared with those obtained via the formula and image-based manual segmentation methods with ITK software using the true tumour volume as the standard reference. The effects of tumour size and shape on GTVs measurements were also investigated. Our results showed that, when compared with the true tumour volume, segmentation for DWI(P = 0.060–0.671) resulted in better accuracy than that mMRI(P < 0.001) and the formula method(P < 0.001). Furthermore, semiautomatic segmentation for DWI(intraclass correlation coefficient, ICC = 0.9999) resulted in higher reliability than manual segmentation(ICC = 0.9996–0.9998). Tumour size and shape had no effects on GTV measurement across all methods. Therefore, DWI-based semiautomatic segmentation, which is accurate and reproducible and also provides biological information, is the optimal GTV measurement method in the assessment of anti-tumour treatments.

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“…Recent advances in image analysis software have enabled evaluation of the advantages of 3-dimensional (3D) measurements over one-dimensional (1D) measurements in assessing changes in tumour size. Several studies have shown the value of tumour volumetry in head and neck cancers, lung cancer, rectal cancer, Ewing sarcoma, rhabdomyosarcoma, metastatic colorectal cancer and metastatic GIST [9; 10; 12; 16; 17; 18; 19; 20; 21; 22; 23; 24; 25]. Within the abdomen, most studies have assessed only rectal cancer, liver metastasis, lymph nodes and peritoneal lesions [13; 18; 19; 20; 24; 25; 26; 27; 28].…”

Section: Introductionmentioning

confidence: 99%

Accuracy and feasibility of estimated tumour volumetry in primary gastric gastrointestinal stromal tumours: validation using semiautomated technique in 127 patients

et al. 2015

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Objective To validate estimated tumour volumetry in primary gastric gastrointestinal stromal tumours (GISTs) using semi-automated volumetry. Materials and Methods In this IRB-approved retrospective study, we measured the three longest diameters in x, y, z axes on CTs of primary gastric GISTs in 127 consecutive patients (52 women, 75 men, mean age: 61 years) at our institute between 2000 and 2013. Segmented volumes (Vsegmented) were obtained using commercial software by two radiologists. Estimate volumes (V1–V6) were obtained using formulae for spheres and ellipsoids. Intra- and inter-observer agreement of Vsegmented and agreement of V1–6 with Vsegmented were analysed with concordance correlation coefficients (CCC) and Bland-Altman plots. Results Median Vsegmented and V1–V6 were 75.9 cm3, 124.9 cm3, 111.6 cm3, 94.0 cm3, 94.4cm3, 61.7 cm3 and 80.3 cm3 respectively. There was strong intra- and inter-observer agreement for Vsegmented. Agreement with Vsegmented was highest for V6 (scalene ellipsoid, x≠y≠z), with CCC of 0.96 [95%CI: 0.95–0.97]. Mean relative difference was smallest for V6 (0.6%), while it was −19.1% for V5, +14.5% for V4, +17.9% for V3, +32.6 % for V2 and +47% for V1. Conclusion Ellipsoidal approximations of volume using three measured axes may be used to closely estimate Vsegmented when semi-automated techniques are unavailable.

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Rectal tumour volume (GTV) delineation using T2-weighted and diffusion-weighted MRI: Implications for radiotherapy planning

Cited by 26 publications

References 26 publications

Magnetic resonance imaging (MRI) compared with computed tomography (CT) for interobserver agreement of gross tumor volume delineation in pancreatic cancer: a multi-institutional contouring study on behalf of the AIRO group for gastrointestinal cancers

Magnetic resonance imaging (MRI) compared with computed tomography (CT) for interobserver agreement of gross tumor volume delineation in pancreatic cancer: a multi-institutional contouring study on behalf of the AIRO group for gastrointestinal cancers

MR diffusion-weighted imaging-based subcutaneous tumour volumetry in a xenografted nude mouse model using 3D Slicer: an accurate and repeatable method

Accuracy and feasibility of estimated tumour volumetry in primary gastric gastrointestinal stromal tumours: validation using semiautomated technique in 127 patients

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