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

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• 作者：Kathy Han^a ; ^b ; ^{Kathy.Han@rmp.uhn.on.ca" class="auth_mail" title="E-mail the corresponding author} ; Jennifer Croke^a ; ^b ; Warren Foltz^b ; Ur Metser^c ; ^d ; Jason Xie^a ; Tina Shek^a ; Brandon Driscoll^a ; Cynthia Mé ; nard^a ; ^b ; ^e ; Doug Vines^a ; ^b ; Catherine Coolens^a ; ^b ; Anna Simeonov^a ; ^b ; Akbar Beiki-Ardakani^a ; ^b ; Eric Leung^a ; ^b ; Wilfred Levin^a ; ^b ; Anthony Fyles^a ; ^b ; Michael F. Milosevic^a ; ^b
• 关键词：Diffusion-weighted MRI ; Dynamic contrast-enhanced MRI ; FDG PET ; Cervical cancer ; Brachytherapy ; Target delineation
• 刊名：Radiotherapy and Oncology
• 出版年：2016
• 出版时间：September 2016
• 年：2016
• 卷：120
• 期：3
• 页码：519-525
• 全文大小：2058 K

文摘

We examined the utility of dynamic contrast-enhanced MRI (DCE-MRI), diffusion-weighted MRI (DWI), and FDG-PET imaging for brachytherapy target delineation in patients with locally advanced cervical cancer.

Materials and methods

Twenty-two patients had DWI, DCE-MRI, and FDG-PET/CT scans after brachytherapy applicator insertion, in addition to standard T2-weighted (T2w) 3T MRI. Gross tumor volume (GTV_B) and high-risk clinical target volume (HRCTV) were contoured first on T2w images, and then modified if indicated upon review of DWI/DCE-MRI/FDG-PET images by two observers. The primary endpoint was utility, determined by the number of patients whose volumes were modified, and interobserver variability.

Results

Eleven patients’ T2w-GTV_B were modified based on DWI/DCE-MRI/FDG-PET by observer 1, due to clearer demarcation (7) and residual disease not well visualized on T2w MRI (4). GTV_B was modified in 17 patients by observer 2 (11 and 6, respectively). Incorporation of functional imaging improved the conformity index (CI) for GTV_B from 0.54 (T2w alone) to 0.65 (P = 0.003). HRCTV was modified in 3 and 8 patients by observers 1 and 2, respectively, with a trend toward higher CI using functional imaging (0.71 to 0.76, P = 0.06).

Conclusions

DWI/DCE-MRI/FDG-PET imaging as a supplement to T2w MRI decreased interobserver variability in GTV_B delineation.