Evaluation of the feasibility of Gd-based contrast clearance difference to delineate subvolume target in radiotherapy for primary and metastatic brain tumors
Wang Yinxing, Gong Guanzhong, Su Ya, Wang Lizhen, Lu Jie, Yin Yong
Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Ji'nan 250117, China
Abstract：Objective To evaluate the feasibility of delineating subvolume target in radiotherapy for brain tumors using Gd-based contrast clearance difference. Methods Twenty-six patients with malignant brain tumors were scanned with MRI. The first and second acquisitions of standard T2-weighted images (T2WI) and T1-weighted images (T1WI) were performed at 5min and 60min after injection of contrast agent. Delayed contrast extravasation (DCEM) MRI computed by Brainlab comprised regions of contrast agent clearance representing active tumors and regions of contrast accumulation representing non-tumor tissues. Based on T2WI images,14 patients with liquefaction necrosis were divided into group A, and 12 patients without liquefaction necrosis into group B, respectively. Then, gross target volume (GTV) was delineated on T1WI images. Based on the GTV, active tumor (GTVtumor) and non-tumor regions (GTVnon-tumor) were delineated on T1WI-DCEM fusion images, while liquefaction necrosis (GTVliquefaction) and non-liquefaction (GTVnon-liquefaction) were delineated on T1-T2WI fusion images. Finally, the differences between different subvolumes were compared by paired t-test. Results In group A, the GTVnon-liquefaction and GTVliquefaction were (13.65±18.15) cm3 and (6.30±7.57) cm3. The GTVtumor was (10.40±13.52) cm3 and the GTVnon-tumor was (9.55±14.57) cm3. The GTVnon-liquefaction was significantly increased by 16.3% on average compared with the GTVtumor (P<0.05). The GTVnon-tumor was significantly increased by 16.3% on average compared with the GTVliquefaction (P<0.05). In group B, The GTVnon-tumor was significantly reduced by 68.8% on average compared with the GTVtumor (P<0.05). Conclusions Compared with T2WI, DCEM has advantages in identifying the liquefaction area and can clearly differentiate the subvolume of active tumors from non-liquefaction necrosis. DCEM provides evidence for guiding the delineation of subvolume in primary and metastatic brain tumors.
Wang Yinxing,Gong Guanzhong,Su Ya et al. Evaluation of the feasibility of Gd-based contrast clearance difference to delineate subvolume target in radiotherapy for primary and metastatic brain tumors[J]. Chinese Journal of Radiation Oncology, 2021, 30(2): 151-155.
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