Volumetric and dosimetric impact of MRI in delineation of gross tumor volume of non-spinal vertebral metastases treated with stereotactic ablative radiation therapy

Cancer Radiother. 2021 Apr;25(2):135-140. doi: 10.1016/j.canrad.2020.06.032. Epub 2021 Jan 7.


Purpose: To investigate the Gross Tumor Volumes (GTV) and its dosimetric impact of magnetic resonance imaging (MRI) assisted contouring for non-spinal metastasis treated with stereotactic ablative body radiotherapy (SABR).

Material and methods: Five observer contours on CT (GTVCT) and CT+MR (GTVCT+MR) were evaluated against expert team contours (GTVEC) for 14 selected cases. Dice Similarity Index (DSC) and Geographical Miss Index (GMI) quantify observer variation. We also analyze the maximum dose (Dmax) and dose received by 0.35cc (D0.35cc) of the spinal cord (SC) for GTVCT and GTVCT+MR, where optimization parameters and priorities were unchanged. Percent rank function is also evaluated for SC doses.

Results: The mean DSC and GMI scores for the CT-only dataset are 0.6974 and 0.2851 and for CT+MR dataset is 0.7764 and 0.1907 respectively. Statistically, significant results were found for mean GTV volumes between GTVEC versus GTVCT and GTVCT versus GTVCT+MR (P<0.001). Dosimetric analysis of Dmax and D0.35cc exceeded 84.2% and 88.5% of times its respective threshold doses for CT-only dataset, whereas for the CT+MR dataset, it exceeded only by 18% and 15.7% times. 'Percent rank' function analysis for SC doses also indicates the same.

Conclusion: This study supports MRI fusion for GTV and OAR delineation for non-spinal metastasis. Our study showed that the dosimetric analysis is vital for observer variation studies and the addition of the MR data set is significant to improve the confidence of Stereotactic treatments.

Keywords: Bone metastasis; Gross tumor volume; Imagerie par résonance magnétique; Magnetic resonance imaging; Métastases osseuses; Radiothérapie ablative stéréotaxique; Stereotactic ablative radiation therapy; Volumes tumoraux macroscopiques.

MeSH terms

  • Algorithms
  • Bone Neoplasms / diagnostic imaging*
  • Bone Neoplasms / pathology
  • Bone Neoplasms / radiotherapy*
  • Datasets as Topic
  • Dose Fractionation, Radiation
  • Female
  • Humans
  • Magnetic Resonance Imaging / methods*
  • Male
  • Observer Variation
  • Organs at Risk / diagnostic imaging*
  • Radiosurgery / methods*
  • Radiotherapy, Image-Guided / methods
  • Retrospective Studies
  • Spine
  • Tomography, X-Ray Computed / methods
  • Tumor Burden*