Recommendation for the contouring of limbic system in patients receiving radiation treatment: A pictorial review for the everyday practice and education

Claudia Sorce; Agnieszka Chalaszczyk; Francesca Rossi; Letizia Ferella; Gianmarco Grimaldi; Alessandra Splendiani; Domenico Genovesi; Francesco Marampon; Ester Orlandi; Alberto Iannalfi; Carlo Masciocchi; Giovanni Luca Gravina

doi:10.1016/j.critrevonc.2021.103229

Recommendation for the contouring of limbic system in patients receiving radiation treatment: A pictorial review for the everyday practice and education

Crit Rev Oncol Hematol. 2021 Mar:159:103229. doi: 10.1016/j.critrevonc.2021.103229. Epub 2021 Jan 19.

Affiliations

¹ Department of Biotechnological and Applied Clinical Sciences, Division of Radiotherapy. Laboratory of Radiobiology, University of L'Aquila, Italy.
² Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy.
³ Radiation Oncology, ThomoTherapy Unit, Hospistal of Aosta, Italy.
⁴ Department of Biotechnology & Applied Clinical Science, University of L'Aquila, Division of Neuroradiology, L'Aquila, Italy.
⁵ Department of Radiotherapy, 'SS Annunziata' Hospital 'G. D'Annunzio' University, Chieti, Italy.
⁶ Department of Radiation Oncology, Policlinico Umberto I Hospital, Sapienza, University of Rome, Rome, Italy.
⁷ Department of Biotechnology & Applied Clinical Science, University of L'Aquila, Division of Radiology, L'Aquila, Italy.
⁸ Department of Biotechnological and Applied Clinical Sciences, Division of Radiotherapy. Laboratory of Radiobiology, University of L'Aquila, Italy. Electronic address: giovanniluca.gravina@univaq.it.

PMID: 33482343
DOI: 10.1016/j.critrevonc.2021.103229

Abstract

Aims: The limbic circuit (LC) is devoted to linking emotion to behavior and cognition. The injury this system results in post-RT cognitive dysfunction. The aim of this study is to create the first radiation oncologist's practical MR-based contouring guide for the delineation of the LC for the everyday clinical practice and education.

Methods: An anonymized diagnostic 3.0 T T1-weighted BRAVO MRI sequence from a healthy patient with typical brain anatomy was used to delineate LC. For each structure key anatomical contours were completed by radiation oncologists, along with a neuro-radiologist to generate the final version of the LC atlas.

Results: a step-by-step MR-based atlas of LC was created. Key structures of the LC, such as, cingulate gyrus, fornix, septal region, mammillary bodies, thalamus and the hippocampal-amygdala formation were contoured.

Conclusions: This article provides the recommendations for the first contouring atlas of LC in the setting of patients receiving RT and education.

Keywords: Contorting atlas; Education; Limbic system; Oncology; Radiotherapy; Toxicity.

Publication types

Review

MeSH terms

Humans
Limbic System / diagnostic imaging
Magnetic Resonance Imaging
Organs at Risk*
Radiation*
Radiotherapy Planning, Computer-Assisted