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Multimodality imaging with CT, MR and FDG-PET for radiotherapy target volume delineation in oropharyngeal squamous cell carcinoma
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Multimodality imaging with CT, MR and FDG-PET for radiotherapy target volume delineation in oropharyngeal squamous cell carcinoma
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Journal Article
Multimodality imaging with CT, MR and FDG-PET for radiotherapy target volume delineation in oropharyngeal squamous cell carcinoma
2015
Overview
Background
This study aimed to quantify the variation in oropharyngeal squamous cell carcinoma gross tumour volume (GTV) delineation between CT, MR and FDG PET-CT imaging.
Methods
A prospective, single centre, pilot study was undertaken where 11 patients with locally advanced oropharyngeal cancers (2 tonsil, 9 base of tongue primaries) underwent pre-treatment, contrast enhanced, FDG PET-CT and MR imaging, all performed in a radiotherapy treatment mask. CT, MR and CT-MR GTVs were contoured by 5 clinicians (2 radiologists and 3 radiation oncologists). A semi-automated segmentation algorithm was used to contour PET GTVs. Volume and positional analyses were undertaken, accounting for inter-observer variation, using linear mixed effects models and contour comparison metrics respectively.
Results
Significant differences in mean GTV volume were found between CT (11.9 cm
3
) and CT-MR (14.1 cm
3
),
p
< 0.006, CT-MR and PET (9.5 cm
3
),
p
< 0.0009, and MR (12.7 cm
3
) and PET,
p
< 0.016. Substantial differences in GTV position were found between all modalities with the exception of CT-MR and MR GTVs. A mean of 64 %, 74 % and 77 % of the PET GTVs were included within the CT, MR and CT-MR GTVs respectively. A mean of 57 % of the MR GTVs were included within the CT GTV; conversely a mean of 63 % of the CT GTVs were included within the MR GTV. CT inter-observer variability was found to be significantly higher in terms of position and/or volume than both MR and CT-MR (
p
< 0.05). Significant differences in GTV volume were found between GTV volumes delineated by radiologists (9.7 cm
3
) and oncologists (14.6 cm
3
) for all modalities (
p
= 0.001).
Conclusions
The use of different imaging modalities produced significantly different GTVs, with no single imaging technique encompassing all potential GTV regions. The use of MR reduced inter-observer variability. These data suggest delineation based on multimodality imaging has the potential to improve accuracy of GTV definition.
Trial registration
ISRCTN Registry:
ISRCTN34165059
. Registered 2nd February 2015.
Publisher
BioMed Central,BioMed Central Ltd,Springer Nature B.V
Subject
/ Aged
/ Biomedical and Life Sciences
/ Cancer
/ Carcinoma, Squamous Cell - diagnostic imaging
/ Carcinoma, Squamous Cell - pathology
/ Complications and side effects
/ Consent
/ Female
/ Fluorodeoxyglucose F18 - chemistry
/ Health Promotion and Disease Prevention
/ Humans
/ Magnetic Resonance Imaging - methods
/ Male
/ Oncology
/ Oropharyngeal Neoplasms - diagnostic imaging
/ Oropharyngeal Neoplasms - pathology
/ Patients
/ Positron-Emission Tomography - methods
/ Tumors
