Gross Tumor Delineation in Esophageal Cancer on MRI Compared With 18F-FDG-PET/CT

Sophie E Vollenbrock; Marlies E Nowee; Francine E M Voncken; Alexis N T J Kotte; Lucas Goense; Peter S N van Rossum; Astrid L H M W van Lier; Stijn W Heijmink; Annemarieke Bartels-Rutten; Frank J Wessels; Berthe M P Aleman; Luc Dewit; Linda G W Kerkmeijer; Edwin P M Jansen; Martijn Intven; Irene M Lips; Gert J Meijer; Jasper Nijkamp

doi:10.1016/j.adro.2019.04.004

Gross Tumor Delineation in Esophageal Cancer on MRI Compared With 18F-FDG-PET/CT

Sophie E Vollenbrock
, Marlies E Nowee
, Francine E M Voncken
, Alexis N T J Kotte
, Lucas Goense
, Peter S N van Rossum
, Astrid L H M W van Lier
, Stijn W Heijmink
, Annemarieke Bartels-Rutten
, Frank J Wessels
, Berthe M P Aleman
, Luc Dewit
, Linda G W Kerkmeijer
, Edwin P M Jansen
, Martijn Intven
, Irene M Lips
, Gert J Meijer
, Jasper Nijkamp

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Purpose: Current delineation of the gross tumor volume (GTV) in esophageal cancer relies on computed tomography (CT) and combination with 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET). There is increasing interest in integrating magnetic resonance imaging (MRI) in radiation treatment, which can potentially obviate CT- or FDG-PET/CT-based delineation. The aim of this study is to evaluate the feasibility of target delineation on T2-weighted (T2W) MRI and T2W including diffusion-weighted MRI (T2W + DW-MRI) compared with current-practice FDG-PET/CT.

Methods: Ten observers delineated primary esophageal tumor GTVs of 6 patients on FDG-PET/CT, T2W-MRI, and T2W + DW-MRI. GTVs, generalized conformity indices, in-slice delineation variation (root mean square), and standard deviations in the position of the most cranial and caudal delineated slice were calculated.

Results: Delineations on MRI showed smaller GTVs compared with FDG-PET/CT-based delineations. The main variation was seen at the cranial and caudal border. No differences were observed in conformity indices (FDG-PET/CT, 0.68; T2W-MRI, 0.66; T2W + DW-MRI, 0.68) and in-slice variation (root mean square, 0.13 cm on FDG-PET/CT; 0.10 cm on T2W-MRI; 0.14 cm on T2W + DW-MRI). In the 2 tumors involving the gastroesophageal junction, addition of DW-MRI to T2W-MRI significantly decreased caudal border variation.

Conclusions: MRI-based target delineation of the esophageal tumor is feasible with interobserver variability comparable to that with FDG-PET/CT, despite limited experience with delineation on MRI. Most variation was seen at cranial-caudal borders, and addition of DW-MRI to T2W-MRI may reduce caudal delineation variation of gastroesophageal junction tumors.

Original language	English
Pages (from-to)	596-604
Number of pages	9
Journal	Advances in Radiation Oncology
Volume	4
Issue number	4
DOIs	https://doi.org/10.1016/j.adro.2019.04.004
Publication status	Published - 1 Oct 2019

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Vollenbrock, S. E., Nowee, M. E., Voncken, F. E. M., Kotte, A. N. T. J., Goense, L., van Rossum, P. S. N., van Lier, A. L. H. M. W., Heijmink, S. W., Bartels-Rutten, A., Wessels, F. J., Aleman, B. M. P., Dewit, L., Kerkmeijer, L. G. W., Jansen, E. P. M., Intven, M., Lips, I. M., Meijer, G. J., & Nijkamp, J. (2019). Gross Tumor Delineation in Esophageal Cancer on MRI Compared With 18F-FDG-PET/CT. Advances in Radiation Oncology, 4(4), 596-604. https://doi.org/10.1016/j.adro.2019.04.004

@article{06ddc5c43aaa4c4c999d894c1bd63b8f,

title = "Gross Tumor Delineation in Esophageal Cancer on MRI Compared With 18F-FDG-PET/CT",

abstract = "Purpose: Current delineation of the gross tumor volume (GTV) in esophageal cancer relies on computed tomography (CT) and combination with 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET). There is increasing interest in integrating magnetic resonance imaging (MRI) in radiation treatment, which can potentially obviate CT- or FDG-PET/CT-based delineation. The aim of this study is to evaluate the feasibility of target delineation on T2-weighted (T2W) MRI and T2W including diffusion-weighted MRI (T2W + DW-MRI) compared with current-practice FDG-PET/CT.Methods: Ten observers delineated primary esophageal tumor GTVs of 6 patients on FDG-PET/CT, T2W-MRI, and T2W + DW-MRI. GTVs, generalized conformity indices, in-slice delineation variation (root mean square), and standard deviations in the position of the most cranial and caudal delineated slice were calculated.Results: Delineations on MRI showed smaller GTVs compared with FDG-PET/CT-based delineations. The main variation was seen at the cranial and caudal border. No differences were observed in conformity indices (FDG-PET/CT, 0.68; T2W-MRI, 0.66; T2W + DW-MRI, 0.68) and in-slice variation (root mean square, 0.13 cm on FDG-PET/CT; 0.10 cm on T2W-MRI; 0.14 cm on T2W + DW-MRI). In the 2 tumors involving the gastroesophageal junction, addition of DW-MRI to T2W-MRI significantly decreased caudal border variation.Conclusions: MRI-based target delineation of the esophageal tumor is feasible with interobserver variability comparable to that with FDG-PET/CT, despite limited experience with delineation on MRI. Most variation was seen at cranial-caudal borders, and addition of DW-MRI to T2W-MRI may reduce caudal delineation variation of gastroesophageal junction tumors.",

author = "Vollenbrock, \{Sophie E\} and Nowee, \{Marlies E\} and Voncken, \{Francine E M\} and Kotte, \{Alexis N T J\} and Lucas Goense and \{van Rossum\}, \{Peter S N\} and \{van Lier\}, \{Astrid L H M W\} and Heijmink, \{Stijn W\} and Annemarieke Bartels-Rutten and Wessels, \{Frank J\} and Aleman, \{Berthe M P\} and Luc Dewit and Kerkmeijer, \{Linda G W\} and Jansen, \{Edwin P M\} and Martijn Intven and Lips, \{Irene M\} and Meijer, \{Gert J\} and Jasper Nijkamp",

note = "{\textcopyright} 2019 The Authors.",

year = "2019",

month = oct,

day = "1",

doi = "10.1016/j.adro.2019.04.004",

language = "English",

volume = "4",

pages = "596--604",

journal = "Advances in Radiation Oncology",

issn = "2452-1094",

publisher = "Elsevier",

number = "4",

}

Vollenbrock, SE, Nowee, ME, Voncken, FEM, Kotte, ANTJ, Goense, L, van Rossum, PSN, van Lier, ALHMW, Heijmink, SW, Bartels-Rutten, A, Wessels, FJ, Aleman, BMP, Dewit, L, Kerkmeijer, LGW, Jansen, EPM, Intven, M, Lips, IM, Meijer, GJ & Nijkamp, J 2019, 'Gross Tumor Delineation in Esophageal Cancer on MRI Compared With 18F-FDG-PET/CT', Advances in Radiation Oncology, vol. 4, no. 4, pp. 596-604. https://doi.org/10.1016/j.adro.2019.04.004

TY - JOUR

T1 - Gross Tumor Delineation in Esophageal Cancer on MRI Compared With 18F-FDG-PET/CT

AU - Vollenbrock, Sophie E

AU - Nowee, Marlies E

AU - Voncken, Francine E M

AU - Kotte, Alexis N T J

AU - Goense, Lucas

AU - van Rossum, Peter S N

AU - van Lier, Astrid L H M W

AU - Heijmink, Stijn W

AU - Bartels-Rutten, Annemarieke

AU - Wessels, Frank J

AU - Aleman, Berthe M P

AU - Dewit, Luc

AU - Kerkmeijer, Linda G W

AU - Jansen, Edwin P M

AU - Intven, Martijn

AU - Lips, Irene M

AU - Meijer, Gert J

AU - Nijkamp, Jasper

PY - 2019/10/1

Y1 - 2019/10/1

N2 - Purpose: Current delineation of the gross tumor volume (GTV) in esophageal cancer relies on computed tomography (CT) and combination with 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET). There is increasing interest in integrating magnetic resonance imaging (MRI) in radiation treatment, which can potentially obviate CT- or FDG-PET/CT-based delineation. The aim of this study is to evaluate the feasibility of target delineation on T2-weighted (T2W) MRI and T2W including diffusion-weighted MRI (T2W + DW-MRI) compared with current-practice FDG-PET/CT.Methods: Ten observers delineated primary esophageal tumor GTVs of 6 patients on FDG-PET/CT, T2W-MRI, and T2W + DW-MRI. GTVs, generalized conformity indices, in-slice delineation variation (root mean square), and standard deviations in the position of the most cranial and caudal delineated slice were calculated.Results: Delineations on MRI showed smaller GTVs compared with FDG-PET/CT-based delineations. The main variation was seen at the cranial and caudal border. No differences were observed in conformity indices (FDG-PET/CT, 0.68; T2W-MRI, 0.66; T2W + DW-MRI, 0.68) and in-slice variation (root mean square, 0.13 cm on FDG-PET/CT; 0.10 cm on T2W-MRI; 0.14 cm on T2W + DW-MRI). In the 2 tumors involving the gastroesophageal junction, addition of DW-MRI to T2W-MRI significantly decreased caudal border variation.Conclusions: MRI-based target delineation of the esophageal tumor is feasible with interobserver variability comparable to that with FDG-PET/CT, despite limited experience with delineation on MRI. Most variation was seen at cranial-caudal borders, and addition of DW-MRI to T2W-MRI may reduce caudal delineation variation of gastroesophageal junction tumors.

AB - Purpose: Current delineation of the gross tumor volume (GTV) in esophageal cancer relies on computed tomography (CT) and combination with 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET). There is increasing interest in integrating magnetic resonance imaging (MRI) in radiation treatment, which can potentially obviate CT- or FDG-PET/CT-based delineation. The aim of this study is to evaluate the feasibility of target delineation on T2-weighted (T2W) MRI and T2W including diffusion-weighted MRI (T2W + DW-MRI) compared with current-practice FDG-PET/CT.Methods: Ten observers delineated primary esophageal tumor GTVs of 6 patients on FDG-PET/CT, T2W-MRI, and T2W + DW-MRI. GTVs, generalized conformity indices, in-slice delineation variation (root mean square), and standard deviations in the position of the most cranial and caudal delineated slice were calculated.Results: Delineations on MRI showed smaller GTVs compared with FDG-PET/CT-based delineations. The main variation was seen at the cranial and caudal border. No differences were observed in conformity indices (FDG-PET/CT, 0.68; T2W-MRI, 0.66; T2W + DW-MRI, 0.68) and in-slice variation (root mean square, 0.13 cm on FDG-PET/CT; 0.10 cm on T2W-MRI; 0.14 cm on T2W + DW-MRI). In the 2 tumors involving the gastroesophageal junction, addition of DW-MRI to T2W-MRI significantly decreased caudal border variation.Conclusions: MRI-based target delineation of the esophageal tumor is feasible with interobserver variability comparable to that with FDG-PET/CT, despite limited experience with delineation on MRI. Most variation was seen at cranial-caudal borders, and addition of DW-MRI to T2W-MRI may reduce caudal delineation variation of gastroesophageal junction tumors.

UR - https://www.scopus.com/pages/publications/85066319353

U2 - 10.1016/j.adro.2019.04.004

DO - 10.1016/j.adro.2019.04.004

M3 - Article

C2 - 31673653

SN - 2452-1094

VL - 4

SP - 596

EP - 604

JO - Advances in Radiation Oncology

JF - Advances in Radiation Oncology

IS - 4

ER -

Gross Tumor Delineation in Esophageal Cancer on MRI Compared With 18F-FDG-PET/CT

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