DE-MR simulation imaging for prone radiotherapy after breast-conserving surgery: assessing its application in lumpectomy cavity delineation based on deformable image registration.

Publisher: BioMed Central Country of Publication: England NLM ID: 101265111 Publication Model: Electronic Cited Medium: Internet ISSN: 1748-717X (Electronic) Linking ISSN: 1748717X NLM ISO Abbreviation: Radiat Oncol Subsets: MEDLINE

Original Publication: [London] : BioMed Central, 2006-

Mastectomy, Segmental* ; Prone Position* ; Radiotherapy, Adjuvant*; Breast/*diagnostic imaging ; Breast Neoplasms/*radiotherapy ; Magnetic Resonance Imaging/*methods ; Postoperative Complications/*diagnostic imaging ; Radiotherapy Planning, Computer-Assisted/*methods ; Seroma/*diagnostic imaging; Adult ; Breast Neoplasms/diagnostic imaging ; Breast Neoplasms/surgery ; Female ; Fiducial Markers ; Humans ; Middle Aged ; Postoperative Complications/etiology ; Seroma/etiology ; Titanium ; Tomography, X-Ray Computed/methods

Background: The application of delayed-enhancement magnetic resonance (DE-MR) simulation imaging in lumpectomy cavity (LC) delineation for prone radiotherapy in patients with an invisible seroma or a low seroma clarity score (SCS) after breast-conserving surgery (BCS) based on deformable image registration (DIR) was assessed.
Methods: Twenty-six patients who were suitable for radiotherapy in prone positions after BCS were enrolled, and both computed tomography (CT) and DE-MR simulation scans were acquired. The LC delineated based on titanium surgical clips on CT images was denoted as LC CT . The LC delineated based on the signal of cavity boundaries on fat-suppressed T2-weighted imaging (T2WI) and multiphase delayed-enhancement T1-weighted imaging (DE-T1WI), which was performed at 2 min, 5 min and 10 min postinjection, were denoted as LC T2 , LC 2T1 , LC 5T1 and LC 10T1 , respectively. Afterwards, DIR was performed to compare the volumes and locations of the LCs with MIM software. The generalized conformity index (CIgen) of inter (intra) observer (Inter-CIgen and Intra-CIgen) was also used to explore the inter(intra) observer variation for LC delineation on each image modality.
Results: LC CT -LC 10T1 provided the best conformal index (CI) and degree of inclusion (DI), increasing by 2.08% and 4.48% compared to LC CT -LC T2 , 11.36% and 2.94% for LC CT -LC 2T1 , and 8.89% and 7.69% for LC 5T1 -LC CT , respectively. The center of mass (COM) of LC CT -LC 10T1 decreased by 17.86%, 6.12% and 13.21% compared with that of LC CT -LC T2 , LC CT -LC 2T1 and LC CT -LC 5T1 , respectively. The agreement of LC delineation was strongest for 10th min DE-TIWI (coefficient of variation, COV = 2.30%, Inter-CIgen = 87.06%, Intra-CIgen = 92.64%).
Conclusion: For patients with a low SCS (SCS ≤ 2) after BCS, it is feasible to contour the LC based on prone DE-MR simulation images. Furthermore, the LC derived from prone DE-T1WI at 10 min was found to be most similar to that derived from prone CT simulation scans using titanium surgical clips regardless of the volume and location of the LC. Inter (intra) variability was minimal for the delineation of the LC based on 10th min DE-TIWI.

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ZR2020QH260 Key Research Development Program of Shandong Province; 81703038 National Natural Science Foundation of China

Keywords: Breast-conserving surgery; Computed tomography simulation image; Delayed-enhancement magnetic resonance simulation image; Lumpectomy cavity delineation; Prone radiotherapy

D1JT611TNE (Titanium)

Date Created: 20210518 Date Completed: 20210525 Latest Revision: 20210525

20240829

PMC8130288

10.1186/s13014-021-01817-2

34001182