Abstract
MRI is being increasingly used in oncology for staging, assessing tumour response and also for treatment planning in radiotherapy. Both conformal and intensity-modulated radiotherapy requires improved means of defining target volumes for treatment planning in order to achieve its intended benefits. MRI can add to the radiotherapy treatment planning (RTP) process by providing excellent and improved characterization of soft tissues compared with CT. Together with its multiplanar capability and increased imaging functionality, these advantages for target volume delineation outweigh its drawbacks of lacking electron density information and potential image distortion. Efficient MR distortion assessment and correction algorithms together with image co-registration and fusion programs can overcome these limitations and permit its use for RTP. MRI developments using new contrast media, such as ultrasmall superparamagnetic iron oxide particles for abnormal lymph node identification, techniques such as dynamic contrast enhanced MRI and diffusion MRI to better characterize tissue and tumour regions as well as ultrafast volumetric or cine MR sequences to define temporal patterns of target and organ at risk deformity and variations in spatial location have all increased the scope and utility of MRI for RTP. Information from these MR developments may permit treatment individualization, strategies of dose escalation and image-guided radiotherapy. These developments will be reviewed to assess their current and potential use for RTP and precision high dose radiotherapy.
References
1 Mackenzie R, Dixon AK. Measuring the effects of imaging: an evaluative framework. Clin Radiol 1995;50:513–8.
2 Khoo VS. MRI–“magic radiotherapy imaging” for treatment planning? Br J Radiol 2000;73:229–33.
3 Harisinghani MG, Saini S, Weissleder R, Hahn PF, Yantiss RK, Tempany C, et al. MR lymphangiography using ultrasmall superparamagnetic iron oxide in patients with primary abdominal and pelvic malignancies: radiographic-pathologic correlation. AJR Am J Roentgenol 1999;172:1347–51.
4 Padhani AR, Husband JE. Dynamic contrast-enhanced MRI studies in oncology with an emphasis on quantification, validation and human studies. Clin Radiol 2001;56:607–20.
5 Rees J. Advances in magnetic resonance imaging of brain tumours. Curr Opin Neurol 2003;16:643–50.
6 Rohlfing T, Maurer CR Jr, O'Dell WG, Zhong J. Modeling liver motion and deformation during the respiratory cycle using intensity-based nonrigid registration of gated MR images. Med Phys 2004;31:427–32.
7 Padhani AR, Khoo VS, Suckling J, Husband JE, Leach MO, Dearnaley DP. Evaluating the effect of rectal distension and rectal movement on prostate gland position using cine MRI. Int J Radiat Oncol Biol Phys 1999;44:525–33.
8 Sundar S, Symonds RP. Diagnostic radiology for radiotherapist: the case for structured training in cross-sectional imaging (CT and MRI). Clin Oncol (R Coll Radiol) 2002;14:413–4.
9 Board of the Faculty of Clinical-Oncology: Imaging for oncologists: collaboration between clinical radiologists and clinical oncologists in diagnosis, staging and radiotherapy planning. London, Royal College of Radiologists, 2004
10 Khoo VS, Dearnaley DP, Finnigan DJ, Padhani A, Tanner SF, Leach MO. Magnetic resonance imaging (MRI): considerations and applications in radiotherapy treatment planning. Radiother Oncol 1997;42:1–15.
11 Thornton AF, Sandler HM, Ten Haken RK, McSchan DL, Fraass BA, La Vigne ML, et al. The clinical utility of magnetic resonance imaging in the 3-dimensional treatment planning of brain tumors. Int J Radiat Oncol Biol Phys 1992;24:767–75.
12 Heester MA, Wijrdeman HK, Strukmans H, Witkamp T, Moerland MA. Brain tumor delineation based on CT and MR imaging. Strahlenther Onkol 1993;169:729–33.
13 Sultanem K, Patrocinio H, Lambert C, Corns R, Leblanc R, Parker W, et al. The use of hypofractionated intensity-modulated irradiation in the treatment of glioblastoma multiforme: preliminary results of a prospective trial. Int J Radiat Oncol Biol Phys 2004;58:247–52.
14 Ten Haken RK, Thornton AF, Sandler HM, La Vigne ML, Quint DJ, Frass BA, et al. A quantitative assessment of the addition of MRI to CT-based, 3-D treatment planning of brain tumors. Radiother Oncol 1992;25:121–33.
15 Khoo VS, Adams EJ, Saran F, Bedford JL, Perks JR, Warrington AP, et al. A comparison of clinical target volumes determined by CT and MRI for the radiotherapy planning of base of skull meningiomas. Int J Radiat Oncol Biol Phys 2000;46:1309–17.
16 Mazzara GP, Velthuizen RP, Pearlman JL, Greenberg HM, Wagner H. Brain tumor target volume determination for radiation treatment planning through automated MRI segmentation. Int J Radiat Oncol Biol Phys 2004;59:300–12.
17 Bondiau PY, Malandain G, Chanalet S, Marcy PY, Habrand JL, Fauchon F, et al. Atlas-based automatic segmentation of MR images: validation study on the brainstem in radiotherapy context. Int J Radiat Oncol Biol Phys 2005;61:289–98.
18 Levivier M, Massager N, Wikler D, Goldman S. Modern multimodal neuroimaging for radiosurgery: the example of PET scan integration. Acta Neurochir Suppl 2004;91:1–7.
19 Manavis J, Sivridis L, Koukourakis MI. Nasopharyngeal carcinoma: the impact of CT-scan and of MRI on staging, radiotherapy treatment planning, and outcome of the disease. Clin Imaging 2005;29:128–33.
20 Emami B, Sethi A, Petruzzelli GJ. Influence of MRI on target volume delineation and IMRT planning in nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 2003;57:481–8.
21 Chung NN, Ting LL, Hsu WC, Lui LT, Wang PM. Impact of magnetic resonance imaging versus CT on nasopharyngeal carcinoma: primary tumor target delineation for radiotherapy. Head Neck 2004;26:241–6.
22 Lee FK, Yeung DK, King AD, Leung SF, Ahuja A. Segmentation of nasopharyngeal carcinoma (NPC) lesions in MR images. Int J Radiat Oncol Biol Phys 2005;61:608–20.
23 Huch Boni RA, Boner JA, Debatin JF, Trinkler F, Knonagel H, Von Hochstetter A, et al. Optimization of prostate carcinoma staging: comparison of imaging and clinical methods. Clin Radiol 1995;50:593–600.
24 Barentsz JO, Engelbrecht MR, Witjes JA, de la Rosette JJ, van der Graaf M. MR imaging of the male pelvis. Eur Radiol 1999;9:1722–36.
25 Heenan SD. Magnetic resonance imaging in prostate cancer. Prostate Cancer Prostatic Dis 2004;7:282–8.
26 Khoo VS, Padhani AR, Tanner SF, Finnigan DJ, Leach MO, Dearnaley DP. Comparison of MRI with CT for the radiotherapy planning of prostate cancer: a feasibility study. Br J Radiol 1999;72:590–7.
27 Wachter S, Wachter-Gerstner N, Bock T, Goldner G, Kovacs G, Fransson A, et al. Interobserver comparison of CT and MRI-based prostate apex definition. Clinical relevance for conformal radiotherapy treatment planning. Strahlenther Onkol 2002;178:263–8.
28 Roach M, Faillace-Akazawa P, Malfatti C, Holland J, Hricak H. Prostate volumes defined by magnetic resonance imaging and computerized tomographic scans for 3-dimensional conformal radiotherapy. Int J Radiat Oncol Biol Phys 1996;35:1011–8.
29 Kagawa K, Lee WR, Schultheiss TE, Hunt MA, Shaer AH, Hanks GE. Initial clinical assessment of CT-MRI image fusion software in localization of the prostate for 3D conformal radiation therapy. Int J Radiat Oncol Biol Phys 1997;38:319–25.
30 Rasch C, Barillot I, Remeijer P, Touw A, van Herk M, Lebesque JV. Definition of the prostate in CT and MRI: a multi-observer study. Int J Radiat Oncol Biol Phys 1999;43:57–66.
31 Sannazzari GL, Ragona R, Ruo Redda MG, Giglioli FR, Isolato G, Guarneri A. CT-MRI image fusion for delineation of volumes in three-dimensional conformal radiation therapy in the treatment of localized prostate cancer. Br J Radiol 2002;75:603–7.
32 Joon DL, Nguyen B, Khoo V, Joon ML, See A, Wada M, et al. Assessing the impact of MRI on determination of planning volumes for conformal prostate radiotherapy. Int J Radiat Oncol Biol Phys 2005;63:(S1):S331
33 Jackson AS, Parker CC, Norman AR, Padhani AR, Huddart RA, Horwich A, et al. Tumour staging using magnetic resonance imaging in clinically localised prostate cancer: relationship to biochemical outcome after neo-adjuvant androgen deprivation and radical radiotherapy. Clin Oncol (R Coll Radiol) 2005;17:167–71.
34 Lau HY, Kagawa K, Lee WR, Hunt MA, Shaer AH, Hanks GE. Short communication: CT-MRI image fusion for 3D conformal prostate radiotherapy: use in patients with altered pelvic anatomy. Br J Radiol 1996;69:1165–70.
35 Steenbakkers RJ, Deurloo KE, Nowak PJ, Lebesque JV, van Herk M, Rasch CR. Reduction of dose delivered to the rectum and bulb of the penis using MRI delineation for radiotherapy of the prostate. Int J Radiat Oncol Biol Phys 2003;57:1269–79.
36 Menard C, Susil RC, Choyke P, Gustafson GS, Kammerer W, Ning H, et al. MRI-guided HDR prostate brachytherapy in standard 1.5T scanner. Int J Radiat Oncol Biol Phys 2004;59:1414–23.
37 Citrin D, Ning H, Guion P, Li G, Susil RC, Miller RW, et al. Inverse treatment planning based on MRI for HDR prostate brachytherapy. Int J Radiat Oncol Biol Phys 2005;61:1267–75.
38 Polo A, Cattani F, Vavassori A, Origgi D, Villa G, Marsiglia H, et al. MR and CT image fusion for postimplant analysis in permanent prostate seed implants. Int J Radiat Oncol Biol Phys 2004;60:1572–9.
39 Crook J, McLean M, Yeung I, Williams T, Lockwood G. MRI-CT fusion to assess postbrachytherapy prostate volume and the effects of prolonged edema on dosimetry following transperineal interstitial permanent prostate brachytherapy. Brachytherapy 2004;3:55–60.
40 Krempien RC, Daeuber S, Hensley FW, Wannenmacher M, Harms W. Image fusion of CT and MRI data enables improved target volume definition in 3D-brachytherapy treatment planning. Brachytherapy 2003;2:164–71.
41 Haie-Meder C, Potter R, Van Limbergen E, Briot E, De Brabandere M, Dimopoulos J, et al. Recommendations from Gynaecological (GYN) GEC-ESTRO Working Group (I): concepts and terms in 3D image based 3D treatment planning in cervix cancer brachytherapy with emphasis on MRI assessment of GTV and CTV. Radiother Oncol 2005;74:235–45.
42 Joon D, Butcher M, Marr M, Quong G, Feigen M, Wada M, et al. Evaluation of the use of CT planning vs orthogonal films in the treatment of rectal carcinoma. Proceedings of the 12th International Congress of Radiation Research (ICRR). Brisbane, Australia, 2003:258
43 Khoo V, Joon D, Tan J, Fitt G, Feigen M, Marr M, et al. The utility of multimodality imaging with MRI to determine treatment volumes for chemoradiation in rectal cancer. Eur J Cancer 2005;3:408
44 Ferri M, Laghi A, Mingazzini P, Iafrate F, Meli L, Ricci F, et al. Pre-operative assessment of extramural invasion and sphincteral involvement in rectal cancer by magnetic resonance imaging with phased-array coil. Colorectal Dis 2005;7:387–93.
45 Urban M, Rosen HR, Holbling N, Feil W, Hochwarther G, Hruby W, et al. MR imaging for the preoperative planning of sphincter-saving surgery for tumors of the lower third of the rectum: use of intravenous and endorectal contrast materials. Radiology 2000;214:503–8.
46 Blomqvist L, Holm T, Nyren S, Svanstrom R, Ulvskog Y, Iselius L. MR imaging and computed tomography in patients with rectal tumours clinically judged as locally advanced. Clin Radiol 2002;57:211–8.
47 Beets-Tan RG, Lettinga T, Beets GL. Pre-operative imaging of rectal cancer and its impact on surgical performance and treatment outcome. Eur J Surg Oncol 2005;31:681–8.
48 Schad LR, Bluml S, Hawighorst H, Wenz F, Lorenz WJ. Radiosurgical treatment planning of brain metastases based on a fast, three-dimensional MR imaging technique. Magn Reson Imaging 1994;12:811–9.
49 Chen L, Price RA Jr, Wang L, Li J, Qin L, McNeeley S, et al. MRI-based treatment planning for radiotherapy: dosimetric verification for prostate IMRT. Int J Radiat Oncol Biol Phys 2004;60:636–47.
50 Lee YK, Bollet M, Charles-Edwards G, Flower MA, Leach MO, McNair H, et al. Radiotherapy treatment planning of prostate cancer using magnetic resonance imaging alone. Radiother Oncol 2003;66:203–16.
51 Finnigan DJ, Tanner SF, Dearnaley DP, Edser E, Horwich A, Khoo VS, et al. Distortion-corrected magnetic resonance images for pelvic radiotherapy treatment planning, In: Faulkner K, Carey B, Crellin A, et al, editors. Quantitative imaging in oncology. London: British Institute of Radiology, 1997:72–6
52 Tanner SF, Finnigan DJ, Khoo VS, Mayles P, Dearnaley DP, Leach MO. Radiotherapy planning of the pelvis using distortion corrected MR images: the removal of system distortions. Phys Med Biol 2000;45:2117–32.
53 Doran SJ, Charles-Edwards L, Reinsberg SA, Leach MO. A complete distortion correction for MR images: I. Gradient warp correction. Phys Med Biol 2005;50:1343–61.
54 Reinsberg SA, Doran SJ, Charles-Edwards EM, Leach MO. A complete distortion correction for MR images: II. Rectification of static-field inhomogeneities by similarity-based profile mapping. Phys Med Biol 2005;50:2651–61.
55 Petersch B, Bogner J, Fransson A, Lorang T, Potter R. Effects of geometric distortion in 0.2T MRI on radiotherapy treatment planning of prostate cancer. Radiother Oncol 2004;71:55–64.
56 Koch N, Liu HH, Olsson LE, Jackson EF. Assessment of geometrical accuracy of magnetic resonance images for radiation therapy of lung cancers. J Appl Clin Med Phys 2003;4:352–64.
57 Sosna J, Pedrosa I, Dewolf WC, Mahallati H, Lenkinski RE, Rofsky NM. MR imaging of the prostate at 3 Tesla: comparison of an external phased-array coil to imaging with an endorectal coil at 1.5 Tesla. Acad Radiol 2004;11:857–62.
58 Bloch BN, Rofsky NM, Baroni RH, Marquis RP, Pedrosa I, Lenkinski RE. 3 Tesla magnetic resonance imaging of the prostate with combined pelvic phased-array and endorectal coils; Initial experience(1). Acad Radiol 2004;11:863–7.
59 Pirzkall A, Li X, Oh J, Chang S, Berger MS, Larson DA, et al. 3D MRSI for resected high-grade gliomas before RT: tumor extent according to metabolic activity in relation to MRI. Int J Radiat Oncol Biol Phys 2004;59:126–37.
60 Pickett B, Vigneault E, Kurhanewicz J, Verhey L, Roach M. Static field intensity modulation to treat a dominant intra-prostatic lesion to 90 Gy compared to seven field 3-dimensional radiotherapy. Int J Radiat Oncol Biol Phys 1999;44:921–9.
61 Mack A, Wolff R, Scheib S, Rieker M, Weltz D, Mack G, et al. Analyzing 3-tesla magnetic resonance imaging units for implementation in radiosurgery. J Neurosurg 2005;102:158–64
62 Mizowaki T, Nagata Y, Okajima K, Murata R, Yamamoto M, Kokubo M, et al. Development of an MR simulator: experimental verification of geometric distortion and clinical application. Radiology 1996;199:855–60.
63 Deasy NP, Conry BG, Lewis JL, Ford TF, Russell GA, Basu R, et al. Local staging of prostate cancer with 0.2 T body coil MRI. Clin Radiol 1997;52:933–7.
64 Buyyounouski MK, Horwitz EM, Price RA, Hanlon AL, Uzzo RG, Pollack A. Intensity-modulated radiotherapy with MRI simulation to reduce doses received by erectile tissue during prostate cancer treatment. Int J Radiat Oncol Biol Phys 2004;58:743–9.
65 Krauss DJ, Kestin LL, Raff G, Yan D, Wong J, Gentry R, et al. MRI-based volumetric assessment of cardiac anatomy and dose reduction via active breathing control during irradiation for left-sided breast cancer. Int J Radiat Oncol Biol Phys 2005;61:1243–50.
66 Plathow C, Ley S, Fink C, Puderbach M, Hosch W, Schmahl A, et al. Analysis of intrathoracic tumor mobility during whole breathing cycle by dynamic MRI. Int J Radiat Oncol Biol Phys 2004;59:952–9.
67 Liu HH, Koch N, Starkschall G, Jacobson M, Forster K, Liao Z, et al. Evaluation of internal lung motion for respiratory-gated radiotherapy using MRI: Part II-margin reduction of internal target volume. Int J Radiat Oncol Biol Phys 2004;60:1473–83.
68 Ghilezan MJ, Jaffray DA, Siewerdsen JH, Van Herk M, Shetty A, Sharpe MB, et al. Prostate gland motion assessed with cine-magnetic resonance imaging (cine-MRI). Int J Radiat Oncol Biol Phys 2005;62:406–17.
69 Khoo VS, Bedford JL, Padhani A, Leach M, Husband J, Dearnaley DP. Prostate and rectal deformation assessed using cine magnetic resonance imaging (MRI) during a course of radical prostate radiotherapy. Radiother Oncol 2002;64:285
70 McBain CA, Sykes JS, Buckley DL, Amer A, Moore CJ, Cowan RA, et al. Optimising bladder radiotherapy: MR assessment of time-dependent organ motion. Clin Oncol (R Coll Radiol) 2003;15:13
71 Mack MG, Balzer JO, Straub R, Eichler K, Vogl TJ. Superparamagnetic iron oxide-enhanced MR imaging of head and neck lymph nodes. Radiology 2002;222:239–44.
72 Portaluri M, Bambace S, Perez C, Giuliano G, Angone G, Scialpi M, et al. Clinical and anatomical guidelines in pelvic cancer contouring for radiotherapy treatment planning. Cancer Radiother 2004;8:222–9.
73 Martin J, Joon DL, Ng N, Grace M, Van-Gelderen D, Lawlor M, et al. Towards individualised radiotherapy for stage I seminoma. Radiother Oncol 2005;76:251–6.
74 Gregoire V, Coche E, Cosnard G, Hamoir M, Reychler H. Selection and delineation of lymph node target volumes in head and neck conformal radiotherapy. Proposal for standardizing terminology and procedure based on the surgical experience. Radiother Oncol 2000;56:135–50.
75 Kim JY, Harisinghani MG. MR imaging staging of pelvic lymph nodes. Magn Reson Imaging Clin N Am 2004;12:581–6.
76 Neeman M, Provenzale JM, Dewhirst MW. Magnetic resonance imaging applications in the evaluation of tumor angiogenesis. Semin Radiat Oncol 2001;11:70–82.
77 Sugahara T, Korogi Y, Kochi M, Ikushima I, Hirai T, Okuda T, et al. Correlation of MR imaging-determined cerebral blood volume maps with histologic and angiographic determination of vascularity of gliomas. AJR Am J Roentgenol 1998;171:1479–86.
78 Dao TH, Rahmouni A, Campana F, Laurent M, Asselain B, Fourquet A. Tumor recurrence versus fibrosis in the irradiated breast: differentiation with dynamic gadolinium-enhanced MR imaging. Radiology 1993;187:751–5.
79 Hawnaur JM, Zhu XP, Hutchinson CE. Quantitative dynamic contrast enhanced MRI of recurrent pelvic masses in patients treated for cancer. Br J Radiol 1998;71:1136–42.
80 De Vries A, Griebel J, Kremser C, Judmaier W, Gneiting T, Debbage P, et al. Monitoring of tumor microcirculation during fractionated radiation therapy in patients with rectal carcinoma: preliminary results and implications for therapy. Radiology 2000;217:385–91.
81 Mayr NA, Yuh WT, Arnholt JC, Ehrhardt JC, Sorosky JI, Magnotta VA, et al. Pixel analysis of MR perfusion imaging in predicting radiation therapy outcome in cervical cancer. J Magn Reson Imaging 2000;12:1027–33.
82 Rouviere O, Valette O, Grivolat S, Colin-Pangaud C, Bouvier R, Chapelon JY, et al. Recurrent prostate cancer after external beam radiotherapy: value of contrast-enhanced dynamic MRI in localizing intraprostatic tumor--correlation with biopsy findings. Urology 2004;63:922–7.
83 Tomura N, Omachi K, Sakuma I, Takahashi S, Izumi J, Watanabe O, et al. Dynamic contrast-enhanced magnetic resonance imaging in radiotherapeutic efficacy in the head and neck tumors. Am J Otolaryngol 2005;26:163–7.
84 Einarsdottir H, Karlsson M, Wejde J, Bauer HC. Diffusion-weighted MRI of soft tissue tumours. Eur Radiol 2004;14:959–63.
85 Dzik-Jurasz A, Domenig C, George M, Wolber J, Padhani A, Brown G, et al. Diffusion MRI for prediction of response of rectal cancer to chemoradiation. Lancet 2002;360:307–8.
86 Kremser C, Judmaier W, Hein P, Griebel J, Lukas P, de Vries A. Preliminary results on the influence of chemoradiation on apparent diffusion coefficients of primary rectal carcinoma measured by magnetic resonance imaging. Strahlenther Onkol 2003;179:641–9.
87 Price SJ, Burnet NG, Donovan T, Green HA, Pena A, Antoun NM, et al. Diffusion tensor imaging of brain tumours at 3T: a potential tool for assessing white matter tract invasion? Clin Radiol 2003;58:455–62.
88 Jena R, Price SJ, Baker C, Jefferies SJ, Pickard JD, Gillard JH, et al. Diffusion tensor imaging: possible implications for radiotherapy treatment planning of patients with high-grade glioma. Clin Oncol (R Coll Radiol) 2005;17:581–90.
89 Aoyama H, Kamada K, Shirato H, Takeuchi F, Kuriki S, Iwasaki Y, et al. Integration of functional brain information into stereotactic irradiation treatment planning using magnetoencephalography and magnetic resonance axonography. Int J Radiat Oncol Biol Phys 2004;58:1177–83.
