Spinal Cord Delineation Based on Computed Tomography Myelogram Versus T2 Magnetic Resonance Imaging in Spinal Stereotactic Body Radiation Therapy
Purpose: Spinal cord delineation is critical to the delivery of stereotactic body radiation therapy (SBRT). Although underestimating the spinal cord can lead to irreversible myelopathy, overestimating the spinal cord may compromise the planning target volume coverage. We compare spinal cord contours...
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2023-05-01
|
| Series: | Advances in Radiation Oncology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2452109422002640 |
| _version_ | 1811168410546995200 |
|---|---|
| author | Lubna Hammoudeh, MD Abdullah M. Abunimer, MD, MPH Ho Young Lee, CMD Edward Christopher Dee, BS Victoria Brennan S, MD Pei Yaguang, CMD Kee-Young Shin, MS Yu-Hui Chen, MS, MPH Mai Anh Huynh, MD, PhD Alexander Spektor, MD, PhD Jeffrey P. Guenette, MD Tracy Balboni, MD, MPH |
| author_facet | Lubna Hammoudeh, MD Abdullah M. Abunimer, MD, MPH Ho Young Lee, CMD Edward Christopher Dee, BS Victoria Brennan S, MD Pei Yaguang, CMD Kee-Young Shin, MS Yu-Hui Chen, MS, MPH Mai Anh Huynh, MD, PhD Alexander Spektor, MD, PhD Jeffrey P. Guenette, MD Tracy Balboni, MD, MPH |
| author_sort | Lubna Hammoudeh, MD |
| collection | DOAJ |
| description | Purpose: Spinal cord delineation is critical to the delivery of stereotactic body radiation therapy (SBRT). Although underestimating the spinal cord can lead to irreversible myelopathy, overestimating the spinal cord may compromise the planning target volume coverage. We compare spinal cord contours based on computed tomography (CT) simulation with a myelogram to spinal cord contours based on fused axial T2 magnetic resonance imaging (MRI). Methods and Materials: Eight patients with 9 spinal metastases treated with spinal SBRT were contoured by 8 radiation oncologists, neurosurgeons, and physicists, with spinal cord definition based on (1) fused axial T2 MRI and (2) CT-myelogram simulation images, yielding 72 sets of spinal cord contours. The spinal cord volume was contoured at the target vertebral body volume based on both images. The mixed-effect model assessed comparisons of T2 MRI- to myelogram-defined spinal cord in centroid deviations (deviations in the center point of the cord) through the vertebral body target volume, spinal cord volumes, and maximum doses (0.035 cc point) to the spinal cord applying the patient's SBRT treatment plan, in addition to in-between and within-subject variabilities. Results: The estimate for the fixed effect from the mixed model showed that the mean difference between 72 CT volumes and 72 MRI volumes was 0.06 cc and was not statistically significant (95% confidence interval, –0.034, 0.153; P = .1832). The mixed model showed that the mean dose at 0.035 cc for CT-defined spinal cord contours was 1.24 Gy lower than that of MRI-defined spinal cord contours and was statistically significant (95% confidence interval, –2.292, –0.180; P = .0271). Also, the mixed model indicated no statistical significance for deviations in any of the axes between MRI-defined spinal cord contours and CT-defined spinal cord contours. Conclusions: CT myelogram may not be required when MRI imaging is feasible, although uncertainty at the cord-to-treatment volume interface may result in overcontouring and hence higher estimated cord dose-maximums with axial T2 MRI-based cord definition. |
| first_indexed | 2024-04-10T16:26:55Z |
| format | Article |
| id | doaj.art-76bf96676cb741088680af741cb814a6 |
| institution | Directory Open Access Journal |
| issn | 2452-1094 |
| language | English |
| last_indexed | 2024-04-10T16:26:55Z |
| publishDate | 2023-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Advances in Radiation Oncology |
| spelling | doaj.art-76bf96676cb741088680af741cb814a62023-02-09T04:14:38ZengElsevierAdvances in Radiation Oncology2452-10942023-05-0183101158Spinal Cord Delineation Based on Computed Tomography Myelogram Versus T2 Magnetic Resonance Imaging in Spinal Stereotactic Body Radiation TherapyLubna Hammoudeh, MD0Abdullah M. Abunimer, MD, MPH1Ho Young Lee, CMD2Edward Christopher Dee, BS3Victoria Brennan S, MD4Pei Yaguang, CMD5Kee-Young Shin, MS6Yu-Hui Chen, MS, MPH7Mai Anh Huynh, MD, PhD8Alexander Spektor, MD, PhD9Jeffrey P. Guenette, MD10Tracy Balboni, MD, MPH11Department of Radiation Medicine, Oregon Health & Science University, Portland, OregonDepartment of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopedic Surgery, Hamad General Hospital, Doha, QatarDepartment of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MassachusettsDepartment of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New YorkDepartment of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New YorkDepartment of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MassachusettsDepartment of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MassachusettsDepartment of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MassachusettsDepartment of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MassachusettsDepartment of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MassachusettsDepartment of Radiation Medicine, Oregon Health & Science University, Portland, Oregon; Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopedic Surgery, Hamad General Hospital, Doha, Qatar; Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York; Division of Neuroradiology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MassachusettsDepartment of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts; Corresponding author: Tracy Balboni, MD, MPHPurpose: Spinal cord delineation is critical to the delivery of stereotactic body radiation therapy (SBRT). Although underestimating the spinal cord can lead to irreversible myelopathy, overestimating the spinal cord may compromise the planning target volume coverage. We compare spinal cord contours based on computed tomography (CT) simulation with a myelogram to spinal cord contours based on fused axial T2 magnetic resonance imaging (MRI). Methods and Materials: Eight patients with 9 spinal metastases treated with spinal SBRT were contoured by 8 radiation oncologists, neurosurgeons, and physicists, with spinal cord definition based on (1) fused axial T2 MRI and (2) CT-myelogram simulation images, yielding 72 sets of spinal cord contours. The spinal cord volume was contoured at the target vertebral body volume based on both images. The mixed-effect model assessed comparisons of T2 MRI- to myelogram-defined spinal cord in centroid deviations (deviations in the center point of the cord) through the vertebral body target volume, spinal cord volumes, and maximum doses (0.035 cc point) to the spinal cord applying the patient's SBRT treatment plan, in addition to in-between and within-subject variabilities. Results: The estimate for the fixed effect from the mixed model showed that the mean difference between 72 CT volumes and 72 MRI volumes was 0.06 cc and was not statistically significant (95% confidence interval, –0.034, 0.153; P = .1832). The mixed model showed that the mean dose at 0.035 cc for CT-defined spinal cord contours was 1.24 Gy lower than that of MRI-defined spinal cord contours and was statistically significant (95% confidence interval, –2.292, –0.180; P = .0271). Also, the mixed model indicated no statistical significance for deviations in any of the axes between MRI-defined spinal cord contours and CT-defined spinal cord contours. Conclusions: CT myelogram may not be required when MRI imaging is feasible, although uncertainty at the cord-to-treatment volume interface may result in overcontouring and hence higher estimated cord dose-maximums with axial T2 MRI-based cord definition.http://www.sciencedirect.com/science/article/pii/S2452109422002640 |
| spellingShingle | Lubna Hammoudeh, MD Abdullah M. Abunimer, MD, MPH Ho Young Lee, CMD Edward Christopher Dee, BS Victoria Brennan S, MD Pei Yaguang, CMD Kee-Young Shin, MS Yu-Hui Chen, MS, MPH Mai Anh Huynh, MD, PhD Alexander Spektor, MD, PhD Jeffrey P. Guenette, MD Tracy Balboni, MD, MPH Spinal Cord Delineation Based on Computed Tomography Myelogram Versus T2 Magnetic Resonance Imaging in Spinal Stereotactic Body Radiation Therapy Advances in Radiation Oncology |
| title | Spinal Cord Delineation Based on Computed Tomography Myelogram Versus T2 Magnetic Resonance Imaging in Spinal Stereotactic Body Radiation Therapy |
| title_full | Spinal Cord Delineation Based on Computed Tomography Myelogram Versus T2 Magnetic Resonance Imaging in Spinal Stereotactic Body Radiation Therapy |
| title_fullStr | Spinal Cord Delineation Based on Computed Tomography Myelogram Versus T2 Magnetic Resonance Imaging in Spinal Stereotactic Body Radiation Therapy |
| title_full_unstemmed | Spinal Cord Delineation Based on Computed Tomography Myelogram Versus T2 Magnetic Resonance Imaging in Spinal Stereotactic Body Radiation Therapy |
| title_short | Spinal Cord Delineation Based on Computed Tomography Myelogram Versus T2 Magnetic Resonance Imaging in Spinal Stereotactic Body Radiation Therapy |
| title_sort | spinal cord delineation based on computed tomography myelogram versus t2 magnetic resonance imaging in spinal stereotactic body radiation therapy |
| url | http://www.sciencedirect.com/science/article/pii/S2452109422002640 |
| work_keys_str_mv | AT lubnahammoudehmd spinalcorddelineationbasedoncomputedtomographymyelogramversust2magneticresonanceimaginginspinalstereotacticbodyradiationtherapy AT abdullahmabunimermdmph spinalcorddelineationbasedoncomputedtomographymyelogramversust2magneticresonanceimaginginspinalstereotacticbodyradiationtherapy AT hoyoungleecmd spinalcorddelineationbasedoncomputedtomographymyelogramversust2magneticresonanceimaginginspinalstereotacticbodyradiationtherapy AT edwardchristopherdeebs spinalcorddelineationbasedoncomputedtomographymyelogramversust2magneticresonanceimaginginspinalstereotacticbodyradiationtherapy AT victoriabrennansmd spinalcorddelineationbasedoncomputedtomographymyelogramversust2magneticresonanceimaginginspinalstereotacticbodyradiationtherapy AT peiyaguangcmd spinalcorddelineationbasedoncomputedtomographymyelogramversust2magneticresonanceimaginginspinalstereotacticbodyradiationtherapy AT keeyoungshinms spinalcorddelineationbasedoncomputedtomographymyelogramversust2magneticresonanceimaginginspinalstereotacticbodyradiationtherapy AT yuhuichenmsmph spinalcorddelineationbasedoncomputedtomographymyelogramversust2magneticresonanceimaginginspinalstereotacticbodyradiationtherapy AT maianhhuynhmdphd spinalcorddelineationbasedoncomputedtomographymyelogramversust2magneticresonanceimaginginspinalstereotacticbodyradiationtherapy AT alexanderspektormdphd spinalcorddelineationbasedoncomputedtomographymyelogramversust2magneticresonanceimaginginspinalstereotacticbodyradiationtherapy AT jeffreypguenettemd spinalcorddelineationbasedoncomputedtomographymyelogramversust2magneticresonanceimaginginspinalstereotacticbodyradiationtherapy AT tracybalbonimdmph spinalcorddelineationbasedoncomputedtomographymyelogramversust2magneticresonanceimaginginspinalstereotacticbodyradiationtherapy |