title: The effective application of segmental image fusion in spinal radiosurgery for improved targeting of spinal tumours.
abstract: OBJECTIVE
  As a result of experiences of failed image fusion, an improved protocol for effective CT and MRI image fusion was developed. Image fusion is a critical part of image-guided stereotactic radiosurgery (IG-SRS) and greatly influences the accurate measurement of gross tumour volume (GTV) and optimal dosimetry. Avoidance of any positional discrepancy is vital for optimal image fusion and results in improved targeting, which improves clinical results. This paper describes a protocol for effective image fusion and how it impacted on the clinical outcome of stereotactic radiosurgery for spinal tumours.
  
  
  METHODS
  Fused MRI/CT images from 20 patients were examined and compared. A protocol for fusing images from thin slice MR images and CTs was developed for improved identification and measurement of tumour volume. Differences in individual GTV values both before and after image fusion were evaluated. The effectiveness of tumour targeting was also assessed by comparing discrepancies in individual and overall GTV values.
  
  
  RESULTS
  Differences in mean GTVs using either CT or MRI alone compared with the mean found through combined CT/MR image fusion showed a difference of 30.5 +/- 4.8% and 14.5 +/- 3.3% respectively. Additionally, the median GTV values from CT- and MR-based imaging were 11.64 +/- 7.8 cm(3) and 11.72 +/- 6.6 cm(3) vs 14.06 +/- 8.0 cm(3). Median GTV from CT-MR fusion was 14.06 +/- 8.0 cm(3). Improved information provided by the fused images enabled us to prescribe more effective dosages, as the fused images gave more accurate information about tumour se due to better delineation of tumour perimeters.
  
  
  CONCLUSIONS
  This protocol provides improved visualisation of spinal tumours and enables better treatment planning. Segmented image fusion was shown to provide significant advantages for planning stereotactic radiosurgery. Fused images provided more precise and accurate data and allowed better targeting of tumours, with improved tumour coverage that resulted in better clinical outcomes.
authors.affiliation: Department of Neurosurgery, Novalis Radiosurgery Center, Inje University Ilsan Paik Hospital, College of Medicine, 2240 Daehwa dong, Ilsan Gu, Goyang City, Gyeonggi Province, Korea, 411-706. mjsohn@paik.ac.kr
authors.forename: Moon-Jun
authors.initials: MJ
authors.lastname: Sohn
authors.forename: Dong-Joon
authors.initials: DJ
authors.lastname: Lee
authors.forename: Sang Won
authors.initials: SW
authors.lastname: Yoon
authors.forename: Hye Ran
authors.initials: HR
authors.lastname: Lee
authors.forename: Yoon Joon
authors.initials: YJ
authors.lastname: Hwang
mesh_terms: D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000517:prevention & control; D016634:Radiosurgery / Q000379:methods*; D013115:Spinal Canal / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D013119:Spinal Cord Injuries / Q000517:prevention & control; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D013131:Spine / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D014057:Tomography, X-Ray Computed / Q000379:methods*