title: MRI to delineate the gross tumor volume of nasopharyngeal cancers: which sequences and planes should be used?
abstract: BACKGROUND
  Magnetic resonance imaging (MRI) has been found to be better than computed tomography for defining the extent of primary gross tumor volume (GTV) in advanced nasopharyngeal cancer. It is routinely applied for target delineation in planning radiotherapy. However, the specific MRI sequences/planes that should be used are unknown.
  
  
  METHODS
  Twelve patients with nasopharyngeal cancer underwent primary GTV evaluation with gadolinium-enhanced axial T1 weighted image (T1) and T2 weighted image (T2), coronal T1, and sagittal T1 sequences. Each sequence was registered with the planning computed tomography scans. Planning target volumes (PTVs) were derived by uniform expansions of the GTVs. The volumes encompassed by the various sequences/planes, and the volumes common to all sequences/planes, were compared quantitatively and anatomically to the volume delineated by the commonly used axial T1-based dataset.
  
  
  RESULTS
  Addition of the axial T2 sequence increased the axial T1-based GTV by 12% on average (p = 0.004), and composite evaluations that included the coronal T1 and sagittal T1 planes increased the axial T1-based GTVs by 30% on average (p = 0.003). The axial T1-based PTVs were increased by 20% by the additional sequences (p = 0.04). Each sequence/plane added unique volume extensions. The GTVs common to all the T1 planes accounted for 38% of the total volumes of all the T1 planes. Anatomically, addition of the coronal and sagittal-based GTVs extended the axial T1-based GTV caudally and cranially, notably to the base of the skull.
  
  
  CONCLUSIONS
  Adding MRI planes and sequences to the traditional axial T1 sequence yields significant quantitative and anatomically important extensions of the GTVs and PTVs. For accurate target delineation in nasopharyngeal cancer, we recommend that GTVs be outlined in all MRI sequences/planes and registered with the planning computed tomography scans.
authors.affiliation: Department of Radiation Oncology, University of Michigan, Ann Arbor, USA.
authors.forename: Aron
authors.initials: A
authors.lastname: Popovtzer
authors.affiliation: Department of Radiology, University of Michigan, Ann Arbor, USA.
authors.forename: Mohannad
authors.initials: M
authors.lastname: Ibrahim
authors.affiliation: Department of Radiation Oncology, University of Michigan, Ann Arbor, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Tatro
authors.affiliation: Department of Radiation Oncology, University of Michigan, Ann Arbor, USA.
authors.forename: Felix Y
authors.initials: FY
authors.lastname: Feng
authors.affiliation: Department of Radiation Oncology, University of Michigan, Ann Arbor, USA.
authors.forename: Randall K
authors.initials: RK
authors.lastname: Ten Haken
authors.affiliation: Department of Radiation Oncology, University of Michigan, Ann Arbor, USA.
authors.forename: Avraham
authors.initials: A
authors.lastname: Eisbruch
keywords: MRI; gross tumor volume; nasopharyngeal cancer; radiotherapy