title: The effect of region of interest strategies on apparent diffusion coefficient assessment in patients treated with palliative radiation therapy to brain metastases.
abstract: BACKGROUND
  Although diffusion-weighted magnetic resonance imaging (DW-MRI) is widely used in radiation therapy (RT) response studies, no standard of delineating the region of interest (ROI) exists. In this retrospective study, we evaluate the effect of four ROI strategies on the apparent diffusion coefficients (ADC) in patients receiving palliative RT to brain metastases.
  
  
  METHODS
  Twenty-two metastases from nine patients, treated with whole-brain irradiation (30 Gy in 10 fractions) were analyzed. Patients were scanned with a 1T MR system to acquire DW- (eight b-values), T2*W-, T2W- and T1W scans, before start of RT (pre-RT) and at the 9th/10th fraction (end-RT). The following ROI strategies were applied. ROIb800 and ROIb0: Entire tumor volume visible on DW(b = 800 s/mm(2)) and DW(b = 0 s/mm(2)) images, respectively. ROIb800vi: Viable tumor volume based on DW(b = 800 s/mm(2)). ROIb800rep: ROIb800 from pre-RT scan replicated to end-RT scan. Delineations were aided by co-registered T1W, T2W and T2*W images. ADC was estimated with two mono-exponential fits and one bi-exponential fit.
  
  
  RESULTS
  Differences in absolute ADC values were non-significant across ROI strategy independent of fitting method, while significantly different between fitting methods. Evaluation of individual metastases showed that ROI strategies disagreed on the relative ADC change (from pre-RT to end-RT) in 13 of the 22 metastases when all fitting methods were added up.
  
  
  CONCLUSIONS
  The ROI strategies have an effect on the relative ADC change, which may be important for the assessment of individual patient's response to RT and the interpretation of the current literature.
authors.affiliation: a Radiotherapy Research Unit (RRU), Department of Oncology , University of Copenhagen, Herlev and Gentofte Hospital , Herlev , Denmark.
authors.forename: Faisal
authors.initials: F
authors.lastname: Mahmood
authors.affiliation: b Department of Radiology , University of Copenhagen, Herlev and Gentofte Hospital , Herlev , Denmark.
authors.forename: Helle H
authors.initials: HH
authors.lastname: Johannesen
authors.affiliation: a Radiotherapy Research Unit (RRU), Department of Oncology , University of Copenhagen, Herlev and Gentofte Hospital , Herlev , Denmark.
authors.forename: Poul
authors.initials: P
authors.lastname: Geertsen
authors.affiliation: a Radiotherapy Research Unit (RRU), Department of Oncology , University of Copenhagen, Herlev and Gentofte Hospital , Herlev , Denmark.
authors.forename: Giske F
authors.initials: GF
authors.lastname: Opheim
authors.affiliation: b Department of Radiology , University of Copenhagen, Herlev and Gentofte Hospital , Herlev , Denmark.
authors.forename: Rasmus H
authors.initials: RH
authors.lastname: Hansen
mesh_terms: D000368:Aged; D001932:Brain Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000556:secondary; D004058:Diffusion / Q000528:radiation effects*; D038524:Diffusion Magnetic Resonance Imaging; D019583:Dose Fractionation, Radiation; D023381:Endpoint Determination / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D010166:Palliative Care; D012189:Retrospective Studies; D016896:Treatment Outcome; D047368:Tumor Burden