Readout-segmented echo-planar diffusion-weighted imaging improves geometric performance for image-guided radiation therapy of pelvic tumors.
OBJECTIVE
Diffusion-weighted imaging using echo-planar imaging (EPI) is prone to geometric inaccuracy, which may limit application to image-guided radiation therapy planning, as well as for voxel-based quantitative multi-parametric or multi-modal approaches. This research investigates pelvic applications at 3 T of a standard single-shot (ssEPI) and a prototype readout-segmented (rsEPI) technique.


METHODS
Apparent diffusion coefficient (ADC) accuracy and geometric performance of rsEPI and ssEPI were compared using phantoms, and in vivo, involving 8 patients prior to MR-guided brachytherapy for locally advanced cervical cancer, and 19 patients with prostate cancer planned for tumor-targeted radiotherapy. Global and local deviations in geometric performance were tested using Dice Similarity Coefficients (DC) and Hausdorff Distances (HD).


RESULTS
In cervix patients, DC increased from 0.76±0.14 to 0.91±0.05 for the high risk clinical target volume, and 0.62±0.26 to 0.85±0.08 for the gross tumor target volume. Tumors in the peripheral zone of the prostate gland were partly projected erroneously outside of the posterior anatomic boundary of the gland by 3.1±1.6 mm in 11 of 19 patients using ADC-ssEPI but not with ADC-rsEPI.


CONCLUSIONS
Both cervix and prostate ssEPI are prone to clinically relevant geometric distortions at 3T. rsEPI provides improved geometric performance without post-processing.
Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada. Electronic address: warren.foltz@rmp.uhn.on.ca.
Warren D
WD
Foltz
Fraunhofer Mevis, Bremen, Germany.
David A
DA
Porter
Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
Anna
A
Simeonov
Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
Amanda
A
Aleong
Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
David
D
Jaffray
Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
Peter
P
Chung
Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
Kathy
K
Han
Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
Cynthia
C
Ménard
D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D017352:Echo-Planar Imaging; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D061089:Radiotherapy, Image-Guided; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy*
Cervical cancer; Diffusion weighted imaging; Geometric distortion; Image-guided radiotherapy; MRI; Prostate cancer