title: A prospective study of DWI, DCE-MRI and FDG PET imaging for target delineation in brachytherapy for cervical cancer.
abstract: We examined the utility of dynamic contrast-enhanced MRI (DCE-MRI), diffusion-weighted MRI (DWI), and FDG-PET imaging for brachytherapy target delineation in patients with locally advanced cervical cancer.
  
  
  
  Twenty-two patients had DWI, DCE-MRI, and FDG-PET/CT scans after brachytherapy applicator insertion, in addition to standard T2-weighted (T2w) 3T MRI. Gross tumor volume (GTVB) and high-risk clinical target volume (HRCTV) were contoured first on T2w images, and then modified if indicated upon review of DWI/DCE-MRI/FDG-PET images by two observers. The primary endpoint was utility, determined by the number of patients whose volumes were modified, and interobserver variability.
  
  
  
  Eleven patients' T2w-GTVBwere modified based on DWI/DCE-MRI/FDG-PET by observer 1, due to clearer demarcation (7) and residual disease not well visualized on T2w MRI (4). GTVBwas modified in 17 patients by observer 2 (11 and 6, respectively). Incorporation of functional imaging improved the conformity index (CI) for GTVBfrom 0.54 (T2w alone) to 0.65 (P=0.003). HRCTV was modified in 3 and 8 patients by observers 1 and 2, respectively, with a trend toward higher CI using functional imaging (0.71 to 0.76, P=0.06).
  
  
  
  DWI/DCE-MRI/FDG-PET imaging as a supplement to T2w MRI decreased interobserver variability in GTVBdelineation.
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada. Electronic address: Kathy.Han@rmp.uhn.on.ca.
authors.forename: Kathy
authors.initials: K
authors.lastname: Han
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Croke
authors.affiliation: Department of Radiation Oncology, University of Toronto, Canada.
authors.forename: Warren
authors.initials: W
authors.lastname: Foltz
authors.affiliation: Joint Department of Medical Imaging, University Health Network, Toronto, Canada; Department of Medical Imaging, University of Toronto, Canada.
authors.forename: Ur
authors.initials: U
authors.lastname: Metser
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
authors.forename: Jason
authors.initials: J
authors.lastname: Xie
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
authors.forename: Tina
authors.initials: T
authors.lastname: Shek
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
authors.forename: Brandon
authors.initials: B
authors.lastname: Driscoll
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Ménard
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada.
authors.forename: Doug
authors.initials: D
authors.lastname: Vines
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada.
authors.forename: Catherine
authors.initials: C
authors.lastname: Coolens
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada.
authors.forename: Anna
authors.initials: A
authors.lastname: Simeonov
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada.
authors.forename: Akbar
authors.initials: A
authors.lastname: Beiki-Ardakani
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Leung
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada.
authors.forename: Wilfred
authors.initials: W
authors.lastname: Levin
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada.
authors.forename: Anthony
authors.initials: A
authors.lastname: Fyles
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Milosevic
mesh_terms: D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000379:methods*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual; D015588:Observer Variation; D000072078:Positron Emission Tomography Computed Tomography; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D061089:Radiotherapy, Image-Guided / Q000379:methods*; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000532:radiotherapy*
chemical_list: D019788:Fluorodeoxyglucose F18
keywords: Brachytherapy; Cervical cancer; Diffusion-weighted MRI; Dynamic contrast-enhanced MRI; FDG PET; Target delineation