Evaluation of Functional Marrow Irradiation Based on Skeletal Marrow Composition Obtained Using Dual-Energy Computed Tomography.
To develop an imaging method to characterize and map marrow composition in the entire skeletal system, and to simulate differential targeted marrow irradiation based on marrow composition.



Whole-body dual energy computed tomography (DECT) images of cadavers and leukemia patients were acquired, segmented to separate bone marrow components, namely, bone, red marrow (RM), and yellow marrow (YM). DECT-derived marrow fat fraction was validated using histology of lumbar vertebrae obtained from cadavers. The fractions of RM (RMF = RM/total marrow) and YMF were calculated in each skeletal region to assess the correlation of marrow composition with sites and ages. Treatment planning was simulated to target irradiation differentially at a higher dose (18 Gy) to either RM or YM and a lower dose (12 Gy) to the rest of the skeleton.



A significant correlation between fat fractions obtained from DECT and cadaver histology samples was observed (r=0.861, P<.0001, Pearson). The RMF decreased in the head, neck, and chest was significantly inversely correlated with age but did not show any significant age-related changes in the abdomen and pelvis regions. Conformity of radiation to targets (RM, YM) was significantly dependent on skeletal sites. The radiation exposure was significantly reduced (P<.05, t test) to organs at risk (OARs) in RM and YM irradiation compared with standard total marrow irradiation (TMI).



Whole-body DECT offers a new imaging technique to visualize and measure skeletal-wide marrow composition. The DECT-based treatment planning offers volumetric and site-specific precise radiation dosimetry of RM and YM, which varies with aging. Our proposed method could be used as a functional compartment of TMI for further targeted radiation to specific bone marrow environment, dose escalation, reduction of doses to OARs, or a combination of these factors.
Department of Radiological Sciences, Faculty of Health Sciences, Komazawa University, Tokyo, Japan; Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota; Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan.
Taiki
T
Magome
Department of Radiology, University of Minnesota, Minneapolis, Minnesota.
Jerry
J
Froelich
Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota; Department of Radiation Oncology, Osaka University, Osaka, Japan.
Yutaka
Y
Takahashi
Department of Therapeutic Radiology, University of Minnesota, Minneapolis, Minnesota.
Luke
L
Arentsen
Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota.
Shernan
S
Holtan
Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota.
Michael R
MR
Verneris
Mindways Software Inc, Austin, Texas.
Keenan
K
Brown
Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan.
Akihiro
A
Haga
Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan.
Keiichi
K
Nakagawa
College of Medicine, Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
Jennifer L
JL
Holter Chakrabarty
Department of Bone Marrow Transplantation, Comprehensive Cancer Center M. Curie-Sklodowska Memorial Institute, Gliwice, Poland.
Sebastian
S
Giebel
Department of Radiation Oncology, Beckman Research Institute, City of Hope, Duarte, California.
Jeffrey
J
Wong
Department of Therapeutic Radiology, University of Minnesota, Minneapolis, Minnesota.
Kathryn
K
Dusenbery
Department of Radiotherapy, Universitair Ziekenhuis Brussel, Brussels, Belgium.
Guy
G
Storme
Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota; Department of Therapeutic Radiology, University of Minnesota, Minneapolis, Minnesota; Department of Radiation Oncology, Beckman Research Institute, City of Hope, Duarte, California. Electronic address: shui@coh.org.
Susanta K
SK
Hui
D000328:Adult; D001853:Bone Marrow / Q000000981:diagnostic imaging* / Q000473:pathology / Q000528:radiation effects*; D002102:Cadaver; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D007938:Leukemia / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015900:Radiography, Dual-Energy Scanned Projection / Q000379:methods; D011879:Radiotherapy Dosage; D061089:Radiotherapy, Image-Guided / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D051598:Whole Body Imaging / Q000379:methods*; D014916:Whole-Body Irradiation / Q000379:methods
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