Multimodality imaging with CT, MR and FDG-PET for radiotherapy target volume delineation in oropharyngeal squamous cell carcinoma

David Bird; Andrew F Scarsbrook; Jonathan Sykes; Satiavani Ramasamy; Manil Subesinghe; Brendan Carey; Daniel J Wilson; Neil Roberts; Gary McDermott; Ebru Karakaya; Evrim Bayman; Mehmet Sen; Richard Speight; Robin J D Prestwich

doi:10.1186/s12885-015-1867-8

Multimodality imaging with CT, MR and FDG-PET for radiotherapy target volume delineation in oropharyngeal squamous cell carcinoma

David Bird, Andrew F Scarsbrook, Jonathan Sykes, Satiavani Ramasamy, Manil Subesinghe, Brendan Carey, Daniel J Wilson, Neil Roberts, Gary McDermott, Ebru Karakaya, Evrim Bayman, Mehmet Sen, Richard Speight, Robin J D Prestwich

PET Imaging Centre Facility

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Abstract

BACKGROUND: This study aimed to quantify the variation in oropharyngeal squamous cell carcinoma gross tumour volume (GTV) delineation between CT, MR and FDG PET-CT imaging.

METHODS: A prospective, single centre, pilot study was undertaken where 11 patients with locally advanced oropharyngeal cancers (2 tonsil, 9 base of tongue primaries) underwent pre-treatment, contrast enhanced, FDG PET-CT and MR imaging, all performed in a radiotherapy treatment mask. CT, MR and CT-MR GTVs were contoured by 5 clinicians (2 radiologists and 3 radiation oncologists). A semi-automated segmentation algorithm was used to contour PET GTVs. Volume and positional analyses were undertaken, accounting for inter-observer variation, using linear mixed effects models and contour comparison metrics respectively.

RESULTS: Significant differences in mean GTV volume were found between CT (11.9 cm(3)) and CT-MR (14.1 cm(3)), p < 0.006, CT-MR and PET (9.5 cm(3)), p < 0.0009, and MR (12.7 cm(3)) and PET, p < 0.016. Substantial differences in GTV position were found between all modalities with the exception of CT-MR and MR GTVs. A mean of 64 %, 74 % and 77 % of the PET GTVs were included within the CT, MR and CT-MR GTVs respectively. A mean of 57 % of the MR GTVs were included within the CT GTV; conversely a mean of 63 % of the CT GTVs were included within the MR GTV. CT inter-observer variability was found to be significantly higher in terms of position and/or volume than both MR and CT-MR (p < 0.05). Significant differences in GTV volume were found between GTV volumes delineated by radiologists (9.7 cm(3)) and oncologists (14.6 cm(3)) for all modalities (p = 0.001).

CONCLUSIONS: The use of different imaging modalities produced significantly different GTVs, with no single imaging technique encompassing all potential GTV regions. The use of MR reduced inter-observer variability. These data suggest delineation based on multimodality imaging has the potential to improve accuracy of GTV definition.

TRIAL REGISTRATION: ISRCTN Registry: ISRCTN34165059 . Registered 2nd February 2015.

Original language	English
Pages (from-to)	844
Journal	BMC Cancer
Volume	15
Early online date	4 Nov 2015
DOIs	https://doi.org/10.1186/s12885-015-1867-8
Publication status	Published - Nov 2015

Keywords

Adult
Aged
Carcinoma, Squamous Cell
Female
Fluorodeoxyglucose F18
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Oropharyngeal Neoplasms
Positron-Emission Tomography
Tomography, X-Ray Computed
Clinical Trial
Journal Article

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1186/s12885-015-1867-8Licence: CC BY

Multimodality imaging with CT_BIRD_2015_GOLD VoR (CC BY)Final published version, 1.5 MBLicence: CC BY

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Bird, D., Scarsbrook, A. F., Sykes, J., Ramasamy, S., Subesinghe, M., Carey, B., Wilson, D. J., Roberts, N., McDermott, G., Karakaya, E., Bayman, E., Sen, M., Speight, R., & Prestwich, R. J. D. (2015). Multimodality imaging with CT, MR and FDG-PET for radiotherapy target volume delineation in oropharyngeal squamous cell carcinoma. BMC Cancer, 15, 844. https://doi.org/10.1186/s12885-015-1867-8

@article{51a1857bd59a49e8a9980637e118764e,

title = "Multimodality imaging with CT, MR and FDG-PET for radiotherapy target volume delineation in oropharyngeal squamous cell carcinoma",

abstract = "BACKGROUND: This study aimed to quantify the variation in oropharyngeal squamous cell carcinoma gross tumour volume (GTV) delineation between CT, MR and FDG PET-CT imaging.METHODS: A prospective, single centre, pilot study was undertaken where 11 patients with locally advanced oropharyngeal cancers (2 tonsil, 9 base of tongue primaries) underwent pre-treatment, contrast enhanced, FDG PET-CT and MR imaging, all performed in a radiotherapy treatment mask. CT, MR and CT-MR GTVs were contoured by 5 clinicians (2 radiologists and 3 radiation oncologists). A semi-automated segmentation algorithm was used to contour PET GTVs. Volume and positional analyses were undertaken, accounting for inter-observer variation, using linear mixed effects models and contour comparison metrics respectively.RESULTS: Significant differences in mean GTV volume were found between CT (11.9 cm(3)) and CT-MR (14.1 cm(3)), p < 0.006, CT-MR and PET (9.5 cm(3)), p < 0.0009, and MR (12.7 cm(3)) and PET, p < 0.016. Substantial differences in GTV position were found between all modalities with the exception of CT-MR and MR GTVs. A mean of 64 %, 74 % and 77 % of the PET GTVs were included within the CT, MR and CT-MR GTVs respectively. A mean of 57 % of the MR GTVs were included within the CT GTV; conversely a mean of 63 % of the CT GTVs were included within the MR GTV. CT inter-observer variability was found to be significantly higher in terms of position and/or volume than both MR and CT-MR (p < 0.05). Significant differences in GTV volume were found between GTV volumes delineated by radiologists (9.7 cm(3)) and oncologists (14.6 cm(3)) for all modalities (p = 0.001).CONCLUSIONS: The use of different imaging modalities produced significantly different GTVs, with no single imaging technique encompassing all potential GTV regions. The use of MR reduced inter-observer variability. These data suggest delineation based on multimodality imaging has the potential to improve accuracy of GTV definition.TRIAL REGISTRATION: ISRCTN Registry: ISRCTN34165059 . Registered 2nd February 2015.",

keywords = "Adult, Aged, Carcinoma, Squamous Cell, Female, Fluorodeoxyglucose F18, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Oropharyngeal Neoplasms, Positron-Emission Tomography, Tomography, X-Ray Computed, Clinical Trial, Journal Article",

author = "David Bird and Scarsbrook, {Andrew F} and Jonathan Sykes and Satiavani Ramasamy and Manil Subesinghe and Brendan Carey and Wilson, {Daniel J} and Neil Roberts and Gary McDermott and Ebru Karakaya and Evrim Bayman and Mehmet Sen and Richard Speight and Prestwich, {Robin J D}",

year = "2015",

month = nov,

doi = "10.1186/s12885-015-1867-8",

language = "English",

volume = "15",

pages = "844",

journal = "BMC Cancer",

issn = "1471-2407",

publisher = "BioMed Central",

}

Bird, D, Scarsbrook, AF, Sykes, J, Ramasamy, S, Subesinghe, M, Carey, B, Wilson, DJ, Roberts, N, McDermott, G, Karakaya, E, Bayman, E, Sen, M, Speight, R & Prestwich, RJD 2015, 'Multimodality imaging with CT, MR and FDG-PET for radiotherapy target volume delineation in oropharyngeal squamous cell carcinoma', BMC Cancer, vol. 15, pp. 844. https://doi.org/10.1186/s12885-015-1867-8

TY - JOUR

T1 - Multimodality imaging with CT, MR and FDG-PET for radiotherapy target volume delineation in oropharyngeal squamous cell carcinoma

AU - Bird, David

AU - Scarsbrook, Andrew F

AU - Sykes, Jonathan

AU - Ramasamy, Satiavani

AU - Subesinghe, Manil

AU - Carey, Brendan

AU - Wilson, Daniel J

AU - Roberts, Neil

AU - McDermott, Gary

AU - Karakaya, Ebru

AU - Bayman, Evrim

AU - Sen, Mehmet

AU - Speight, Richard

AU - Prestwich, Robin J D

PY - 2015/11

Y1 - 2015/11

N2 - BACKGROUND: This study aimed to quantify the variation in oropharyngeal squamous cell carcinoma gross tumour volume (GTV) delineation between CT, MR and FDG PET-CT imaging.METHODS: A prospective, single centre, pilot study was undertaken where 11 patients with locally advanced oropharyngeal cancers (2 tonsil, 9 base of tongue primaries) underwent pre-treatment, contrast enhanced, FDG PET-CT and MR imaging, all performed in a radiotherapy treatment mask. CT, MR and CT-MR GTVs were contoured by 5 clinicians (2 radiologists and 3 radiation oncologists). A semi-automated segmentation algorithm was used to contour PET GTVs. Volume and positional analyses were undertaken, accounting for inter-observer variation, using linear mixed effects models and contour comparison metrics respectively.RESULTS: Significant differences in mean GTV volume were found between CT (11.9 cm(3)) and CT-MR (14.1 cm(3)), p < 0.006, CT-MR and PET (9.5 cm(3)), p < 0.0009, and MR (12.7 cm(3)) and PET, p < 0.016. Substantial differences in GTV position were found between all modalities with the exception of CT-MR and MR GTVs. A mean of 64 %, 74 % and 77 % of the PET GTVs were included within the CT, MR and CT-MR GTVs respectively. A mean of 57 % of the MR GTVs were included within the CT GTV; conversely a mean of 63 % of the CT GTVs were included within the MR GTV. CT inter-observer variability was found to be significantly higher in terms of position and/or volume than both MR and CT-MR (p < 0.05). Significant differences in GTV volume were found between GTV volumes delineated by radiologists (9.7 cm(3)) and oncologists (14.6 cm(3)) for all modalities (p = 0.001).CONCLUSIONS: The use of different imaging modalities produced significantly different GTVs, with no single imaging technique encompassing all potential GTV regions. The use of MR reduced inter-observer variability. These data suggest delineation based on multimodality imaging has the potential to improve accuracy of GTV definition.TRIAL REGISTRATION: ISRCTN Registry: ISRCTN34165059 . Registered 2nd February 2015.

AB - BACKGROUND: This study aimed to quantify the variation in oropharyngeal squamous cell carcinoma gross tumour volume (GTV) delineation between CT, MR and FDG PET-CT imaging.METHODS: A prospective, single centre, pilot study was undertaken where 11 patients with locally advanced oropharyngeal cancers (2 tonsil, 9 base of tongue primaries) underwent pre-treatment, contrast enhanced, FDG PET-CT and MR imaging, all performed in a radiotherapy treatment mask. CT, MR and CT-MR GTVs were contoured by 5 clinicians (2 radiologists and 3 radiation oncologists). A semi-automated segmentation algorithm was used to contour PET GTVs. Volume and positional analyses were undertaken, accounting for inter-observer variation, using linear mixed effects models and contour comparison metrics respectively.RESULTS: Significant differences in mean GTV volume were found between CT (11.9 cm(3)) and CT-MR (14.1 cm(3)), p < 0.006, CT-MR and PET (9.5 cm(3)), p < 0.0009, and MR (12.7 cm(3)) and PET, p < 0.016. Substantial differences in GTV position were found between all modalities with the exception of CT-MR and MR GTVs. A mean of 64 %, 74 % and 77 % of the PET GTVs were included within the CT, MR and CT-MR GTVs respectively. A mean of 57 % of the MR GTVs were included within the CT GTV; conversely a mean of 63 % of the CT GTVs were included within the MR GTV. CT inter-observer variability was found to be significantly higher in terms of position and/or volume than both MR and CT-MR (p < 0.05). Significant differences in GTV volume were found between GTV volumes delineated by radiologists (9.7 cm(3)) and oncologists (14.6 cm(3)) for all modalities (p = 0.001).CONCLUSIONS: The use of different imaging modalities produced significantly different GTVs, with no single imaging technique encompassing all potential GTV regions. The use of MR reduced inter-observer variability. These data suggest delineation based on multimodality imaging has the potential to improve accuracy of GTV definition.TRIAL REGISTRATION: ISRCTN Registry: ISRCTN34165059 . Registered 2nd February 2015.

KW - Adult

KW - Aged

KW - Carcinoma, Squamous Cell

KW - Female

KW - Fluorodeoxyglucose F18

KW - Humans

KW - Magnetic Resonance Imaging

KW - Male

KW - Middle Aged

KW - Oropharyngeal Neoplasms

KW - Positron-Emission Tomography

KW - Tomography, X-Ray Computed

KW - Clinical Trial

KW - Journal Article

U2 - 10.1186/s12885-015-1867-8

DO - 10.1186/s12885-015-1867-8

M3 - Article

C2 - 26530182

SN - 1471-2407

VL - 15

SP - 844

JO - BMC Cancer

JF - BMC Cancer

ER -

Multimodality imaging with CT, MR and FDG-PET for radiotherapy target volume delineation in oropharyngeal squamous cell carcinoma

Abstract

Keywords

UN SDGs

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