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Prostate Cancer: Precision of Integrating Functional MR Imaging with Radiation Therapy Treatment by Using Fiducial Gold Markers¹

¹ From the Departments of Radiology (H.J.H., J.J.F., A.W., T.W.J.S., J.A.v.D., J.O.B.), Radiotherapy (E.N.J.T.v.L., A.G.V.), and Urology (J.A.W.), Radboud University Nijmegen Medical Center, Geert Grooteplein zuid 10, NL 6500 HB, Nijmegen, the Netherlands. Received March 26, 2004; revision requested June 8; revision received August 20; accepted October 1. Address correspondence to H.J.H. (e-mail: h.huisman{at}rad.umcn.nl).

View larger version (97K): [in a new window]   Figure 1. Transverse CT (left) and T2*-weighted MR (right) images (see Table 1 for MR imaging parameters) before image registration. Markers appear as bright spots at CT (arrows) and as dark spots at MR imaging.

View larger version (131K): [in a new window]   Figure 2. Fused display of transverse T2*-weighted MR (gray value) and CT (red overlay) images for validation of registration (see Table 1 for MR imaging parameters). CT markers overlay transverse T2*-weighted markers completely, which confirms good prostate registration. Notice bone landmark shift (arrows) illustrating inability to register prostate by using bone landmarks.

View larger version (57K): [in a new window]   Figure 3a. Images show integration of T2-weighted MR, dynamic contrast-enhanced MR, and 3D spectroscopic image information into a single tumor map (see Table 1 for MR imaging parameters). (a) T2-weighted MR image shows hypointense area in sagittal (left), coronal (center), and transverse (right) position fused with (b) volume transfer constant, (c) wash-out phase, and (d) choline-to-citrate ratio (see body text for explanation of parameters), all of which confirm DIL position. (e) Red DIL outline is visualized according to its cross section.

View larger version (56K): [in a new window]   Figure 3b. Images show integration of T2-weighted MR, dynamic contrast-enhanced MR, and 3D spectroscopic image information into a single tumor map (see Table 1 for MR imaging parameters). (a) T2-weighted MR image shows hypointense area in sagittal (left), coronal (center), and transverse (right) position fused with (b) volume transfer constant, (c) wash-out phase, and (d) choline-to-citrate ratio (see body text for explanation of parameters), all of which confirm DIL position. (e) Red DIL outline is visualized according to its cross section.

View larger version (58K): [in a new window]   Figure 3c. Images show integration of T2-weighted MR, dynamic contrast-enhanced MR, and 3D spectroscopic image information into a single tumor map (see Table 1 for MR imaging parameters). (a) T2-weighted MR image shows hypointense area in sagittal (left), coronal (center), and transverse (right) position fused with (b) volume transfer constant, (c) wash-out phase, and (d) choline-to-citrate ratio (see body text for explanation of parameters), all of which confirm DIL position. (e) Red DIL outline is visualized according to its cross section.

View larger version (78K): [in a new window]   Figure 3d. Images show integration of T2-weighted MR, dynamic contrast-enhanced MR, and 3D spectroscopic image information into a single tumor map (see Table 1 for MR imaging parameters). (a) T2-weighted MR image shows hypointense area in sagittal (left), coronal (center), and transverse (right) position fused with (b) volume transfer constant, (c) wash-out phase, and (d) choline-to-citrate ratio (see body text for explanation of parameters), all of which confirm DIL position. (e) Red DIL outline is visualized according to its cross section.

View larger version (117K): [in a new window]   Figure 3e. Images show integration of T2-weighted MR, dynamic contrast-enhanced MR, and 3D spectroscopic image information into a single tumor map (see Table 1 for MR imaging parameters). (a) T2-weighted MR image shows hypointense area in sagittal (left), coronal (center), and transverse (right) position fused with (b) volume transfer constant, (c) wash-out phase, and (d) choline-to-citrate ratio (see body text for explanation of parameters), all of which confirm DIL position. (e) Red DIL outline is visualized according to its cross section.

View larger version (95K): [in a new window]   Figure 4a. Images show (a) registered tumor map overlaid in red on top of transverse treatment-planning CT image and (b) radiation therapy treatment plan. Notice how boost dose area conforms to DIL area demonstrated at MR imaging.

View larger version (153K): [in a new window]   Figure 4b. Images show (a) registered tumor map overlaid in red on top of transverse treatment-planning CT image and (b) radiation therapy treatment plan. Notice how boost dose area conforms to DIL area demonstrated at MR imaging.

View larger version (30K): [in a new window]   Figure 5. Bar graphs demonstrate relative frequency (y axis) of prostate registration errors (x axis) for ICP (top graphs) and landmark (bottom graphs) registration methods at centroid (left graphs) and rim location (right graphs). Notice broader error distribution for landmark method.