Glioblastoma differ from many other tumors in the sense that they grow infiltratively into the brain tissue instead of forming a solid tumor mass with a defined boundary. Only the part of the tumor with high tumor cell density can be localized through imaging directly. In contrast, brain tissue infiltrated by tumor cells at low density appears normal on current imaging modalities. In current clinical practice, a uniform margin, typically two centimeters, is applied to account for microscopic spread of disease that is not directly assessable through imaging.The current treatment planning procedure can potentially be improved by accounting for the anisotropy of tumor growth, which arises from different factors: Anatomical barriers such as the falx cerebri represent boundaries for migrating tumor cells. In addition, tumor cells primarily spread in white matter and infiltrate gray matter at lower rate. We investigate the use of a phenomenological tumor growth model for treatment planning. The model is based on the FisherKolmogorov equation, which formalizes these growth characteristics and estimates 1 arXiv:1311.5902v2 [physics.med-ph] 19 Dec 2013 the spatial distribution of tumor cells in normal appearing regions of the brain. The target volume for radiotherapy planning can be defined as an isoline of the simulated tumor cell density.This paper analyzes the model with respect to implications for target volume definition and identifies its most critical components. A retrospective study involving 10 glioblastoma patients treated at our institution has been performed. To illustrate the main findings of the study, a detailed case study is presented for a glioblastoma located close to the falx. In this situation, the falx represents a boundary for migrating tumor cells, whereas the corpus callosum provides a route for the tumor to spread to the contralateral hemisphere. We further discuss the sensitivity of the model with respect to the input parameters. Correct segmentation of the brain appears to be the most crucial model input. We conclude that the tumor growth model provides a method to account for anisotropic growth patterns of glioma, and may therefore provide a tool to make target delineation more objective and automated.

Abstract. Cardiac Magnetic Resonance (CMR) imaging is commonly used to assess cardiac structure and function. One disadvantage of CMR is that post-processing of exams is tedious. Without automation, precise assessment of cardiac function via CMR typically requires an annotator to spend tens of minutes per case manually contouring ventricular structures. Automatic contouring can lower the required time per patient by generating contour suggestions that can be lightly modified by the annotator. Fully convolutional networks (FCNs), a variant of convolutional neural networks, have been used to rapidly advance the state-of-theart in automated segmentation, which makes FCNs a natural choice for ventricular segmentation. However, FCNs are limited by their computational cost, which increases the monetary cost and degrades the user experience of production systems. To combat this shortcoming, we have developed the FastVentricle architecture, an FCN architecture for ventricular segmentation based on the recently developed ENet architecture. FastVentricle is 4× faster and runs with 6× less memory than the previous state-of-the-art ventricular segmentation architecture while still maintaining excellent clinical accuracy.

Recent work on brain tumor growth modeling for glioblastoma using reaction-diffusion equations suggests that the diffusion coefficient and the proliferation rate can be related to clinically relevant information. However, estimating these parameters is difficult due to the lack of identifiability of the parameters, the uncertainty in the tumor segmentations, and the model approximation, which cannot perfectly capture the dynamics of the tumor. Therefore, we propose a method for conducting the Bayesian personalization of the tumor growth model parameters. Our approach estimates the posterior probability of the parameters, and allows the analysis of the parameters correlations and uncertainty. Moreover, this method provides a way to compute the evidence of a model, which is a mathematically sound way of assessing the validity of different model hypotheses. Our approach is based on a highly parallelized implementation of the reaction-diffusion equation, and the Gaussian Process Hamiltonian Monte Carlo (GPHMC), a high acceptance rate Monte Carlo technique. We demonstrate our method on synthetic data, and four glioblastoma patients. This promising approach shows that the infiltration is better captured by the model compared to the speed of growth.