Integration of BOLD-fMRI and DTI into radiation treatment planning for high-grade gliomas located near the primary motor cortexes and corticospinal tracts

Abstract

BackgroundThe main objective of this study was to evaluate the efficacy of integrating the blood oxygen level dependent functional magnetic resonance imaging (BOLD-fMRI) and diffusion tensor imaging (DTI) data into radiation treatment planning for high-grade gliomas located near the primary motor cortexes (PMCs) and corticospinal tracts (CSTs).MethodsA total of 20 patients with high-grade gliomas adjacent to PMCs and CSTs between 2012 and 2014 were recruited. The bilateral PMCs and CSTs were located in the normal regions without any overlapping with target volume of the lesions. BOLD-fMRI, DTI and conventional MRI were performed on patients (Karnofsky performance score ≥ 70) before radical radiotherapy treatment. Four different imaging studies were conducted in each patient: a planning computed tomography (CT), an anatomical MRI, a DTI and a BOLD-fMRI. For each case, three treatment plans (3DCRT, IMRT and IMRT_PMC&CST) were developed by 3 different physicists using the Pinnacle planning system.ResultsOur study has shown that there was no significant difference between the 3DCRT and IMRT plans in terms of dose homogeneity, but IMRT displayed better planning target volume (PTV) dose conformity. In addition, we have found that the Dmax and Dmean to the ipsilateral and contralateral PMC and CST regions were considerably decreased in IMRT_PMC&CST group (p < 0.001).ConclusionsIn conclusion, integration of BOLD-fMRI and DTI into radiation treatment planning is feasible and beneficial. With the assistance of the above-described techniques, the bilateral PMCs and CSTs adjacent to the target volume could be clearly marked as OARs and spared during treatment.

Transient effects of tumor location on the functional architecture at rest in glioblastoma patients: three longitudinal case studies

“…Whether the integration of fMRI information into RT treatment planning could further improve patients’ prognosis is an interesting and open research question. It has already been shown feasible by Wang et al [ 41 ] who reported no significant difference between the 3DCRT and IMRT plans in terms of dose homogeneity while in the same time maximizing the dose to the tumor and sparing functional regions. However, it is still premature to draw a final conclusion on the factors leading to alterations in the connectivity as many factors play a role.…”

The Feasibility of Integrating Resting-State fMRI Networks into Radiotherapy Treatment Planning

“…To our knowledge, previous research investigating incorporating functional information into RT plans has relied extensively on task-based fMRI acquisition [2][3][4][5][6][7]. These previous studies have predominately focused on avoiding damage to functional relevant networks that are associated with sensory processing or language production.…”

“…Functional magnetic resonance imaging (fMRI) presents the ability to selectively protect functionally significant regions of the brain during radiation therapy (RT) of primary brain tumors [1]. Previous investigations have focused on incorporating task-based fMRI information from sensory networks (motor, visual, auditory) or language networks into conventional treatment plans [2][3][4][5][6][7]. In addition, multiple investigators have demonstrated the feasibility of incorporating tissue-specific functional information derived from advanced imaging modalities into treatment plans.…”

“…In addition, multiple investigators have demonstrated the feasibility of incorporating tissue-specific functional information derived from advanced imaging modalities into treatment plans. These studies include functional task-based information from magnetoencephalography [8], metabolic information from magnetic resonance spectroscopy [2,3], as well as structural information from diffusion tensor imaging data [4,7]. These studies provide evidence that the radiation dose to areas demonstrating functional significance on neuroimaging studies can be reduced while maintaining clinically acceptable doses of radiation to the tumor and organs at risk (OARs).…”

Prevention of radiotherapy-induced neurocognitive dysfunction in survivors of paediatric brain tumours: the potential role of modern imaging and radiotherapy techniques

“…A planning study has shown that integrating diffusion tensor tractography into IMRT planning has significantly reduced radiotherapy dose to the corticospinal tract in patients with glioblastoma (91). In another study of 20 patients with high-grade glioma, bilateral motor cortex and corticospinal tracts were marked using integrated DTI and BOLD-fMRI as organs at risk (OARs), which led to a reduction in the dose of radiotherapy using IMRT (92). Thus studies have shown that both DTI and BOLD-fMRI can be integrated into planning CT/MRI scan to delineate critical nerve tracks and eloquent regions for functional avoidance radiotherapy (figure 2).…”