Correction of diffusion-weighted magnetic resonance imaging for brachytherapy of locally advanced cervical cancer

Abstract

Background. Geometrical distortion is a major obstacle for the use of echo planar diffusion-weighted magnetic resonance imaging (DW-MRI) in planning of radiotherapy. This study compares geometrical distortion correction methods of DW-MRI at time of brachytherapy (BT) in locally advanced cervical cancer patients.

Material and methods. In total 21 examinations comprising DW-MRI, dual gradient echo (GRE) for B₀ field map calculation and T2-weighted (T2W) fat-saturated MRI of eight patients with locally advanced cervical cancer were acquired during BT with a plastic tandem and ring applicator in situ. The ability of B₀ field map correction (B₀M) and deformable image registration (DIR) to correct DW-MRI geometric image distortion was compared to the non-corrected DW-MRI including evaluation of apparent diffusion coefficient (ADC) for the gross tumor volume (GTV).

Results. Geometrical distortion correction decreased tandem displacement from 3.3 ± 0.9 mm (non-corrected) to 2.9 ± 1.0 mm (B₀M) and 1.9 ± 0.6 mm (DIR), increased mean normalized cross-correlation from 0.69 ± 0.1 (non- corrected) to 0.70 ± 0.10 (B₀M) and 0.77 ± 0.1 (DIR), and increased the Jaccard similarity coefficient from 0.72 ± 0.1 (non-corrected) to 0.73 ± 0.06 (B₀M) and 0.77 ± 0.1 (DIR). For all parameters only DIR corrections were significant (p < 0.05). ADC of the GTV did not change significantly with either correction method.

Conclusion. DIR significantly improved geometrical accuracy of DW-MRI, with remaining residual uncertainties of less than 2 mm, while no significant improvement was seen using B₀ field map correction

Acknowledgments

The work also benefited from the use of the software packages SPM (http://www.fil.ion.ucl.ac.uk/spm/software/) and Elastix (http://elastix.isi.uu.nl/).

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

This study has been supported by research grants from CIRRO – the Lundbeck Foundation Centre for Interventional Research in Radiation Oncology, MindLab founding from the Danish Research Council, the European Programme (FP7/2013–2016) under grant agreement n° [ICT-2011.5.2] (DrTherapat).