Erschienen in:
08.07.2016 | Original Article
MRI morphologic alterations after liver SBRT
Direct dose correlation with intermodal matching
verfasst von:
Judit Boda-Heggemann, MD PhD, Ulrike Attenberger, MD, Johannes Budjan, MD, Anika Jahnke, PhD, Lennart Jahnke, PhD, Lena Vogel, Anna O. Simeonova-Chergou, MD, Carsten Herskind, PhD, Frederik Wenz, MD, Frank Lohr, MD
Erschienen in:
Strahlentherapie und Onkologie
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Ausgabe 9/2016
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Abstract
Aim
CT morphologic and histopathologic alterations have been reported after SBRT. We analyzed the correlation of MRI morphologic alterations with radiation doses to assess the potential for MRI-based dose–effect correlation in healthy liver tissue.
Patients and methods
MRI data of 24 patients with liver metastases 7±3 weeks after image-guided SBRT in deep-inspiration breath-hold were retrospectively analyzed. MRI images were intermodally matched to the planning CT and corresponding dose distribution. Absolute doses were converted to EQD2,α/β =x with α/β values of 2, 3 for healthy liver tissue, 8 Gy for modelled predamaged liver tissue and 10 Gy for tumor tissue.
Results
A central nonenhancing area was observed within the isodose lines of nominally 48.2 ± 15.2 Gy, EQD2Gy/α/β =10 92.5 ± 27.7 Gy. Contrast-enhancement around the central nonenhancing area was observed within the isodose lines of nominally 46.9 ± 15.3 Gy, EQD2Gy/α/β =10 90.5 ± 28.3 Gy.
Outside the high-dose volume, in the beam path, characteristic sharply defined, nonblurred MRI morphologic alterations were observed that corresponded with the following isodose lines: T1-intensity changes occurred at isodose lines of nominally 21.9 ± 6.7 Gy (EQD2,α/β =2 42.5 ± 8.7 Gy, EQD2,α/β =3 38.5 ± 7.6 Gy, EQD2,α/β =8 30.2 ±6.3 Gy). T2-hyper/hypointensity was observed within isodose lines of nominally 22.4 ± 6.6 Gy (EQD2,α/β=2 42.7 ± 8.1 Gy, EQD2,α/β=3 38.7 ± 7 Gy; EQD2,α/β=8 30.5 ± 5.9 Gy).
Conclusions
Using deformable matching, direct spatial/dosimetric correlation of SBRT-induced changes in liver tissue was possible. In the PTV high-dose region, a central nonenhancing area and peripheral contrast medium accumulation was observed. Beam path doses of 38–42 Gy (EQD2,α/β =2–3) induce characteristic MRI morphologic alterations.