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Impact of 18F-FDG PET/MR based tumor delineation in radiotherapy planning for cholangiocarcinoma

  • Hepatobiliary
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Abstract

Purpose

Radiation therapy (RT) is an effective treatment for unresectable cholangiocarcinoma (CC). Accurate tumor volume delineation is critical in achieving high rates of local control while minimizing treatment-related toxicity. This study compares 18F-FDG PET/MR to MR and CT for target volume delineation for RT planning.

Methods

We retrospectively included 22 patients with newly diagnosed unresectable primary CC who underwent 18F-FDG PET/MR for initial staging. Gross tumor volume (GTV) of the primary mass (GTVM) and lymph nodes (GTVLN) were contoured on CT images, MR images, and PET/MR fused images and compared among modalities. The dice similarity coefficient (DSC) was calculated to assess spatial coverage between different modalities.

Results

GTV PET/MRM (median: 94 ml, range 16–655 ml) was significantly greater than GTV MRM (69 ml, 11–635 ml) (p = 0.0001) and GTV CTM (96 ml, 4–564 ml) (p = 0.035). There was no significant difference between GTV CTM and GTV MRM (p = 0.078). Subgroup analysis of intrahepatic and extrahepatic tumors showed that the median GTV PET/MRM was significantly greater than GTV MRM in both groups (117.5 ml, 22–655 ml vs. 102.5 ml, 22–635 ml, p = 0.004 and 37 ml, 16–303 ml vs. 34 ml, 11–207 ml, p = 0.042, respectively). The GTV PET/MRLN (8.5 ml, 1–27 ml) was significantly higher than GTV CTLN (5 ml, 4–16 ml) (p = 0.026). GTVPET/MR had the highest similarity to the GTVMR, i.e., DSCPET/MR-MR (0.82, 0.25–1.00), compared to DSC PET/MR-CT of 0.58 (0.22–0.87) and DSCMR-CT of 0.58 (0.03–0.83).

Conclusion

18F-FDG PET/MR-based CC delineation yields greater GTVs and detected a higher number of positive lymph nodes compared to CT or MR, potentially improving RT planning by reducing the risk of geographic misses.

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Data availability

Data of the study is available on demand.

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Funding

No funding was received for conducting this study.

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Author notes

  1. Gauthier Delaby and Bahar Ataeinia: Equal contribution.

Authors and Affiliations

  1. Department of Nuclear Medicine, University of Lille, Lille, France

    Gauthier Delaby

  2. Department of Radiology, Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Gauthier Delaby, Bahar Ataeinia, Onofrio Antonio Catalano & Pedram Heidari

  3. Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Jennifer Wo

  4. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, 149, 13th St., Charlestown, MA, 02129, USA

    Onofrio Antonio Catalano

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  1. Gauthier Delaby
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  2. Bahar Ataeinia
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Correspondence to Onofrio Antonio Catalano.

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Delaby, G., Ataeinia, B., Wo, J. et al. Impact of 18F-FDG PET/MR based tumor delineation in radiotherapy planning for cholangiocarcinoma. Abdom Radiol 46, 3908–3916 (2021). https://doi.org/10.1007/s00261-021-03053-4

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