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The effective application of segmental image fusion in spinal radiosurgery for improved targeting of spinal tumours

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Abstract

Purpose

As a result of experiences of failed image fusion, an improved protocol for effective CT and MRI image fusion was developed. Image fusion is a critical part of image-guided stereotactic radiosurgery (IG-SRS) and greatly influences the accurate measurement of gross tumour volume (GTV) and optimal dosimetry. Avoidance of any positional discrepancy is vital for optimal image fusion and results in improved targeting, which improves clinical results. This paper describes a protocol for effective image fusion and how it impacted on the clinical outcome of stereotactic radiosurgery for spinal tumours.

Methods

Fused MRI/CT images from 20 patients were examined and compared. A protocol for fusing images from thin slice MR images and CTs was developed for improved identification and measurement of tumour volume. Differences in individual GTV values both before and after image fusion were evaluated. The effectiveness of tumour targeting was also assessed by comparing discrepancies in individual and overall GTV values.

Results

Differences in mean GTVs using either CT or MRI alone compared with the mean found through combined CT/MR image fusion showed a difference of 30.5 ± 4.8% and 14.5 ± 3.3% respectively. Additionally, the median GTV values from CT- and MR-based imaging were 11.64 ± 7.8 cm3 and 11.72 ± 6.6 cm3 vs 14.06 ± 8.0 cm3. Median GTV from CT–MR fusion was 14.06 ± 8.0 cm3. Improved information provided by the fused images enabled us to prescribe more effective dosages, as the fused images gave more accurate information about tumour se due to better delineation of tumour perimeters.

Conclusions

This protocol provides improved visualisation of spinal tumours and enables better treatment planning. Segmented image fusion was shown to provide significant advantages for planning stereotactic radiosurgery. Fused images provided more precise and accurate data and allowed better targeting of tumours, with improved tumour coverage that resulted in better clinical outcomes.

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Conflict of interest

The present study is supported by the 2005 Inje University research grant and the MEST/KOSEF (Ministry of Education, Science and Technology/Korea Science and Engineering Foundation) Grant No. M20709005484–08B0900–48410

There is no conflict of interest for any author.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Novalis Radiosurgery Center, Inje University Ilsan Paik Hospital, College of Medicine, 2240 Daehwa dong, Ilsan Gu, Goyang City, Gyeonggi Province, Korea, 411–706

    Moon-Jun Sohn, Dong-Joon Lee & Sang Won Yoon

  2. Department of Internal Medicine, Novalis Radiosurgery Center, Inje University Ilsan Paik Hospital, College of Medicine, 2240 Daehwa dong, Ilsan Gu, Goyang City, Gyeonggi Province, Korea, 411–706

    Hye Ran Lee

  3. Department of Radiology, Novalis Radiosurgery Center, Inje University Ilsan Paik Hospital, College of Medicine, 2240 Daehwa dong, Ilsan Gu, Goyang City, Gyeonggi Province, Korea, 411–706

    Yoon Joon Hwang

Authors
  1. Moon-Jun Sohn
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  2. Dong-Joon Lee
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  3. Sang Won Yoon
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  4. Hye Ran Lee
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  5. Yoon Joon Hwang
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Corresponding author

Correspondence to Moon-Jun Sohn.

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Comments

This manuscript presents a segmental image fusion (SIF) protocol on the image fusion of MR with the simulation CT images for accurate delineation of the target in spinal radiosurgery. MR images are important for contouring the soft tissue component of the target as well as the spinal cord.

However, because the spine of a patient may be in different curvature during MR and CT imaging, perfect fusion of the MR and CT images is often difficult, although advanced fusion algorithms such as deformable fusion or using a region of interest may solve the problem. The SIF protocol proposed by the authors is another approach to dealing with the problem. In this protocol, the MR images are divided into several motion segments (individual vertebra) and each segment is fused with a CT image set separately. Overall, this is a well-written paper and it has potential value for the spinal radiosurgery community.

Jianyue Jin

Henry Ford Hospital

Michigan, USA

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Sohn, MJ., Lee, DJ., Yoon, S.W. et al. The effective application of segmental image fusion in spinal radiosurgery for improved targeting of spinal tumours. Acta Neurochir (Wien) 151, 231–238 (2009). https://doi.org/10.1007/s00701-009-0210-z

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  • DOI: https://doi.org/10.1007/s00701-009-0210-z

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