INTEGRATION OF FUNCTIONAL MRI AND WHITE MATTER TRACTOGRAPHY IN STEREOTACTIC RADIOSURGERY CLINICAL PRACTICE
INTEGRATION OF FUNCTIONAL MRI AND WHITE MATTER TRACTOGRAPHY IN STEREOTACTIC RADIOSURGERY CLINICAL PRACTICE
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DOI：
10.1016/j.ijrobp.2009.10.064
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发表时间：
2010-09-01
影响因子：
7
通讯作者：
Salvaras, Nikolaos
中科院分区：
文献类型：
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作者：
Pantelis, Evaggelos;Papadakis, Nikolaos;Salvaras, Nikolaos
目的：探讨功能磁共振成像(FMRI)和扩散张量成像(DTI)数据在立体定向放射外科临床应用中的效果。方法：采集fMRI和扩散张量成像数据集，并与相应的动静脉畸形(AVM)、星形细胞瘤、脑转移瘤、血管瘤患者的MR和CT图像进行融合，为立体定向放射外科手术提供参考。获得的数据集被输入到赛伯刀立体定向放射外科系统中，并用于描绘靶点、危险器官以及附近的功能结构和纤维束。结果：如果将邻近的功能结构和纤维束排除在规划过程之外，可获得最大剂量的50%。在AVM的情况下，Broadmann-17结构和视束接收的剂量在纳入优化过程后分别从1400cGy和2000cGy减至700cGy.在转移病例中，运动皮质的照射剂量为850cGy，而不是1400cGy；在血管瘤病例中，锥体束的照射剂量为780cGy，而不是990cGy。在星形细胞瘤病例中，邻近病变的运动皮质的剂量从2,100cGy减至1900cGy.因此，三个部分的生物等效剂量被给予。结论：如果在治疗计划中不考虑功能结构和纤维束，可以接受高剂量。借助功能磁共振成像和纤维束成像图像，它们可以被描绘和保留。(C)2010年爱思唯尔公司。
Purpose: To study the efficacy of the integration of functional magnetic resonance imaging (fMRI) and diffusion tensor imaging tractography data into stereotactic radiosurgery clinical practice.Methods and Materials: fMRI and tractography data sets were acquired and fused with corresponding anatomical MR and computed tomography images of patients with arteriovenous malformation (AVM), astrocytoma, brain metastasis, or hemangioma and referred for stereotactic radiosurgery. The acquired data sets were imported into a Cyber Knife stereotactic radiosurgery system and used to delineate the target, organs at risk, and nearby functional structures and fiber tracts. Treatment plans with and without the incorporation of the functional structures and the fiber tracts into the optimization process were developed and compared.Results: The nearby functional structures and fiber tracts could receive doses of > 50% of the maximum dose if they were excluded from the planning process. In the AVM case, the doses received by the Broadmann-17 structure and the optic tract were reduced to 700 cGy from 1,400 cGy and to 1,200 cGy from 2,000 cGy, respectively, upon inclusion into the optimization process. In the metastasis case, the motor cortex received 850 cGy instead of 1,400 cGy; and in the hemangioma case, the pyramidal tracts received 780 cGy instead of 990 cGy. In the astrocytoma case, the dose to the motor cortex bordering the lesion was reduced to 1,900 cGy from 2,100 cGy, and therefore, the biologically equivalent dose in three fractions was delivered instead.Conclusions: Functional structures and fiber tracts could receive high doses if they were not considered during treatment planning. With the aid of fMRI and tractography images, they can be delineated and spared. (C) 2010 Elsevier Inc.