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First published online October 26, 2006
British Journal of Radiology (2007) 80, 347-354
© 2007 British Institute of Radiology
doi: 10.1259/bjr/65349468
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Use of MR spectroscopy and functional imaging in the treatment planning of gliomas

A Narayana, MD 1 J Chang, PhD 2 S Thakur, PhD 2 W Huang, PhD 2,3 S Karimi, MD 3 B Hou, PhD 2,3 A Kowalski, MS 2 G Perera, MS 2 A Holodny, MD 3 and P H Gutin, MD 4,5

Departments of 1 Radiation Oncology, 2 Medical Physics, 3 Radiology and 4 Surgery, Memorial Sloan-Kettering Cancer Center and 5 Department of Neuro-Surgery, Weill Medical College of Cornell University, 1275 York Avenue, New York, NY 10021, USA


Figure 1
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  		Figure 1. Magnetic resonance spectroscopic imaging(MRSI) incorporation in treatment planning. (a) Fluid attenuated inversion recovery (FLAIR) image of a right frontal glioma. (b) Superimposition of multivoxel MRSI over the image. (c) Conversion of Cho:Cr ratio into a grayscale.

 

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  		Figure 2. Functional MRI(fMRI) incorporation in treatment planning. (a) Text file of motor cortical mapping in a patient with frontal glioblastoma. (b) three-dimensional reconstruction of motor cortical mapping in the same patient.

 

Figure 3
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  		Figure 3. Intensity-modulated radiation therapy (IMRT) planning in glioma. (a) Fluid attenuated inversion recovery (FLAIR) image of a patient with brain stem glioma. (b)Multivoxel MR spectroscopic imaging (MRSI). (c) Conversion into grayscale of Cho:Cr ratio to define the target volume. (d) Intensity-modulated radiation therapy (IMRT) plan with dose painting.

 

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  		Figure 4. Comparison of target volumes with(a,b) MR spectroscopic imaging (MRSI) information and fluid attenuated inversion recovery (FLAIR) defined CTV, and (c,d) MRSI defined CTV showing both overestimation (upper arrow) and underestimation (lower arrow) with MRI defined volumes.

 

Figure 5
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  		Figure 5. Comparison of treatment plans with MR spectroscopic imaging(MRSI) information. (a) MRI defined plan. (b) MRSI defined plan.

 

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  		Figure 6. Comparison of planned target volumes(PTV) with MRI and MR spectroscopic imaging (MRSI) defined volumes.

 

Figure 7
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  		Figure 7. Use of functional MRI(fMRI) in treatment planning. (a) MR spectroscopic imaging (MRSI) defined plan. (b) MRSI with fMRI defined plan.

 

Figure 8
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  		Figure 8. Pattern of failure in a patient with brain stem glioma.(a) FLAIR image of a low grade brain stem glioma. (b) Superimposition of multi-voxel MR spectroscopic imaging (MRSI) over the image showing areas of high (upper arrow) and low (lower arrow) Cho:Cr ratios. (c) Recurrence 4 months later in the area of high Cho:Cr ratio.

 




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