Abstract
Purpose of our research was to develop a four‐dimensional (4D) magnetic resonance imaging (MRI) method of liver. Requirements of the method were to create a clinical procedure with acceptable imaging time and sufficient temporal and spatial accuracy. The method should produce useful planning image sets for stereotactic body radiation therapy delivery both during breath‐hold and in free breathing. The purpose of the method was to improve the localization of liver metastasis. The method was validated with phantom tests. Imaging parameters were optimized to create a 4D dataset compressed to one respiratory cycle of the whole liver with clinically reasonable level of image contrast and artifacts. Five healthy volunteers were imaged with T2‐weighted SSFSE research sequence. The respiratory surrogate signal was observed by the linear navigator interleaved with the anatomical liver images. The navigator was set on head‐feet — direction on the superior surface of the liver to detect the edge of diaphragm. The navigator signal and 2D liver image data were retrospectively processed with a self‐developed MATLAB algorithm. A deformable phantom for 4D imaging tests was constructed by combining deformable tissue‐equivalent material and a commercial programmable motor unit of the 4D phantom with a clinically relevant range of deformation patterns. 4D Computed Tomography images were used as reference to validate the MRI protocol. The best compromise of reasonable accuracy and imaging time was found with 2D T2‐weighted SSFSE imaging sequence using parameters: TR = 500–550 ms, images/slices = 20, slice thickness = 3 mm. Then, image processing with number of respiratory phases = 8 constructed accurate 4D images of liver. We have developed the 4D‐MRI method visualizing liver motions three‐dimensionally in one representative respiratory cycle. From phantom tests it was found that the spatial agreement to 4D‐CT is within 2 mm that is considered sufficient for clinical applications.
Highlights
IntroductionStereotactic body radiotherapy (SBRT) is targeted to small tumor volumes in body area and is typically applied in lung lesions and increasingly in prostate
1.A | Stereotactic radiotherapy of liver and medical imagingStereotactic body radiotherapy (SBRT) is targeted to small tumor volumes in body area and is typically applied in lung lesions and increasingly in prostate
New evidence of the benefits of higher radiotherapy (RT) doses to small liver metastases compared with traditional lower dose levels of palliative RT indicates a future increase in the need of liver SBRT
Summary
Stereotactic body radiotherapy (SBRT) is targeted to small tumor volumes in body area and is typically applied in lung lesions and increasingly in prostate. Small liver lesions are suitable targets of SBRT.[1] New evidence of the benefits of higher radiotherapy (RT) doses to small liver metastases compared with traditional lower dose levels of palliative RT indicates a future increase in the need of liver SBRT. Motion of the liver is mainly caused by three separate factors: respiration, random peristaltic motion, and pulsatile cardiac motion.[2] While respiratory motion can affect a relatively large portion of the liver, cardiac‐induced motion of the liver is mainly found in the area underneath the heart.[3] Respiratory‐induced motion is continuous and repeated, which enables averaging the motion of the whole liver. Liver tissue is deformable; as these separate motion forces affect from different directions, the resultant motion pattern in different parts of liver will be complex
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