3D Volumetry Research Articles

3D volumetry comparison using 3T magnetic resonance imaging between normal and adenoma-containing pituitary glands

Computed-assisted three-dimensional data (3D) allows for an accurate evaluation of volumes compared with traditional measurements. An in vitro method comparison between geometric volume and 3D volumetry to obtain reference data for pituitary volumes in normal pituitary glands (PGs) and PGs containing adenomas. Prospective, transverse, analytical study. Forty-eight subjects underwent brain magnetic resonance imaging (MRI) with 3D sequencing for computer-aided volumetry. PG phantom volumes by both methods were compared. Using the best volumetric method, volumes of normal PGs and PGs with adenoma were compared. Statistical analysis used the Bland-Altman method, t-statistics, effect size and linear regression analysis. Method comparison between 3D volumetry and geometric volume revealed a lower bias and precision for 3D volumetry. A total of 27 patients exhibited normal PGs (mean age, 42.07 ± 16.17 years), although length, height, width, geometric volume and 3D volumetry were greater in women than in men. A total of 21 patients exhibited adenomas (mean age 39.62 ± 10.79 years), and length, height, width, geometric volume and 3D volumetry were greater in men than in women, with significant volumetric differences. Age did not influence pituitary volumes on linear regression analysis. Results from the present study showed that 3D volumetry was more accurate than the geometric method. In addition, the upper normal limits of PGs overlapped with lower volume limits during early stage microadenomas.

P21.08: Ovarian metastasis as the initial presentation of intestinal non-Hodgkin's lymphoma: an unusual case report

Objectives: The goal of this study is the correct measurement of the volume of tumor in cervical Cancer neoplasia with clinical stage IbI which were treated surgically. The mean goal of the study remains the use of endovaginal ultrasonography in correct stage of the patients with cervical cancer neoplasia. Methods: Total of 27 women with diagnosis of cervical cancer neoplasia after biopsies (no cone) and with clinical stage of disease IbI (after FIGO). All the measurements that we did in 2D and 3D level were in comparison with their histopathological findings were in our study is the gold standard. In every woman we examined 2D dimensions measurements, colour spectral parameters (RI, PI PSV), 3D colour Doppler angiography, 3D volumetry(VOCAL method). Measurements were done with Voluson 730 pro GE. Results: The final results were: mean volume of tumor in 2D 4.86 cm3/mean volume in 3D (VOCAL) 6.1 cm3/mean volume in Pathologoanatomic specimen 4.78 cm3. U/S seems to be more accurate in its measurements 1) mainly in tumors with longest diameter 3 cm and in exophytic ones and give us information about node involvement and parametrial extension of the disease. MRI in total subestimate its measurements. U/S estimate accurately the longest diameter of tumor. 3D volumetry (VOCAL) seems to supraestimate the measurements and mainly in tumors >3 cm. Conclusions: We strongly believe that ultrasound in 2D and 3D level with the help of power Doppler angiography is a good and cheap tool in estimation of the volume of tumor in cervical cancer neoplasia and with the measurement of its longest diameter gives accurate information for stage of the disease mainly in small tumors were a conservative management is an issue.

Expulsion of dominant submucosal fibroids after uterine artery embolization

Purpose Purpose of this study was to evaluate the frequency, probability, and factors associated with expulsion of submucosal fibroids after uterine artery embolization (UAE) in addition to the technical and clinical results at 1-year follow-up. Materials and methods We determined the preinterventional volume of each dominant submucosal fibroid using the commonly used ellipsoid formula and a 3D volumetry in the MRI to define a threshold value in milliliters that indicates the probability for a fibroid expulsion. Assessment of fibroid expulsion was done by MRI at 3-month intervals for a year. Assessment of clinical mid term success was achieved by applying questionnaires at 1-year follow-up. Results Technical success was observed in all 20 patients (mean age of 41.4 ± 5.6 years; range: 29.2–51.1 years). Two (10%) minor and one (5%) major complications occurred. 10/20 dominant submucosal fibroids were completely expelled during the follow-up. Using 3D MRI volumetry the preinterventional mean volume of the later expelled fibroids was 56.8 ± 57.0 ml (range 2.3–198.0 ml) and the mean volume of non-expelled fibroids was 123.8 ± 147.3 ml (range 24.0–531.8 ml). This difference was statistically significant, but weak ( p = 0.0494). Fibroids with a volume equal or less than the threshold value (66.0 ml) were 73% likely to be expelled and fibroids larger than 66.0 ml were 78% likely not to be expelled. All 20 patients demonstrated a significant reduction in the fibroid related symptoms. Conclusion In our study the complication rate was low despite increased rates of fibroid expulsion (50%); simultaneously the rate of treatment satisfaction was very high. Patients with a dominant submucosal fibroid under 66.0 ml should be informed about the probability of fibroid expulsion and the accompanying symptoms.

Tumor Volume Changes Assessed by Three-Dimensional Magnetic Resonance Volumetry in Rectal Cancer Patients After Preoperative Chemoradiation: The Impact of the Volume Reduction Ratio on the Prediction of Pathologic Complete Response

The aim of this study was to determine the correlation between tumor volume changes assessed by three-dimensional (3D) magnetic resonance (MR) volumetry and the histopathologic tumor response in rectal cancer patients undergoing preoperative chemoradiation therapy (CRT). A total of 84 patients who underwent preoperative CRT followed by radical surgery were prospectively enrolled in the study. The post-treatment tumor volume and tumor volume reduction ratio (% decrease ratio), as shown by 3D MR volumetry, were compared with the histopathologic response, as shown by T and N downstaging and the tumor regression grade (TRG). There were no significant differences in the post-treatment tumor volume and the volume reduction ratio shown by 3D MR volumetry with respect to T and N downstaging and the tumor regression grade. In a multivariate analysis, the tumor volume reduction ratio was not significantly associated with T and N downstaging. The volume reduction ratio (>75%, p = 0.01) and the pretreatment carcinoembryonic antigen level (< or =3 ng/ml, p = 0.01), but not the post-treatment volume shown by 3D MR (< or = 5 ml), were, however, significantly associated with an increased pathologic complete response rate. More than 75% of the tumor volume reduction ratios were significantly associated with a high pathologic complete response rate. Therefore, limited treatment options such as local excision or simple observation might be considered after preoperative CRT in this patient population.

Visualization, quantification and correlation of brain atrophy with clinical symptoms in spinocerebellar ataxia types 1, 3 and 6

Background and objectiveBiomarkers to monitor neurological dysfunction in autosomal dominant inherited spinocerebellar ataxias (SCA) are lacking. We therefore aimed to visualize, quantify and correlate localized brain atrophy with clinical symptoms in SCA1, SCA3, and SCA6. MethodsWe compared patients suffering from SCA1 (n=48), SCA3 (n=24), and SCA6 (n=10) with 32 controls using magnetic resonance imaging (MRI) on four different scanners in eight centers followed by voxel-based morphometry (VBM) and quantitative three-dimensional (3D) volumetry. ResultsSCA1 and SCA3 patients presented with severe atrophy in total brainstem (consisting of midbrain, pons, and medulla), pons, medulla, total cerebellum, cerebellar hemispheres and cerebellar vermis, putamen and caudate nucleus. Atrophy in the cerebellar hemispheres was less severe in SCA3 than in SCA1 and SCA6. Atrophy in SCA6 was restricted to the grey matter of the cerebellum (VBM and volumetry), total brainstem and pons (volumetry only). Overall, we did not observe substantial atrophy in the cerebral cortex. A discriminant analysis taking into account data from pons, cerebellar hemispheres, medulla, midbrain and putamen achieved a reclassification probability of 81.7% for SCA1, SCA3, and SCA6. The repeat length of the expanded allele showed a weak negative correlation with the volume of the brainstem, pons, caudate nucleus and putamen in SCA3, and a weak correlation with the pons in SCA1, whereas no such correlation was found in SCA6. Clinical dysfunction as measured by the Scale for the Assessment and Rating of Ataxia (SARA) and the Unified Huntington's Disease Rating Scale functional assessment correlated best with the atrophy of pons in SCA1, with total brainstem atrophy in SCA3 and atrophy of total cerebellum in SCA6. ConclusionsOur data provide strong evidence that MRI is an attractive surrogate marker for clinical studies of SCA. In each SCA genotype clinical dysfunction may be caused by different patho-anatomical processes.

Two-Staged Procedure of Portal Ligation and Hepatectomy Monitored by ICG Clearance

Background: The aim of the study was to predict and estimate the optimal time of resection following portal vein ligation (PVL) with the aid of three dimensional (3D) computed tomography (CT) volumetry and indocyanine green (ICG) clearance in healthy liver. Following right PVL, we induced hypertrophy of the left liver lobe prior to an extended right hepatectomy. Methods: Fourteen patients with right lobe liver metastases from colorectal cancer underwent right PVL. Cutoff points for the ICG clearance test were: R15 < 14% or PDR > 15%/min. The criteria for resection also required a remnant liver volume of 25% of the whole liver volume. The latter was assessed by CT scan prior to the procedures. Liver function was measured with routine biochemical tests and ICG clearance. Postoperatively, repeated ICG clearance and 3D CT volumetry tests were used to estimate the liver's regeneration. Liver resections were performed as a second stage. Results: After portal ligation, ICG clearance increased significantly in some patients, while in others, the ICG clearance remained unchanged with borderline low or normal clearance values. Between the two operations, patients with high clearance had less complications and a better regeneration rate of the left lobe with a shorter waiting period in contrast to the “low ICG group.” Conclusions: ICG clearance has a significant prognostic value. Patients with an apparently inoperable right lobe liver tumor can be successfully treated using a two-staged procedure of portal vain ligation followed by hepatectomy. The 3D CT volumetry and ICG clearance test are essential monitoring tools in these liver resections.

MDCT Cystography for Detection of Vesicourethral Leak After Prostatectomy

The purpose of this study was to compare detection rates with MDCT cystography and conventional cystography in the evaluation of vesicourethral leakage after radical prostatectomy. From September 2004 to May 2005, 51 sets of MDCT and conventional cystographic images of 46 patients who underwent retropubic radical prostatectomy were included in the study. The mean age of the patients was 65.3 +/- 2.1 years. The rates of detection of vesicourethral leakage at the anastomotic site were compared on conventional and MDCT cystographic images. In cases in which leakage was detected at MDCT cystography, the amount of contrast medium leaked was calculated with 3D volumetry. Correlation between leakage volume and hospital stay or indwelling time of a Foley catheter also was evaluated. The rate of detection of vesicourethral leakage determined with MDCT cystography was 80.4% (37 of 46 cases), and that determined with conventional cystography was 54.3% (25 of 46 cases). The mean volume of leakage detected only with MDCT cystography was 2.2 +/- 2.1 mL, and that with both conventional and MDCT cystography was 19.3 +/- 14.1 mL. There was a moderate positive correlation between Foley catheter indwelling time and leakage volume. MDCT cystography can be used for evaluation of leaks at the anastomotic site after prostatectomy and may have a better leak detection rate than conventional cystography.

Egocentric memory impaired and allocentric memory intact as assessed by virtual reality in subjects with unilateral parietal cortex lesions

Present evidence suggests that medial temporal cortices subserve allocentric representation and memory, whereas egocentric representation and memory mainly depends on inferior and superior parietal cortices. Virtual reality environments have a major advantage for the assessment of spatial navigation and memory formation, as computer-simulated first-person environments can simulate navigation in a large-scale space. However, virtual reality studies on allocentric memory in subjects with cortical lesions are rare, and studies on egocentric memory are lacking. Twenty-four subjects with unilateral parietal cortex lesions due to infarction or intracerebral haemorrhage (14 left-sided, 10 right-sided) were compared with 36 healthy matched control subjects on two virtual reality tasks affording to learn a virtual park (allocentric memory) and a virtual maze (egocentric memory). Subjects further received a comprehensive clinical and neuropsychological investigation, and MRI lesion assessment using T 1, T 2 and FLAIR sequences as well as 3D MRI volumetry at the time of the assessment. Results indicate that left- and right-sided lesioned subjects did not differ on task performance. Compared with control subjects, subjects with parietal cortex lesions were strongly impaired learning the virtual maze. On the other hand, performance of subjects with parietal cortex lesions on the virtual park was entirely normal. Volumes of the right-sided precuneus of lesioned subjects were significantly related to performance on the virtual maze, indicating better performance of subjects with larger volumes. It is concluded that parietal cortices support egocentric navigation and imagination during spatial learning in large-scale environments.

Method of Tumor Volume Evaluation using Magnetic Resonance Imaging for Outcome Prediction in Cervical Cancer Treated with Concurrent Chemotherapy and Radiotherapy

PURPOSE To evaluate the patterns of tumor shape and to compare tumor volume derived from simple diameter-based measurement with that derived from tracing the entire tumor contour using region of interest (ROI)-based 3D volumetry with respect to the prediction outcome in cervical cancer patients treated with concurrent chemotherapy and radiotherapy. MATERIALS AND METHODS Magnetic resonance imaging was performed in 98 patients with cervical cancer (stage IB-IIIB). The tumor shape was classified into two categories: and non-ellipsoid shape. ROI-based volumetry was derived from each magnetic resonance slice on the work station. For the diameter-based surrogate ellipsoid volume, the three orthogonal diameters were measured to calculate volume as an ellipsoid. RESULTS The more than half of tumor (55.1%) had a non-ellipsoid configuration. The predictions for outcome were consistent between two volume groups, with overall survival of 93.6% and 87.7% for small tumor (<20 mL), 62.9% and 69.1% for intermediate-size tumor (20-39 mL), and 14.5% and 16.7% for large tumors (≥40 mL) using ROI and diameter based measurement, respectively. Disease-free survival was 93.8% and 90.6% for small tumor, 54.3% and 62.7% for intermediate-size tumor, and 13.7% and 10.3% for large tumor using ROI and diameter based method, respectively. Differences in outcome between size groups were statistically significant, and the differences in outcome predicted by the tumor volume by two different methods. CONCLUSION Our data suggested that large numbers of cervical cancers are not ellipsoid. However, simple diameter-based tumor volume measurement appears to be useful in comparison with ROI-based volumetry for predicting outcome in cervical cancer patients.

Weight estimation by three‐dimensional ultrasound imaging in the small fetus

To improve birth weight estimation in fetuses weighing <or= 1600 g at birth by deriving a new formula including measurements obtained using three-dimensional (3D) sonography. In a prospective cohort study, biometric data of 150 singleton fetuses weighing <or= 1600 g at birth were obtained by sonographic examination within 1 week before delivery. Exclusion criteria were multiple pregnancy, intrauterine death as well as major structural or chromosomal anomalies. A new formula was derived using our data, and was then compared with currently available equations for estimating weight in the preterm fetus. Different statistical estimation strategies were pursued. Gradient boosting with component- wise smoothing splines achieved the best results. The resulting new formula (estimated fetal weight = 656.41 + 1.8321 x volABDO + 31.1981 x HC + 5.7787 x volFEM + 73.5214 x FL + 8.3009 x AC - 449.8863 x BPD + 32.5340 x BPD(2), where volABDO is abdominal volume determined by 3D volumetry, HC is head circumference, volFEM is thigh volume determined by 3D volumetry, FL is femur length and BPD is biparietal diameter) proved to be superior to established equations in terms of mean squared prediction errors, signed percentage errors and absolute percentage errors. Our new formula is relatively easy to use and needs no adjustment to weight percentiles or to fetal lie. In fetuses weighing <or= 1600 g at birth it is superior to weight estimation by traditional formulae using two-dimensional measurements.

Three‐dimensional volumetry and fetal weight measurement

Three‐dimensional volumetry and fetal weight measurement

WE‐D‐M100J‐07: Impact of Hemoglobin On Outcome of Chemo/Radiation Therapy for Cervical Cancer

Purpose: Hemoglobin (Hgb) has been considered as an important factor on radiation therapy for cervical cancer. However, recent studies reported that anemia is only a secondary symptom associated with disease stage and tumor volume, but not an independent predictor for outcome. Our study is to investigate whether low Hgb actively influences the effectiveness of radiation therapy or is merely a symptom of tumor burden. Materials/Methods: The study was based on 67 cervical cancer patients (stage IB2‐IVA). Serial Hgb measurements were performed before and during therapy. Tumor volume was obtained from 3D MRI volumetry. Median follow‐up was 2.9 years (range 0.09∼6.4 years). Treatment outcome was evaluated with local tumor‐control and disease‐free survival. Correlations between Hgb parameters and clinical variables were evaluated with Spearman‐rank method. Outcome prediction was based on univariate and multivariate analyses with Cox regression model. Survival analysis was assessed using Kaplan‐Meier method. Results: Hgb levels were not correlated with tumor stage (correlation coefficient −0.1∼ −0.2) and weakly correlated with tumor volume (correlation coefficient −0.4∼ −0.5). In univariate analysis, local tumor‐control was predicted by mean Hgb (p=0.009) and nadir Hgb (p=0.004); disease‐free survival was only predicted by nadir Hgb (p=0.031). In multivariate analysis, Hgb parameters were the best predictors of outcome: local tumor‐control was predicted by mean Hgb (p=0.013) and nadir Hgb (p=0.007); disease‐free survival was only marginally predicted by nadir Hgb (p=0.053). Kaplan‐Meier analysis demonstrated that Hgb (&gt;12g/dl vs &lt;12g/dl) could potentially differentiate patients in terms of local tumor‐control and disease‐free survival. Conclusion: Preliminary results suggest that Hgb may not be associated with tumor burden (volume and stage). This early work suggests that chronically low Hgb during RT course negatively affects outcome. The independent role of Hgb in combination with other factors may be useful in outcome prediction.

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TH‐E‐ValB‐03: Tumor Volume Regression During Radiation Therapy to Predict Treatment Outcome for Cervical Cancer

Purpose: To investigate the outcome predictive power of tumor volume measured by serial MR imaging (MRI) of cervical cancer, including the sensitivity and specificity to identify patients at risk of local failure. Method and Materials: Seventy‐nine patients with cervical cancer stages IB2‐IVA, treated with radiation/chemotherapy (RT/CT), underwent serial MRI: MRI 1(pre‐RT), MRI 2(at 20–25 Gy/2 weeks), MRI 3(at 40–50 Gy/4 weeks), and MRI 4(at 1–2 months post‐RT). Mean follow up was 6.2 (0.2–9.4) years. Tumor volumes (V1,V2,V3,V4) and regression ratios (V2/V1,V3/V1,V4/V1) were measured by MRI 3D volumetry, and correlated with local tumor‐control and disease‐free survival using Mann‐Whitney rank‐sum test. Results: The volume data collected in this study were analyzed and the predictive power in terms of p‐value to discriminate local tumor‐control and disease‐free survival was computed. The absolute tumor volumes (V2,V3,V4) and the regression ratios (V2/V1,V3/V1,V4/V1) strongly correlated with local tumor‐control (p&lt;0.001). These parameters also correlated with disease‐free survival, but only the last measurement (MRI 4) showed significant predictive value (p=0.02). Four methods had been developed to identify patients at risk for tumor recurrence (sensitivity 61%–100% and specificity 87%–100%). The most powerful method is based on the volume regression measured in MRI 3 and MRI 4 (V3/V1 &gt;20% and V4/V1 &gt;10%), which have a sensitivity of 89% and a specificity of 100%. Local failure can also be predicted as early as 2–3 weeks (MRI 2), the method of V1 &gt;40 cc and V2/V1 &gt;75% shows a sensitivity of 61% and a specificity of 93%. Conclusion: MRI‐based volumetric tumor measurement provides important predictive information about tumor response to the ongoing RT/CT. The methods developed in this study demonstrate a high specificity (87%–100%) for patients at risk of local failure based on long‐term follow‐up. These methods may classify patients who require more aggressive therapeutic intervention.

High Levels of Immunoexpression of the Endothelial Cell Proliferation Marker CD105 Predict for Local Failure in Early-Stage Cervical Cancer

(RT/CT) underwent serial MRI before (1st MRI) and during RT at 2–2.5 weeks (2nd MRI, at 20–25 Gy), at 4–5 weeks of RT (3rd MRI, at 45–50 Gy), and 1–2 months post-RT. Mean follow up was 6.2 (0.2–9.4) years. Tumor volume was measured by MRI 3D volumetry, and plotted as time/tumor volume regression curves. The volume regression parameters were correlated with local tumor control and disease-free survival.

Fetal three-dimensional ultrasound: quantitative assessment

In this communication, we report our studies on the clinical use of quantitative 3D ultrasound (US) in assessing fetal organ volume and circulation. In brief, our studies can be divided into three phases as follows. Phase I: Fetal organ volumetry. Conventional 2D US has the limitation in assessing fetal organ volume, especially for the fetal organs with unique shapes. In other words, 2D US volumetry has to assume fetal organs have ideal geometric shapes, which is not correct. With the advent of 3D US, fetal organ volumetry can be assessed. We have reported a series of fetal organ volume assessments using 3D US, such as fetal liver, lungs, brain, cerebellum, and renal volumes, and proved that 3D US can achieve high reproducibility and accuracy in assessing fetal organ volumes. With these normal data of 3D fetal organ volumetry, fetal organ growth can be assessed more precisely, and thus abnormal conditions in fetal growth may be revealed. Phase II: Fetal weight prediction. To date, the accuracy of fetal weight prediction by 2D US remains to be improved. Using 3D US in assessing fetal upper arm volume and fetal thigh volume, we obtained better results in predicting fetal weight than using conventional 2D weight-predicting formulae. Other investigators have also confirmed our studies that fetal weight prediction may be improved by using 3D volumetry. Phase III: Vascularization and flow of fetal organs. The vascularization and blood flow of fetal organs cannot be assessed directly by 2D US. With the quantitative 3D power Doppler, the vascularization and flow of fetal organs can be evaluated directly in utero. The quantitative 3D power Doppler flow indexes, i.e., vascularization index (VI), flow index (FI), and vascularization-flow index (VFI), of fetal kidney, liver, brain, and placenta all significantly correlated with gestational age. In fetal growth restriction, abnormal VI, FI, and VFI may be detected. In conclusion, we believe that quantitative 3D US will be of help in assessing fetal well-being, either in organ growth or in fetal hemodynamics. Further studies of quantitative fetal 3D US are warranted.

3D versus 2D ultrasound: accuracy of volume measurement in human cadaver kidneys.

Comparison of the accuracy of 3D and 2D ultrasound in assessing the volume of human cadaver kidneys. Before autopsy the volume of 22 kidneys was assessed from a 3D data set after manually tracing organ contours (3D volumetry) and by applying a 3D ellipsoid formula both on a 3D data set and 2D images. Measurements by water-displacement served as the gold standard. 3D volumetry showed a mean absolute deviation of 31 mL (18.5%) compared with the mean gold standard measurement (168 mL), yielding a concordance correlation (Lin's rho(c) ) of 0.71. Calculation based on the ellipsoid formula revealed a mean absolute deviation of 37 mL (22.0%) when applied on the 3D data set (rho(c) = 0.65) and of 42 mL (25.0%) when applied on 2D images (rho(c) = 0.61). 3D volumetry showed a satisfactory concordance correlation and is superior to volume calculation based on the ellipsoid formula either applied to a 3D data set or to conventional 2D images in assessing the volume of human cadaver kidneys.

3D Versus 2D Ultrasound

Partik B, Stadler A, Schamp S, et al. 3D versus 2D ultrasound. Accuracy of volume measurement in human cadaver kidneys. Invest Radiol 2002;37:489–495. Rationale and Objectives. Comparison of the accuracy of 3D and 2D ultrasound in assessing the volume of human cadaver kidneys. Materials and Methods. Before autopsy the volume of 22 kidneys was assessed from a 3D data set after manually tracing organ contours (3D volumetry) and by applying a 3D ellipsoid formula both on a 3D data set and 2D images. Measurements by water-displacement served as the gold standard. Results. 3D volumetry showed a mean absolute deviation of 31 mL (18.5%) compared with the mean gold standard measurement (168 mL), yielding a concordance correlation (Lin’s ρc) of 0.71. Calculation based on the ellipsoid formula revealed a mean absolute deviation of 37 mL (22.0%) when applied on the 3D data set (ρc = 0.65) and of 42 mL (25.0%) when applied on 2D images (ρc = 0.61), respectively. Conclusions. 3D volumetry showed a satisfactory concordance correlation and is superior to volume calculation based on the ellipsoid formula either applied to a 3D data set or to conventional 2D images in assessing the volume of human cadaver kidneys.

Method and timing of tumor volume measurement for outcome prediction in cervical cancer using magnetic resonance imaging

Purpose : Recently, imaging-based tumor volume before, during, and after radiation therapy (RT) has been shown to predict tumor response in cervical cancer. However, the effectiveness of different methods and timing of imaging-based tumor size assessment have not been investigated. The purpose of this study was to compare the predictive value for treatment outcome derived from simple diameter-based ellipsoid tumor volume measurement using orthogonal diameters (with ellipsoid computation) with that derived from more complex contour tracing/region-of-interest (ROI) analysis 3D tumor volumetry. Methods and Materials : Serial magnetic resonance imaging (MRI) examinations were prospectively performed in 60 patients with advanced cervical cancer (Stages IB 2-IVB/recurrent) at the start of RT, during early RT (20–25 Gy), mid-RT (45–50 Gy), and at follow-up (1–2 months after RT completion). ROI-based volumetry was derived by tracing the entire tumor region in each MR slice on the computer work station. For the diameter-based surrogate “ellipsoid volume,” the three orthogonal diameters (d 1, d 2, d 3) were measured on film hard copies to calculate volume as an ellipsoid (d 1 × d 2 × d 3 × π/6). Serial tumor volumes and regression rates determined by each method were correlated with local control, disease-free and overall survival, and the results were compared between the two measuring methods. Median post-therapy follow-up was 4.9 years (range, 2.0–8.2 years). Results : The best method and time point of tumor size measurement for the prediction of outcome was the tumor regression rate in the mid-therapy MRI examination (at 45–50 Gy) using 3D ROI volumetry. For the pre-RT measurement both the diameter-based method and ROI volumetry provided similar predictive accuracy, particularly for patients with small (<40 cm 3) and large (≥100 cm 3) pre-RT tumor size. However, the pre-RT tumor size measured by either method had much less predictive value for the intermediate-size (40–99 cm 3) tumors, which accounted for the majority of patients (55%). Tumor regression rate (fast vs. slow) obtained during mid-RT (45–50 Gy), which could only be appreciated by 3D ROI volumetry, had the best outcome prediction rate for local control (84% vs. 22%, p < 0.0001) and disease-free survival (63% vs. 20%, p = 0.0005). Within the difficult to classify intermediate pre-RT size group, slow ROI-based regression rate predicted all treatment failures (local control rate: 0% vs. 91%, p < 0.0001; disease-free survival: 0% vs. 73%, p < 0.0001). Mid-RT regression rate based on simple diameter measurement did not predict outcome. The early-RT and post-RT measurements were least useful with either measuring method. Conclusion : Our preliminary data suggest that for the prediction of treatment outcome in cervical cancer, initial tumor volume can be estimated by simple diameter-based measurement obtained from film hard copies. When initial tumor volume is in the intermediate size range, ROI volumetry and an additional MRI during RT are needed to quantitatively analyze tumor regression rate for the prediction of treatment outcome.

Sonographic Cervical Volumetry in Higher Order Multiple Gestation

Objective: The aim of this study of multifetal pregnancies was the comparison of three-dimensional (3D) volumetry of the cervix, conventional sonographic cervical length measurement and clinical assessment. Methods: 10 mothers were investigated in an observational study between 5/1999 and 9/2000. A total of 34 consecutive 2D- and 3D-transabdominal ultrasound measurements were performed. Results: Volumetry of the cervix was possible in all 34 exams. 2D-cervical length assessment could not be obtained in 6% because the presenting fetal part obstructed the sonographic plane. Both methods allowed equal judgement of the configuration of the cervix. A significant correlation was found between mean 2D-cervical length (28.7 mm, 7.7 SD) and mean cervical volume (30.0 cm³, 16.0 SD). Parity, subjective preterm labor or need of tocolytics showed no correlation with any biometrical parameter studied. Conclusion: Volumetry was superior for the assessment of cervical biometry and conformation in women when the transabdominal 2D-plane was obstructed. When cervical length was obtainable by a conventional scan, the technically more complex 3D-imaging did not provide further information.