Diffusion tensor magnetic resonance imaging driven growth modeling for radiotherapy target definition in glioblastoma

The clinical target volume (CTV) in radiotherapy is routinely based on gadolinium contrast enhanced T1 weighted (T1w + Gd) and T2 weighted fluid attenuated inversion recovery (T2w FLAIR) magnetic resonance imaging (MRI) sequences which have been shown to over- or underestimate the microscopic tumor cell spread. Gliomas favor spread along the white matter fiber tracts. Tumor growth models incorporating the MRI diffusion tensors (DTI) allow to account more consistently for the glioma growth. The aim of the study was to investigate the potential of a DTI driven growth model to improve target definition in glioblastoma (GBM).

Eleven GBM patients were scanned using T1w, T2w FLAIR, T1w + Gd and DTI. The brain was segmented into white matter, gray matter and cerebrospinal fluid. The Fisher-Kolmogorov growth model was used assuming uniform proliferation and a difference in white and gray matter diffusion of a ratio of 10. The tensor directionality was tested using an anisotropy weighting parameter set to zero (γ0) and twenty (γ20). The volumetric comparison was performed using Hausdorff distance, Dice similarity coefficient (DSC) and surface area.

The median of the standard CTV (CTVstandard) was 180 cm³. The median surface area of CTVstandard was 211 cm². The median surface area of respective CTV_γ0 and CTV_γ20 significantly increased to 338 and 376 cm², respectively. The Hausdorff distance was greater than zero and significantly increased for both CTV_γ0 and CTV_γ20 with respective median of 18.7 and 25.2 mm. The DSC for both CTV_γ0 and CTV_γ20 were significantly below one with respective median of 0.74 and 0.72, which means that 74 and 72% of CTVstandard were included in CTV_γ0 and CTV_γ20, respectively.

DTI driven growth models result in CTVs with a significantly increased surface area, a significantly increased Hausdorff distance and decreased overlap between the standard and model derived volume.