Radiation therapy planning using MRI-CT fusion in dogs and cats with brain tumors

Volume definition is a delicate step within the radiation treatment planning process and the precision of defining the volumes to irradiate is important for the success of the radiation treatment. Traditionally, radiation plans are created using computed tomography (CT) studies. Due to its different mechanism of action, magnetic resonance imaging (MRI) is more sensitive for detection of brain lesions. Therefore, using fused images of both imaging modalities should result in a more precise definition of the volumes to irradiate. The feasibility to fuse CT and MRI studies performed at different institutions was tested to subsequently analyse the influence of the fused images on target volume definition.

Fourteen dogs and four cats with brain lesions having MR- and CT-imaging were included. Contrast-enhanced radiotherapy planning CT scans were fused to T1-weighted post-contrast and T2-weighted MRI scans. The gross tumor volume (GTV), the clinical tumor volume (CTV) and the planning target volume (PTV) were delineated on CT- and MRI studies. CT and MRI volumes were compared with regard to volumetric and spatial differences.

The mean GTV was larger on MRI than on CT (2.15 vs.1.54 cm³). Also the mean CTV was larger on MRI than on CT (5.34 vs. 4.38 cm³). Consequently, the mean PTV was larger on MRI than on CT (14.20 vs. 10.82 cm³) as well. None of the differences in defined volumes were significant. Fusion images were accepted showing mean errors of 1.32 mm (mean error) and 1.73 mm (maximal error).

CT-MRI fusion was feasible especially when defined, reliable, and consistent anatomic landmarks were used as registration points. Volumetric differences between CT and MRI were insignificant. In general, GTV and CTV were easier identified on MRI.