Magnetic resonance imaging (MRI) compared with computed tomography (CT) for interobserver agreement of gross tumor volume delineation in pancreatic cancer: a multi-institutional contouring study on behalf of the AIRO group for gastrointestinal cancers

Authors

  • Luciana Caravatta Department of Radiotherapy, ‘SS Annunziata’ Hospital ‘G. D’Annunzio’ University, Chieti, Italy
  • Francesco Cellini Gemelli Advanced Radiation Therapy Center Fondazione Policlinico Universitario ‘A. Gemelli’ Catholic University of Sacred Heart, Rome, Italy
  • Nicola Simoni Radiotherapy Unit Azienda Ospedaliera Universitaria, Verona, Italy
  • Consuelo Rosa Department of Radiotherapy, ‘SS Annunziata’ Hospital ‘G. D’Annunzio’ University, Chieti, Italy
  • Rita Marina Niespolo Department of Radiation Oncology, Azienda Ospedaliera S. Gerardo, Monza, Italy
  • Marco Lupattelli Radiation Oncology Section University of Perugia and Perugia General Hospital, Perugia, Italy
  • Vincenzo Picardi Radiotherapy Unit Department of Oncology, ‘Giovanni Paolo II’ Foundation Catholic University of Sacred Heart, Campobasso, Italy
  • Gabriella Macchia Radiotherapy Unit Department of Oncology, ‘Giovanni Paolo II’ Foundation Catholic University of Sacred Heart, Campobasso, Italy
  • Aldo Sainato Radiotherapy Unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
  • Giovanna Mantello Department of Radiotherapy, State Hospital, Ancona, Italy
  • Francesco Dionisi Proton Therapy Unit, Department of Oncology, Azienda Provinciale per i Servizi Sanitari, APSS, Trento, Italy
  • Maria Elena Rosetto Department of Radiation Oncology, Ospedale Belcolle, Viterbo, Italy
  • Vincenzo Fusco Department of Radiation Oncology, Centro di Riferimento Oncologico Regionale, Rionero in Vulture, Potenza, Italy
  • Federico Navarria Department of Radiation Oncology Centro di Riferimento Oncologico, National Cancer Institute, Aviano, Italy
  • Antonino De Paoli Department of Radiation Oncology Centro di Riferimento Oncologico, National Cancer Institute, Aviano, Italy
  • Alessandra Guido Radiation Oncology Center, Department of Experimental Diagnostic and Specialty Medicine - DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
  • Claudio Vecchi Tecnologie Avanzate, Srl, Torino, Italy
  • Raffaella Basilico Department of Radiology, ‘SS Annunziata’ Hospital ‘G. D’Annunzio’ University, Chieti, Italy
  • Roberta Cianci Department of Radiology, ‘SS Annunziata’ Hospital ‘G. D’Annunzio’ University, Chieti, Italy
  • Andrea Delli Pizzi Department of Radiology, ‘SS Annunziata’ Hospital ‘G. D’Annunzio’ University, Chieti, Italy
  • Marta Di Nicola Laboratory of Biostatistics Department of Medical, Oral and Biotechnological Sciences ‘G. D'Annunzio’ University, Chieti, Italy
  • Gian Carlo Mattiucci Gemelli Advanced Radiation Therapy Center Fondazione Policlinico Universitario ‘A. Gemelli’ Catholic University of Sacred Heart, Rome, Italy
  • Vincenzo Valentini Gemelli Advanced Radiation Therapy Center Fondazione Policlinico Universitario ‘A. Gemelli’ Catholic University of Sacred Heart, Rome, Italy
  • Alessio Giuseppe Morganti Radiation Oncology Center, Department of Experimental Diagnostic and Specialty Medicine - DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
  • Domenico Genovesi Department of Radiotherapy, ‘SS Annunziata’ Hospital ‘G. D’Annunzio’ University, Chieti, Italy

DOI:

https://doi.org/10.1080/0284186X.2018.1546899

Abstract

Background: Due to the high soft tissue resolution, magnetic resonance imaging (MRI) could improve the accuracy of pancreatic tumor delineation in radiation treatment planning. A multi-institutional study was proposed to evaluate the impact of MRI on inter-observer agreement in gross tumor volume (GTV) and duodenum delineation for pancreatic cancer compared with computer tomography (CT).

Material and Methods: Two clinical cases of borderline resectable (Case 1) and unresectable (Case 2) pancreatic cancer were selected. In two sequential steps, diagnostic contrast-enhanced CT scan and MRI sequences were sent to the participating centers. CT-GTVs were contoured while blinded to MRI data sets. DICE index was used to evaluate the spatial overlap accuracy.

Results: Thirty-one radiation oncologists from different Institutions submitted the delineated volumes. CT- and MRI-GTV mean volumes were 21.6 ± 9.0 cm3 and 17.2 ± 6.0 cm3, respectively for Case 1, and 31.3 ± 15.6 cm3 and 33.2 ± 20.2 cm3, respectively for Case 2. Resulting MRI-GTV mean volume was significantly smaller than CT–GTV in the borderline resectable case (p < .05). A substantial agreement was shown by the median DICE index for CT– and MRI–GTV resulting as 0.74 (IQR: 0.67–0.75) and 0.61 (IQR: 0.57–0.67) for Case 1; a moderate agreement was instead reported for Case 2: 0.59 (IQR:0.52–0.66) and 0.53 (IQR:0.42–0.62) for CT– and MRI–GTV, respectively.

Conclusion: Diagnostic MRI resulted in smaller GTV in borderline resectable case with a substantial agreement between observers, and was comparable to CT scan in interobserver variability, in both cases. The greater variability in the unresectable case underlines the critical issues related to the outlining when vascular structures are more involved. The integration of MRI with contrast-enhancement CT, thanks to its high definition of tumor relationship with neighboring vessels, could offer a greater accuracy of target delineation.

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Published

2019-04-03

How to Cite

Caravatta, L., Cellini, F., Simoni, N., Rosa, C., Marina Niespolo, R., Lupattelli, M., … Genovesi, D. (2019). Magnetic resonance imaging (MRI) compared with computed tomography (CT) for interobserver agreement of gross tumor volume delineation in pancreatic cancer: a multi-institutional contouring study on behalf of the AIRO group for gastrointestinal cancers. Acta Oncologica, 58(4), 439–447. https://doi.org/10.1080/0284186X.2018.1546899

Issue

Vol. 58 No. 4 (2019): Acta Oncologica

Section

Articles