3 Tesla multiparametric MRI for GTV-definition of Dominant Intraprostatic Lesions in patients with Prostate Cancer – an interobserver variability study

Radiation Oncology

Cordula A Jilg³  Anca L Grosu¹  Simon Kirste¹  Stefan Knippen¹  Jutta Scholber¹  Karl Henne¹  Natalja Volegova-Neher¹  Christian Doll¹  Tobias Fechter¹  Ursula Nestle¹  Hans Christian Rischke² 

[1] Department of Radiation Oncology, University of Freiburg, Robert Koch Str. 3, 79106 Freiburg, Germany;Department of Nuclear Medicine, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany;Department of Urology, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany

关键词: Interobserver variability;    3 Tesla MRI;    Simultaneous integrated boost;    Focal dose escalation;    Gross tumor volume;    Prostate cancer;   

Others  :  1153331
DOI  :  10.1186/1748-717X-8-183

 received in 2013-02-21, accepted in 2013-07-20,  发布年份 2013

【 摘 要 】

Purpose

To evaluate the interobserver variability of gross tumor volume (GTV) - delineation of Dominant Intraprostatic Lesions (DIPL) in patients with prostate cancer using published MRI criteria for multiparametric MRI at 3 Tesla by 6 different observers.

Material and methods

90 GTV-datasets based on 15 multiparametric MRI sequences (T2w, diffusion weighted (DWI) and dynamic contrast enhanced (DCE)) of 5 patients with prostate cancer were generated for GTV-delineation of DIPL by 6 observers. The reference GTV-dataset was contoured by a radiologist with expertise in diagnostic imaging of prostate cancer using MRI. Subsequent GTV-delineation was performed by 5 radiation oncologists who received teaching of MRI-features of primary prostate cancer before starting contouring session. GTV-datasets were contoured using Oncentra Masterplan® and iplan® Net. For purposes of comparison GTV-datasets were imported to the Artiview® platform (Aquilab®), GTV-values and the similarity indices or Kappa indices (KI) were calculated with the postulation that a KI > 0.7 indicates excellent, a KI > 0.6 to < 0.7 substantial and KI > 0.5 to < 0.6 moderate agreement. Additionally all observers rated difficulties of contouring for each MRI-sequence using a 3 point rating scale (1 = easy to delineate, 2 = minor difficulties, 3 = major difficulties).

Results

GTV contouring using T2w (KI-T2w = 0.61) and DCE images (KI-DCE = 0.63) resulted in substantial agreement. GTV contouring using DWI images resulted in moderate agreement (KI-DWI = 0.51). KI-T2w and KI-DCE was significantly higher than KI-DWI (p = 0.01 and p = 0.003). Degree of difficulty in contouring GTV was significantly lower using T2w and DCE compared to DWI-sequences (both p < 0.0001). Analysis of delineation differences revealed inadequate comparison of functional (DWI, DCE) to anatomical sequences (T2w) and lack of awareness of non-specific imaging findings as a source of erroneous delineation.

Conclusions

Using T2w and DCE sequences at 3 Tesla for GTV-definition of DIPL in prostate cancer patients by radiation oncologists with knowledge of MRI features results in substantial agreement compared to an experienced MRI-radiologist, but for radiotherapy purposes higher KI are desirable, strengthen the need for expert surveillance. DWI sequence for GTV delineation was considered as difficult in application.

【 授权许可】

   
2013 Rischke et al.; licensee BioMed Central Ltd.

【 图 表 】

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