Impact of 18F-FDG PET/MR based tumor delineation in radiotherapy planning for cholangiocarcinoma

Abdom Radiol (NY). 2021 Mar 27.

Purpose: Radiation therapy (RT) is an effective treatment for unresectable cholangiocarcinoma (CC). Accurate tumor volume delineation is critical in achieving high rates of local control while minimizing treatment-related toxicity. This study compares 18F-FDG PET/MR to MR and CT for target volume delineation for RT planning.

Methods: We retrospectively included 22 patients with newly diagnosed unresectable primary CC who underwent 18F-FDG PET/MR for initial staging. Gross tumor volume (GTV) of the primary mass (GTVM) and lymph nodes (GTVLN) were contoured on CT images, MR images, and PET/MR fused images and compared among modalities. The dice similarity coefficient (DSC) was calculated to assess spatial coverage between different modalities.

Results: GTV M PET/MR (median: 94 ml, range 16-655 ml) was significantly greater than GTV M MR(69 ml, 11-635 ml) (p = 0.0001) and GTV M CT (96 ml, 4-564 ml) (p = 0.035). There was no significant difference between GTV M CT and GTV M MR (p = 0.078). Subgroup analysis of intrahepatic and extrahepatic tumors showed that the median GTV M PET/MR was significantly greater than GTV M MR in both groups (117.5 ml, 22-655 ml vs. 102.5 ml, 22-635 ml, p = 0.004 and 37 ml, 16-303 ml vs. 34 ml, 11-207 ml, p = 0.042, respectively). The GTV LN PET/MR (8.5 ml, 1-27 ml) was significantly higher than GTV LN CT (5 ml, 4-16 ml) (p = 0.026). GTVPET/MR had the highest similarity to the GTVMR, i.e., DSCPET/MR-MR (0.82, 0.25-1.00), compared to DSC PET/MR-CT of 0.58 (0.22-0.87) and DSCMR-CT of 0.58 (0.03-0.83).

Conclusion: 18F-FDG PET/MR-based CC delineation yields greater GTVs and detected a higher number of positive lymph nodes compared to CT or MR, potentially improving RT planning by reducing the risk of geographic misses.