Implementation and evaluation of a dynamic contrast enhanced mr perfusion protocol for glioblastoma using a 0.35T mri-Linac system

TL;DR

This study demonstrates that a 0.35T MRI-Linac system can effectively acquire post-contrast 3DT1-weighted and DCE MRI data to monitor glioblastoma response to radiotherapy, showing comparable results to standard 3T MRI.

Contribution

First implementation of a DCE MRI protocol on a 0.35T MRI-Linac system for glioblastoma assessment during radiotherapy.

Findings

3DT1 contrast enhancement volumes are similar between 0.35T MRI-Linac and 3T MRI.

DCE-derived K-trans maps are consistent with patient treatment response.

K-trans values decrease in responders and increase in non-responders during treatment.

Abstract

MRI-linear accelerator (MRI-Linac) systems allow for daily tracking of MRI changes during radiotherapy (RT). Since one common MRI-Linac operates at 0.35T, there are efforts towards developing protocols at that field strength. In this study we demonstrate the implementation of a post-contrast 3DT1-weighted (3DT1w) and dynamic contrast enhancement (DCE) protocol to assess glioblastoma response to RT using a 0.35T MRI-Linac. The protocol implemented was used to acquire 3DT1w and DCE data from a flow phantom and two patients with glioblastoma (a responder and a non-responder) who underwent RT on a 0.35T-MRI-Linac. The detection of post-contrast enhanced volumes was evaluated by comparing the 3DT1w images from the 0.35T-MRI-Linac to images obtained using a 3T-standalone scanner. The DCE data were tested temporally and spatially using data from the flow phantom and patients. K-trans maps were derived from DCE at three time points (a week before treatment: Pre RT, four weeks through treatment: Mid RT, and three weeks after treatment: Post RT) and were validated with patients treatment outcomes. The 3D-T1 contrast enhancement volumes were visually and volumetrically similar (+/- 0.6-3.6%) between 0.35T MRI-Linac and 3T. DCE images showed temporal stability, and associated K-trans maps were consistent with patient response to treatment. On average, K-trans values showed a 54% decrease and 8.6% increase for a responder and non-responder respectively when Pre RT and Mid RT images were compared. Our findings support the feasibility of obtaining post-contrast 3DT1w and DCE data from patients with glioblastoma using a 0.35T MRI-Linac system.