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| 2. |
- Brynolfsson, Patrik, et al.
(author)
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ADC texture-An imaging biomarker for high-grade glioma?
- 2014
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In: Medical physics (Lancaster). - : Wiley. - 0094-2405. ; 41:10, s. 101903-
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Journal article (peer-reviewed)abstract
- Purpose:Survival for high-grade gliomas is poor, at least partly explained by intratumoral heterogeneity contributing to treatment resistance. Radiological evaluation of treatment response is in most cases limited to assessment of tumor size months after the initiation of therapy. Diffusion-weighted magnetic resonance imaging (MRI) and its estimate of the apparent diffusion coefficient (ADC) has been widely investigated, as it reflects tumor cellularity and proliferation. The aim of this study was to investigate texture analysis of ADC images in conjunction with multivariate image analysis as a means for identification of pretreatment imaging biomarkers.Methods:Twenty-three consecutive high-grade glioma patients were treated with radiotherapy (2 Gy/60 Gy) with concomitant and adjuvant temozolomide. ADC maps and T1-weighted anatomical images with and without contrast enhancement were collected prior to treatment, and (residual) tumor contrast enhancement was delineated. A gray-level co-occurrence matrix analysis was performed on the ADC maps in a cuboid encapsulating the tumor in coronal, sagittal, and transversal planes, giving a total of 60 textural descriptors for each tumor. In addition, similar examinations and analyses were performed at day 1, week 2, and week 6 into treatment. Principal component analysis (PCA) was applied to reduce dimensionality of the data, and the five largest components (scores) were used in subsequent analyses. MRI assessment three months after completion of radiochemotherapy was used for classifying tumor progression or regression.Results:The score scatter plots revealed that the first, third, and fifth components of the pretreatment examinations exhibited a pattern that strongly correlated to survival. Two groups could be identified: one with a median survival after diagnosis of 1099 days and one with 345 days, p = 0.0001.Conclusions:By combining PCA and texture analysis, ADC texture characteristics were identified, which seems to hold pretreatment prognostic information, independent of known prognostic factors such as age, stage, and surgical procedure. These findings encourage further studies with a larger patient cohort. (C) 2014 Author(s).
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| 3. |
- Johansson, Adam, et al.
(author)
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CT substitute derived from MRI sequences with ultrashort echo time
- 2011
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In: Medical physics (Lancaster). - : American Association of Physicists in Medicine. - 0094-2405. ; 38:5, s. 2708-2714
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Journal article (peer-reviewed)abstract
- Purpose: Methods for deriving computed tomography (CT) equivalent information from MRI are needed for attenuation correction in PET/MRI applications, as well as for patient positioning and dose planning in MRI based radiation therapy workflows. This study presents a method for generating a drop in substitute for a CT image from a set of magnetic resonance (MR)images. Methods:A Gaussian mixture regression model was used to link the voxel values in CT images to the voxel values in images from three MRI sequences: one T2 weighted 3D spin echo based sequence and two dual echo ultrashort echo time MRI sequences with different echo times and flip angles. The method used a training set of matched MR and CT data that after training was able to predict a substitute CT (s-CT) based entirely on the MR information for a new patient. Method validation was achieved using datasets covering the heads of five patients and applying leave-one-out cross-validation (LOOCV). During LOOCV, the model was estimated from the MR and CT data of four patients (training set) and applied to the MR data of the remaining patient (validation set) to generate an s-CT image. This procedure was repeated for all five training and validation data combinations. Results: The mean absolute error for the CT number in the s-CT images was 137 HU. No large differences in method accuracy were noted for the different patients, indicating a robust method. The largest errors in the s-CT images were found at air–tissue and bone–tissue interfaces. The model accurately discriminated between air and bone, as well as between soft tissues and nonsoft tissues. Conclusions: The s-CT method has the potential to provide an accurate estimation of CT information without risk of geometrical inaccuracies as the model is voxel based. Therefore, s-CT images could be well suited as alternatives to CT images for dose planning in radiotherapy and attenuation correction in PET/MRI.
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| 4. |
- Johansson, Adam, 1984-, et al.
(author)
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CT substitutes derived from MR images reconstructed with parallel imaging
- 2014
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In: Medical physics (Lancaster). - : Wiley. - 0094-2405. ; 41:8, s. 474-480
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Journal article (peer-reviewed)abstract
- Purpose: Computed tomography (CT) substitute images can be generated from ultrashort echo time (UTE) MRI sequences with radial k-space sampling. These CT substitutes can be used as ordinary CT images for PET attenuation correction and radiotherapy dose calculations. Parallel imaging allows faster acquisition of magnetic resonance (MR) images by exploiting differences in receiver coil element sensitivities. This study investigates whether non-Cartesian parallel imaging reconstruction can be used to improve CT substitutes generated from shorter examination times.Methods: The authors used gridding as well as two non-Cartesian parallel imaging reconstruction methods, SPIRiT and CG-SENSE, to reconstruct radial UTE and gradient echo (GE) data into images of the head for 23 patients. For each patient, images were reconstructed from the full dataset and from a number of subsampled datasets. The subsampled datasets simulated shorter acquisition times by containing fewer radial k-space spokes (1000, 2000, 3000, 5000, and 10 000 spokes) than the full dataset (30 000 spokes). For each combination of patient, reconstruction method, and number of spokes, the reconstructed UTE and GE images were used to generate a CT substitute. Each CT substitute image was compared to a real CT image of the same patient.Results: The mean absolute deviation between the CT number in CT substitute and CT decreased when using SPIRiT as compared to gridding reconstruction. However, the reduction was small and the CT substitute algorithm was insensitive to moderate subsampling (≥5000 spokes) regardless of reconstruction method. For more severe subsampling (≤3000 spokes), corresponding to acquisition times less than aminute long, the CT substitute quality was deteriorated for all reconstructionmethods but SPIRiT gave a reduction in the mean absolute deviation of down to 25 Hounsfield units compared to gridding.Conclusions: SPIRiT marginally improved the CT substitute quality for a given number of radial spokes as compared to gridding. However, the increased reconstruction time of non-Cartesian parallel imaging reconstruction is difficult to motivate from this improvement. Because the CT substitute algorithm was insensitive to moderate subsampling, data for a CT substitute could be collected in as little as minute and reconstructed with gridding without deteriorating the CT substitute quality.
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| 5. |
- Johansson, Adam, et al.
(author)
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Improved quality of computed tomography substitute derived from magnetic resonance (MR) data by incorporation of spatial information : potential application for MR-only radiotherapy and attenuation correction in positron emission tomography
- 2013
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In: Acta Oncologica. - 0284-186X .- 1651-226X. ; 52:7, s. 1369-1373
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Journal article (peer-reviewed)abstract
- Background: Estimation of computed tomography (CT) equivalent data, i.e. a substitute CT (s-CT), from magnetic resonance (MR) images is a prerequisite both for attenuation correction of positron emission tomography (PET) data acquired with a PET/MR scanner and for dose calculations in an MR-only radiotherapy workflow. It has previously been shown that it is possible to estimate Hounsfield numbers based on MR image intensities, using ultra short echo-time imaging and Gaussian mixture regression (GMR). In the present pilot study we investigate the possibility to also include spatial information in the GMR, with the aim to improve the quality of the s-CT. Material and methods: MR and CT data for nine patients were used in the present study. For each patient, GMR models were created from the other eight patients, including either both UTE image intensities and spatial information on a voxel by voxel level, or only UTE image intensities. The models were used to create s-CT images for each respective patient. Results: The inclusion of spatial information in the GMR model improved the accuracy of the estimated s-CT. The improvement was most pronounced in smaller, complicated anatomical regions as the inner ear and post-nasal cavities. Conclusions: This pilot study shows that inclusion of spatial information in GMR models to convert MR data to CT equivalent images is feasible. The accuracy of the s-CT is improved and the spatial information could make it possible to create a general model for the conversion applicable to the whole body.
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| 6. |
- Johansson, Adam, 1984-
(author)
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Magnetic resonance imaging with ultrashort echo time as a substitute for X-ray computed tomography
- 2014
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Doctoral thesis (other academic/artistic)abstract
- Radiotherapy dose calculations have evolved from simple factor based methods performed with pen and paper, into computationally intensive simulations based on Monte Carlo theory and energy deposition kernel convolution.Similarly, in the field of positron emission tomography (PET), attenuation correction, which was originally omitted entirely, is now a crucial component of any PET reconstruction algorithm.Today, both of these applications – radiotherapy and PET – derive their needed in-tissue radiation attenuation coefficients from images acquired with X-ray computed tomography (CT). Since X-ray images are themselves acquired using ionizing radiation, the intensity at a point in an image will reflect the radiation interaction properties of the tissue located at that point.Magnetic resonance imaging (MRI), on the other hand, does not use ionizing radiation. Instead MRI make use of the net transverse magnetization resulting from the spin polarization of hydrogen nuclei. MR image contrast can be varied to a greater extent than CT and the soft tissue contrast is, for most MR sequences, superior to that of CT. Therefore, for many cases, MR images provide a considerable advantage over CT when identifying or delineating tumors or other diseased tissues.For this reason, there is an interest to replace CT with MRI for a great number of diagnostic and therapeutic workflows. Also, replacing CT with MRI would reduce the exposure to ionizing radiation experienced by patients and, by extension, reduce the associated risk to induce cancer.In part MRI has already replaced CT, but for radiotherapy dose calculations and PET attenuation correction, CT examinations are still necessary in clinical practice. One of the reasons is that the net transverse magnetization imaged in MRI cannot be converted into attenuation coefficients for ionizing radiation in a straightforward way. More specifically, regions with similar appearance in magnetic resonance (MR) images, such as bone and air pockets, are found at different ends of the spectrum of attenuation coefficients present in the human body. In a CT image, bone will appear bright white and air as black corresponding to high and no attenuation, respectively. In an MR image, bone and air both appear dark due to the lack of net transverse magnetization.The weak net transverse magnetization of bone is a result of low hydrogen density and rapid transverse relaxation. A particular category of MRI sequences with so-called ultrashort echo time (UTE) can sample the MRI signal from bone before it is lost due to transverse relaxation. Thus, UTE sequences permit bone to be imaged with MRI albeit with weak intensity and poor resolution.Imaging with UTE in combination with careful image analysis can permit ionizing-radiation attenuation-maps to be derived from MR images. This dissertation and appended articles present a procedure for this very purpose. However, as attenuation coefficients are radiation-quality dependent the output of the method is a Hounsfield unit map, i.e. a substitute for a CT image. It can be converted into an attenuation map using conventional clinical procedure.Obviating the use of CT would reduce the number of examinations that patients have to endure during preparation for radiotherapy. It would also permit PET attenuation correction to be performed on images from the new imaging modality that combines PET and MRI in one scanner – PET/MR.
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| 7. |
- Johansson, Adam, et al.
(author)
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Voxel-wise uncertainty in CT substitute derived from MRI
- 2012
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In: Medical physics (Lancaster). - : American Association of Physicists in Medicine. - 0094-2405. ; 39:6, s. 3283-3290
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Journal article (peer-reviewed)abstract
- Purpose: In an earlier work, we demonstrated that substitutes for CT images can be derived from MR images using ultrashort echo time (UTE) sequences, conventional T2 weighted sequences, and Gaussian mixture regression (GMR). In this study, we extend this work by analyzing the uncertainties associated with the GMR model and the information contributions from the individual imaging sequences.Methods: An analytical expression for the voxel-wise conditional expected absolute deviation (EAD) in substitute CT (s-CT) images was derived. The expression depends only on MR images and can thus be calculated along with each s-CT image. The uncertainty measure was evaluated by comparing the EAD to the true mean absolute prediction deviation (MAPD) between the s-CT and CT images for 14 patients. Further, the influence of the different MR images included in the GMR model on the generated s-CTs was investigated by removing one or more images and evaluating the MAPD for a spectrum of predicted radiological densities.Results: The largest EAD was predicted at air-soft tissue and bone-soft tissue interfaces. The EAD agreed with the MAPD in both these regions and in regions with lower EADs, such as the brain. Two of the MR images included in the GMR model were found to be mutually redundant for the purpose of s-CT generation.Conclusions: The presented uncertainty estimation method accurately predicts the voxel-wise MAPD in s-CT images. Also, the non-UTE sequence previously used in the model was found to be redundant.
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| 8. |
- Jonsson, Joakim H, et al.
(author)
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Internal fiducial markers and susceptibility effects in MRI : simulation and measurement of spatial accuracy
- 2012
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In: International Journal of Radiation Oncology, Biology, Physics. - : Elsevier BV. - 0360-3016 .- 1879-355X. ; 82:5, s. 1612-1618
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Journal article (peer-reviewed)abstract
- BACKGROUND: It is well-known that magnetic resonance imaging (MRI) is preferable to computed tomography (CT) in radiotherapy target delineation. To benefit from this, there are two options available: transferring the MRI delineated target volume to the planning CT or performing the treatment planning directly on the MRI study. A precondition for excluding the CT study is the possibility to define internal structures visible on both the planning MRI and on the images used to position the patient at treatment. In prostate cancer radiotherapy, internal gold markers are commonly used, and they are visible on CT, MRI, x-ray, and portal images. The depiction of the markers in MRI are, however, dependent on their shape and orientation relative the main magnetic field because of susceptibility effects. In the present work, these effects are investigated and quantified using both simulations and phantom measurements.METHODS AND MATERIALS: Software that simulated the magnetic field distortions around user defined geometries of variable susceptibilities was constructed. These magnetic field perturbation maps were then reconstructed to images that were evaluated. The simulation software was validated through phantom measurements of four commercially available gold markers of different shapes and one in-house gold marker.RESULTS: Both simulations and phantom measurements revealed small position deviations of the imaged marker positions relative the actual marker positions (<1 mm).CONCLUSION: Cylindrical gold markers can be used as internal fiducial markers in MRI.
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| 9. |
- Jonsson, Joakim H, et al.
(author)
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Registration accuracy for MR images of the prostate using a subvolume based registration protocol
- 2011
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In: Radiation Oncology. - 1748-717X .- 1748-717X. ; 6:1, s. 73-
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Journal article (peer-reviewed)abstract
- BACKGROUND: In recent years, there has been a considerable research effort concerning the integration of magnetic resonance imaging (MRI) into the external radiotherapy workflow motivated by the superior soft tissue contrast as compared to computed tomography. Image registration is a necessary step in many applications, e.g. in patient positioning and therapy response assessment with repeated imaging. In this study, we investigate the dependence between the registration accuracy and the size of the registration volume for a subvolume based rigid registration protocol for MR images of the prostate.METHODS: Ten patients were imaged four times each over the course of radiotherapy treatment using a T2 weighted sequence. The images were registered to each other using a mean square distance metric and a step gradient optimizer for registration volumes of different sizes. The precision of the registrations was evaluated using the center of mass distance between the manually defined prostates in the registered images. The optimal size of the registration volume was determined by minimizing the standard deviation of these distances.RESULTS: We found that prostate position was most uncertain in the anterior-posterior (AP) direction using traditional full volume registration. The improvement in standard deviation of the mean center of mass distance between the prostate volumes using a registration volume optimized to the prostate was 3.9 mm (p < 0.001) in the AP direction. The optimum registration volume size was 0 mm margin added to the prostate gland as outlined in the first image series.CONCLUSIONS: Repeated MR imaging of the prostate for therapy set-up or therapy assessment will both require high precision tissue registration. With a subvolume based registration the prostate registration uncertainty can be reduced down to the order of 1 mm (1 SD) compared to several millimeters for registration based on the whole pelvis.
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| 10. |
- Jonsson, Joakim H, et al.
(author)
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Treatment planning using MRI data: an analysis of the dose calculation accuracy for different treatment regions
- 2010
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In: Radiation Oncology. - 1748-717X .- 1748-717X. ; 5, s. 62-
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Journal article (peer-reviewed)abstract
- BACKGROUND: Because of superior soft tissue contrast, the use of magnetic resonance imaging (MRI) as a complement to computed tomography (CT) in the target definition procedure for radiotherapy is increasing. To keep the workflow simple and cost effective and to reduce patient dose, it is natural to strive for a treatment planning procedure based entirely on MRI. In the present study, we investigate the dose calculation accuracy for different treatment regions when using bulk density assignments on MRI data and compare it to treatment planning that uses CT data.METHODS: MR and CT data were collected retrospectively for 40 patients with prostate, lung, head and neck, or brain cancers. Comparisons were made between calculations on CT data with and without inhomogeneity corrections and on MRI or CT data with bulk density assignments. The bulk densities were assigned using manual segmentation of tissue, bone, lung, and air cavities.RESULTS: The deviations between calculations on CT data with inhomogeneity correction and on bulk density assigned MR data were small. The maximum difference in the number of monitor units required to reach the prescribed dose was 1.6%. This result also includes effects of possible geometrical distortions.CONCLUSIONS: The dose calculation accuracy at the investigated treatment sites is not significantly compromised when using MRI data when adequate bulk density assignments are made. With respect to treatment planning, MRI can replace CT in all steps of the treatment workflow, reducing the radiation exposure to the patient, removing any systematic registration errors that may occur when combining MR and CT, and decreasing time and cost for the extra CT investigation.
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