Fifty-seventh annual meeting of the American association of physicists in medicine
WE-G-BRD-07: Automated MR Image Standardization and Auto-Contouring Strategy for MRI-Based Adaptive Brachytherapy for Cervix Cancer
MRI-based adaptive brachytherapy (ABT) is an emerging treatment modality for patients with gynecological tumors. However, MR image intensity non-uniformities (IINU) can vary from fraction to fraction, complicating image interpretation and auto-contouring accuracy. We demonstrate here an automated MR image standardization and auto-contouring strategy for MRI-based ABT of cervix cancer.
MR image standardization consisted of: 1) IINU correction using the MNI N3 algorithm, 2) noise filtering using anisotropic diffusion, and 3) signal intensity normalization using the volumetric median. This post-processing chain was implemented as a series of custom Matlab and Java extensions in MIM (v6.4.5, MIM Software) and was applied to 3D T2 SPACE images of six patients undergoing MRI-based ABT at 3T. Coefficients of variation (CV=σ/µ) were calculated for both original and standardized images and compared using Mann-Whitney tests. Patient-specific cumulative MR atlases of bladder, rectum, and sigmoid contours were constructed throughout ABT, using original and standardized MR images from all previous ABT fractions. Auto-contouring was performed in MIM two ways: 1) best-match of one atlas image to the daily MR image, 2) multi-match of all previous fraction atlas images to the daily MR image. Dice's Similarity Coefficients (DSCs) were calculated for auto-generated contours relative to reference contours for both original and standardized MR images and compared using Mann-Whitney tests.
Significant improvements in CV were detected following MR image standardization (p=0.0043), demonstrating an improvement in MR image uniformity. DSCs consistently increased for auto-contoured bladder, rectum, and sigmoid following MR image standardization, with the highest DSCs detected when the combination of MR image standardization and multi-match cumulative atlas-based auto-contouring was utilized.
MR image standardization significantly improves MR image uniformity. The combination of MR image standardization and multi-match cumulative atlas-based auto-contouring produced the highest DSCs and is a promising strategy for MRI-based ABT for cervix cancer.