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Prospective Feasibility Trial of Radiotherapy Target Definition for Head and Neck Cancer Using 3-Dimensional PET and CT Imaging

¹ Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
² Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
³ Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
⁴ Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
⁵ Biostatistics Shared Resource, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee

View larger version (49K): [in a new window]   FIGURE 1. Typical landmarks demonstrate correlation of images for coregistration (patient 6). High-resolution CT anatomic data (A) and corresponding color-enhanced 18F-FDG PET emission image (B). Image pair shows correspondence between alignment points used for registration of the 2 datasets.

View larger version (49K): [in a new window]   FIGURE 2. PET contour contained within corresponding CT contour (patient 5). CT (A), corresponding color-enhanced 18F-FDG PET (B), and coregistered images (C). Extent of CT GTV is indicated by blue contour (A and B). Corresponding PET contour is in yellow (A and B). This example demonstrates an 18F-FDG–avid region within CT-defined GTV.

View larger version (92K): [in a new window]   FIGURE 3. Example variations in agreement between PET and CT contours (patient 6). Transverse CT (A) and corresponding 18F-FDG PET image (B). In this example there is good agreement between CT (orange) and PET (yellow) contours of right lymph node. PET definition of primary target contour (red), however, includes more tissue laterally when compared with CT contour of this same area (green).

View larger version (67K): [in a new window]   FIGURE 4. Primary CT and PET contour overlap (patient 4). CT (A) and corresponding 18F-FDG PET image (B) of right side hypermetabolic lymph node. This slice level shows CT (yellow) and PET (green) contours nearly overlapping. Taking into account slight differences between contours on other slice levels, original CT volume was increased by 3.4 cm3 to include portions of PET-avid regions.

View larger version (70K): [in a new window]   FIGURE 5. PET contour extending outside CT-defined contour (patient 2). CT (A) and corresponding 18F-FDG PET image (B). PET definition of right side node (blue contour) extends beyond CT-defined node (green contour) to include other soft tissue. CT-defined GTV (central red contour) shows no corresponding PET uptake in this region at this slice level.

View larger version (30K): [in a new window]   FIGURE 6. Visualization of 18F-FDG PET–avid lymph nodes (patient 6). CT (A), 18F-FDG PET (B), and blended view (C). CT contour of right side lymph node is in aqua, and 18F-FDG PET contour of this same node is in red. 18F-FDG PET image (B) indicates 18F-FDG–avid node on left side not visualized on CT.

View larger version (50K): [in a new window]   FIGURE 7. IMRT dose distribution (patient 2). Five-field IMRT plan is optimized to CT GTV (red contour in A). Corresponding PET GTV (yellow contour) is also shown in (A). IMRT plan is optimized to combined PET/CT GTV (red contour in B).