Evaluation of automatic contour propagation in T2-weighted 4DMRI for normal-tissue motion assessment using internal organ-at-risk volume (IRV)

Purpose: The purpose of this study was to evaluate the quality of automatically propagated contours of organs at risk (OARs) based on respiratory-correlated navigator-triggered four-dimensional magnetic resonance imaging (RC-4DMRI) for calculation of internal organ-at-risk volume (IRV) to account for intra-fractional OAR motion. Methods and Materials: T2-weighted RC-4DMRI images were of 10 volunteers acquired and reconstructed using an internal navigator-echo surrogate and concurrent external bellows under an IRB-approved protocol. Four major OARs (lungs, heart, liver, and stomach) were delineated in the 10-phase 4DMRI. Two manual-contour sets were delineated by two clinical personnel and two automatic-contour sets were propagated using free-form deformable image registration. The OAR volume variation within the 10phase cycle was assessed and the IRV was calculated as the union of all OAR contours. The OAR contour similarity between the navigator-triggered and bellows-rebinned 4DMRI was compared. A total of 2400 contours were compared to the most probable ground truth with a 95% confidence level (S95) in similarity, sensitivity, and specificity using the simultaneous truth and performance level estimation (STAPLE) algorithm. Results: Visual inspection of automatically propagated contours finds that approximately 5 10% require manual correction. The similarity, sensitivity, and specificity between manual and automatic contours are indistinguishable (P > 0.05). The Jaccard similarity indexes are 0.92 +/- 0.02 (lungs), 0.89 +/- 0.03 (heart), 0.92 +/- 0.02 (liver), and 0.83 +/- 0.04 (stomach). Volume variations within the breathing cycle are small for the heart (2.6 +/- 1.5%), liver (1.2 +/- 0.6%), and stomach (2.6 1 - 0.8%), whereas the IRV is much larger than the OAR volume by: 20.3 +/- 8.6% (heart), 24.0 +/- 8.6% (liver), and 47.6 +/- 20.2% (stomach). The Jaccard index is higher in navigator-triggered than bellows-rebinned 4DMRI by 4% (P < 0.05), due to the higher image quality of navigator-based 4DMRI. Conclusion: Automatic and manual OAR contours from Navigator-triggered 4DMRI are not statistically distinguishable. The navigator-triggered 4DMRI image provides higher contour quality than bellows-rebinned 4DMRI. The IRVs are 20 50% larger than OAR volumes and should be considered in dose estimation.