Detection and localization of radiation-induced pneumonitis using T2-mapping magnetic resonance imaging
Klaar R, Begaj K, Rabe M, Corradini S, Eze C, Belka C, Sabel B, Landry G, Kurz C, Dinkel J (2025)
Publication Type: Journal article
Publication year: 2025
Journal
Book Volume: 36
Article Number: 100878
DOI: 10.1016/j.phro.2025.100878
Abstract
Background and purpose: Radiation-induced pneumonitis (RP), a complication of lung radiotherapy, occurs at the earliest 6–12 weeks post-treatment. To assess RP, repeated computed tomography (CT)-scans post-radiotherapy are standard-of-care, but increase the patients’ dose burden and secondary cancer risk. We propose a pipeline based on magnetic resonance imaging (MRI) T2-mapping acquired 2–3 months post-radiotherapy that provides an automated patient stratification and initial segmentation of the RP lung volume. Materials and methods: In total, 24 lung tumor patients received MRI-guided radiotherapy at a 0.35 T MR-Linac. MRI T2-maps were retrieved from T2-weighted images acquired at a diagnostic 1.5 T MRI-scanner 8–20 weeks post-radiotherapy. Mean baseline-corrected T2-values were calculated in the planning target volume and the lung volume receiving≥20 Gy excluding the gross tumor volume. Their stratification potential (endpoint RP grade≥1) was assessed in a univariate receiver operating characteristic curve–area under the curve (ROC–AUC) analysis using bootstrapping. Significant differences were probed (Mann–Whitney U test, αStats=0.05). Thresholding using the maximal Youden index was utilized for the T2-based RP segmentation. The Dice similarity coefficient (DSC), 95% Hausdorff distance (HD95), sensitivity, precision and segmentation AUC (SegAUC) were used for the comparison with the ground-truth CT-based RP segmentation. Results: RP grade≥1 was diagnosed in 15/24 patients. The T2-values in both regions achieved significant separation of distributions (median 13.8/2.9 ms and 5.0/-2.6 ms RP/non-RP) with p-values<0.05 and AUC≥0.76. Moderate quantitative agreement was found between T2-based and ground-truth segmentation (DSC=0.32, HD95=20.1 mm and SegAUC=0.76). Conclusion: MRI T2-values allow an automated RP patient stratification and initial RP lung volume estimation.
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How to cite
APA:
Klaar, R., Begaj, K., Rabe, M., Corradini, S., Eze, C., Belka, C.,... Dinkel, J. (2025). Detection and localization of radiation-induced pneumonitis using T2-mapping magnetic resonance imaging. Physics and Imaging in Radiation Oncology, 36. https://doi.org/10.1016/j.phro.2025.100878
MLA:
Klaar, Rabea, et al. "Detection and localization of radiation-induced pneumonitis using T2-mapping magnetic resonance imaging." Physics and Imaging in Radiation Oncology 36 (2025).
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