Validation of quantitative magnetic resonance imaging techniques in head and neck healthy structures involved in the salivary and swallowing function: Accuracy and repeatability.

Background and Purpose: Radiation-induced damage to the organs at risk (OARs) in head-and-neck cancer (HNC) patient can result in long-term complications. Quantitative magnetic resonance imaging (qMRI) techniques such as diffusion-weighted imaging (DWI), DIXON for fat fraction (FF) estimation and T2 mapping could potentially provide a spatial assessment of such damage. The goal of this study is to validate these qMRI techniques in terms of accuracy in phantoms and repeatability in-vivo across a broad selection of healthy OARs in the HN region. Materials and Methods: Scanning was performed at a 3 T diagnostic MRI scanner, including the calculation of apparent diffusion coefficient (ADC) from DWI, FF and T2 maps. Phantoms were scanned to estimate the qMRI techniques bias using Bland-Altman statistics. Twenty-six healthy subjects were scanned twice in a test-retest study to determine repeatability. Repeatability coefficients (RC) were calculated for the parotid, submandibular, sublingual and tubarial salivary glands, oral cavity, pharyngeal constrictor muscle and brainstem. Additionally, a linear mixed-effect model analysis was used to evaluate the effect of subject-specific characteristics on the qMRI values. Results: Bias was 0.009x10-3 mm2/s for ADC, -0.7 % for FF and -7.9 ms for T2. RCs ranged 0.11-0.25x10-3 mm2/s for ADC, 1.2-6.3 % for FF and 2.5-6.3 ms for T2. A significant positive linear relationship between age and the FF and T2 for some of the OARs was found. Conclusion: These qMRI techniques are feasible, accurate and repeatable, which is promising for treatment response monitoring and/or differentiating between healthy and unhealthy tissues due to radiation-induced damage in HNC patients.

The noise navigator for MRI-guided radiotherapy: an independent method to detect physiological motion.

Motion is problematic during radiotherapy as it could lead to potential underdosage of the tumor, and/or overdosage in organs-at-risk. A solution is adaptive radiotherapy guided by magnetic resonance imaging (MRI). MRI allows for imaging of target volumes and organs-at-risk before and during treatment delivery with superb soft tissue contrast in any desired orientation, enabling motion management by means of (real-time) adaptive radiotherapy. The noise navigator, which is independent of the MR signal, could serve as a secondary motion detection method in synergy with MR imaging. The feasibility of respiratory motion detection by means of the noise navigator was demonstrated previously. Furthermore, from electromagnetic simulations we know that the noise navigator is sensitive to tissue displacement and thus could in principle be used for the detection of various types of motion. In this study we demonstrate the detection of various types of motion for three anatomical use cases of MRI-guided radiotherapy, i.e. torso (bulk movement and variable breathing), head-and-neck (swallowing) and cardiac. Furthermore, it is shown that the noise navigator can detect bulk movement, variable breathing and swallowing on a hybrid 1.5 T MRI-linac system. Cardiac activity detection through the noise navigator seems feasible in an MRI-guided radiotherapy setting, but needs further optimization. The noise navigator is a versatile and fast (millisecond temporal resolution) motion detection method independent of MR signal that could serve as an independent verification method to detect the occurrence of motion in synergy with real-time MRI-guided radiotherapy.