Glioma consensus contouring recommendations from a MR-Linac International Consortium Research Group and evaluation of a
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CLINICAL STUDY
Glioma consensus contouring recommendations from a MR‑Linac International Consortium Research Group and evaluation of a CT‑MRI and MRI‑only workflow Chia‑Lin Tseng1 · James Stewart1 · Gillian Whitfield2 · Joost J. C. Verhoeff3 · Joseph Bovi4 · Hany Soliman1 · Caroline Chung5 · Sten Myrehaug1 · Mikki Campbell1 · Eshetu G. Atenafu6 · Chinthaka Heyn7 · Sunit Das8 · James Perry9 · Mark Ruschin1 · Arjun Sahgal1 Received: 5 July 2020 / Accepted: 23 August 2020 © The Author(s) 2020
Abstract Introduction This study proposes contouring recommendations for radiation treatment planning target volumes and organsat-risk (OARs) for both low grade and high grade gliomas. Methods Ten cases consisting of 5 glioblastomas and 5 grade II or III gliomas, including their respective gross tumor volume (GTV), clinical target volume (CTV), and OARs were each contoured by 6 experienced neuro-radiation oncologists from 5 international institutions. Each case was first contoured using only MRI sequences (MRI-only), and then re-contoured with the addition of a fused planning CT (CT-MRI). The level of agreement among all contours was assessed using simultaneous truth and performance level estimation (STAPLE) with the kappa statistic and Dice similarity coefficient. Results A high level of agreement was observed between the GTV and CTV contours in the MRI-only workflow with a mean kappa of 0.88 and 0.89, respectively, with no statistically significant differences compared to the CT-MRI workflow (p = 0.88 and p = 0.82 for GTV and CTV, respectively). Agreement in cochlea contours improved from a mean kappa of 0.39 to 0.41, to 0.69 to 0.71 with the addition of CT information (p
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