Distortion inherent to magnetic resonance imaging can lead to geometric miss in radiosurgery planning.

Abstract

Anatomic distortion is present in all magnetic resonance imaging (MRI) data because of nonlinearity of gradient fields; it measures up to several millimeters. We evaluated the potential for uncorrected MRI to lead to geometric miss of the target volume in stereotactic radiosurgery (SRS). Twenty-eight SRS cases were studied retrospectively. MRI scans were corrected for gradient nonlinearity distortion in 3 dimensions, and gross tumor volumes (GTVs) were contoured. The manufacturer-specified distortion field was then reapplied to GTV masks to allow measurement of GTV displacement in uncorrected images. The uncorrected GTV was used for SRS planning, and the dose received by the true (corrected) GTV was measured. Median displacement of the GTV resulting from gradient distortion was 1.2 mm (interquartile range, 0.1-2.3 mm), with a minimum of 0 mm and a maximum of 3.9 mm. Eight of the 28 cases met a priori criteria for "geometric miss." Although MRI distortion is often subtle on visual inspection, there is a significant clinical impact of this distortion on SRS planning. Distortion-corrected MRI should uniformly be used for intracranial radiosurgery planning because uncorrected MRI can lead to potential geometric miss.