Abstract
BACKGROUND: The poor soft tissue resolution of four-dimensional computed tomography (4D-CT) limits its utility in delineating liver cancer target volumes. PURPOSE: To compare the consistency between four-dimensional magnetic resonance imaging (4D-MRI) using T1-weighted (T1w) radial stack-of-stars (SOS) gradient echo (GRE) sequences and 4D-CT in assessing tumor motion and morphology, for defining internal target volume in liver tumor radiotherapy. MATERIALS AND METHODS: Position and geometric accuracy and the impact of baseline drift between 4D-MRI (using T1w radial SOS GRE sequence) and 4D-CT were evaluated using a motion phantom. Ten primary liver cancer patients were included for comparison. Volume, centroid position, dice similarity coefficient (DSC), and 95% Hausdorff distance (HD95) were assessed. RESULTS: Baseline drift did not significantly affect target motion or morphology descriptions in 4D-MRI (normal vs. drift: p = 0.139, DSC = 0.94 ± 0.01, HD95 = 1.82 ± 0.43) or 4D-CT (p = 0.051, DSC = 0.95 ± 0.03, HD95 = 1.59 ± 0.71), but significantly impacted target volume delineation (4D-CT: p = 0.040; 4D-MRI: p = 0.024). Phantom studies showed consistent motion amplitude measurements between modalities for small motion patterns (2 s/10 mm; p = 0.192), while 4D-MRI underestimated amplitudes in large patterns (4 s/20 mm; p = 0.012), consistent with patient data (small: p = 0.453; large: p = 0.004). Volume analysis revealed 4D-MRI underestimated phantom volumes by 6.33% (2 s/10 mm) and 6.10% (4 s/20 mm) versus ground truth, contrasting with 4D-CT's overestimations (2.01% and 2.51%). Clinically, 4D-CT-derived gross tumor volumes (GTVs)/internal tumor volumes (ITVs) exceeded 4D-MRI measurements, particularly in large motion patterns (GTVs: (11.79 ± 13.13)%; ITVs: (22.08 ± 18.59)%) versus small patterns (GTVs: (9.70 ± 9.10)%; ITVs: (11.01 ± 8.05)%). Temporal stability metrics were comparable between modalities for small motion (phantom DSC p = 0.770, HD95 p = 0.131; patient DSC p = 0.156), with overall GTV/ITV spatial agreement (DSC: 0.79 ± 0.06 vs. 0.83 ± 0.04 for 4D-CT vs. 4D-MRI). CONCLUSION: The results show 4D-MRI with a T1w radial SOS GRE sequence matches 4D-CT's accuracy in target motion characterization and morphological delineation, while providing precise tumor delineation for primary liver cancer patients.