In-vivo assessment of tissue parameters with intra- and inter-patient variation using dual-energy CT

Purpose/Objective:

The precise and reliable knowledge of radiological tissue properties is essential for a multitude of radiotherapeutic applications, such as input parameters for Monte Carlo simulation, stoichiometric CT calibration as well as for tissue-mimicking phantoms. However, so far only limited data based on ex-vivo experimental studies is available, summarized in ICRU46. Utilizing a clinically validated Dual-Energy-CT (DECT)-based tissue characterization approach (DirectSPR), we present a precise in-vivo assessment of relative electron density (RED), effective atomic number (EAN) and stopping-power ratio (SPR) for organs in the head and pelvis in a patient cohort analysis of clinical DECT scans.
Material/Methods:
Organ-specific tissue parameters were obtained from clinical DECT scans of 107 brain-tumour and 103 pelvic cancer patients applying the DirectSPR approach. DirectSPR is characterised by a voxel-wise, patient-specific parameter determination based on a specific superposition of low- and high-energy DECT scans. In total, six structures in the head (brain, brainstem, spinal cord, chiasm, optical nerve, lens) and four in the pelvic region (prostate, kidney, liver, bladder) were investigated. To minimise contamination from surrounding tissues, clinical contours were shrunk and smoothed in 2D. Image slices with artefacts (e.g. due to metal implants) were omitted from analysis. Organ tissue parameters were characterised regarding the cohort mean value as well as the variation within each patient (2σ_intra) and between the investigated patients (2σ_inter).
Results:
For 10 organs, including 4 organs not listed in ICRU46, the mean RED, EAN and SPR as well as their respective intra- and inter-patient variation were determined (Table 1). Results are exemplarily illustrated for SPR, crucial for proton therapy planning (Figure 1). SPR intra-patient variation was higher than 1.4% (1.4-5.3%) in all organs and always exceeded the inter-patient variation of the organ mean SPR (0.5-2.0%). The largest intra-patient variation was observed in the kidney, where renal parenchyma and calyx were included in the contours. The average inter-patient variation over all organs was 1.2%, highlighting the potential benefit of considering variation in tissue parameters instead of using tabulated mean values. For brain, lens, liver and urine the ICRU46 values are within the determined 2σ_inter interval around the respective mean value, while for prostate and kidney the ICRU46 values are outside this interval. For kidney, cohort mean SPR was 2.3% below ICRU46.
Conclusion:
Radiological tissue parameters in the head and pelvis were characterised in-vivo in a large patient cohort using dual-energy CT. This substantially expands and reassesses the current standard database defined in ICRU46 by smaller substructures in the brain as well as by the quantification of organ-specific inter- and intra-patient variation. Our results can be used as input to simulate intra- and inter-patient variability e.g. in Monte Carlo simulations.