Magnetic resonance spectroscopy imaging (MRSI) and brain functional magnetic resonance imaging (fMRI) for radiotherapy treatment planning of glioma

Conventional radiotherapy of glioma is ineffective due to uncertainties in target delineation, inadequate radiation dose, and difficulties in identifying radio-resistant high-grade tumor for dose escalation. Magnetic resonance spectroscopy imaging (MRSI) and functional magnetic resonance imaging (fMRI) provide information on altered metabolic activity of tumor cells and functionally critical brain tissues, which are not available from anatomical imaging. In this paper, we review the pathological and physiological information that might be derived from MRSI and fMRI to better delineate the treatment volume and critical organs for glioma radiotherapy. Technical difficulties for incorporating MRSI and fMRI into radiotherapy treatment planning process are discussed and potential solutions are presented. A fusion protocol is used to illustrate the feasibility of registering MRSI and fMRI with simulation CT for one glioma case. An IMRT (intensity-modulated radiotherapy) dose painting plan for this case is also presented using the fused MRSI and fMRI to delineate the clinical target volumes and Broca's area.