Optimizing the Radiation Treatment Planning of Brain Tumors by Integration of Functional MRI and White Matter Tractography

BACKGROUND: Diffusion tensor imaging (DTI) and functional magnetic resonance imaging (fMRI) present the ability to selectively protect functional regions and fiber tracts of the brain when brain tumors are treated with radiotherapy. OBJECTIVE: This study aimed to assess whether the incorporation of fMRI and DTI data into the radiation treatment planning process of brain tumors could prevent the neurological parts of the brain from high doses of radiation. MATERIAL AND METHODS: In this investigational theoretical study, the fMRI and DTI data were obtained from eight glioma patients. This patient-specific fMRI and DTI data were attained based on tumor location, the patient’s general conditions, and the importance of the functional and fiber tract areas. The functional regions, fiber tracts, anatomical organs at risk, and the tumor were contoured for radiation treatment planning. Finally, the radiation treatment planning with and without fMRI & DTI information was obtained and compared. RESULTS: The mean dose to the functional areas and the maximum doses were reduced by 25.36% and 18.57% on fMRI & DTI plans compared with the anatomical plans. In addition, 15.59% and 20.84% reductions were achieved in the mean and maximum doses of the fiber tracts, respectively. CONCLUSION: This study demonstrated the feasibility of using fMRI and DTI data in radiation treatment planning to maximize radiation protection of the functional cortex and fiber tracts. The mean and maximum doses significantly decreased to neurologically relevant brain regions, resulting in reducing the neuro-cognitive complications and improving the patient’s quality of life.