Repetitive MRI of organs at risk in head and neck cancer patients undergoing radiotherapy

With emerging technical advances like real-time MR imaging during radiotherapy (RT) with an integrated MR linear accelerator, it will soon be possible to analyze changes in the organs at risk (OARs) during radiotherapy without additional effort for the patients. Until then, patients have to undergo additional MR imaging and often without the same immobilization devices as used for radiotherapy. Consequently, studies with repetitive MRI during the course of radiotherapy are rare, with low patient numbers and with the challenge of registration between the different MR sequences and the varying imaging time points. This review focuses on studies with at least two MRIs, one before and another either during or post-RT, in order to report on RT-induced changes in normal tissues and their correlation with toxicity. We therefore included clinical studies published in English until March 2019, with repetitive MRI of OARs in head and neck cancer patients receiving external beam radiotherapy. OARs analyzed were salivary glands, musculoskeletal structures and bones. MR sequences used included T1, T2, dynamic contrast enhanced (DCE) imaging, diffusion-weighted imaging (DWI), DIXON and MR sialography.