Evaluation of Effective Parameters on Quality of Magnetic Resonance Imaging‑computed Tomography Image Fusion in Head and Neck Tumors for Application in Treatment Planning

In radiation therapy, computed tomography (CT) simulation is used for treatment planning to define the location of tumor. Magnetic resonance imaging (MRI)‑CT image fusion leads to more efficient tumor contouring. This work tried to identify the practical issues for the combination of CT and MRI images in real clinical cases. The effect of various factors is evaluated on image fusion quality.

In this study, the data of thirty patients with brain tumors were used for image fusion. The effect of several parameters on possibility and quality of image fusion was evaluated. These parameters include angles of the patient’s head on the bed, slices thickness, slice gap, and height of the patient’s head.

According to the results, the first dominating factor on quality of image fusion was the difference slice gap between CT and MRI images (cor = 0.86, P < 0.005) and second factor was the angle between CT and MRI slice in the sagittal plane (cor = 0.75, P < 0.005). In 20% of patients, this angle was more than 28° and image fusion was not efficient. In 17% of patients, difference slice gap in CT and MRI was >4 cm and image fusion quality was <25%.

The most important problem in image fusion is that MRI images are taken without regard to their use in treatment planning. In general, parameters related to the patient position during MRI imaging should be chosen to be consistent with CT images of the patient in terms of location and angle.