Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology · 2026
Technical and biological validation of prostate apparent diffusion coefficient measurements on an MRI-linac.
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McHugh Damien J, Swinton Martin, Hart Claire A, Martinez Diego Sanchez, Moore Chris, Oates Jeremy, Lau Maurice, Ramani Vijay, Sachdeva Ashwin, Clarke Noel, Buckley David L, van Herk Marcel, Hudson Andrew, Choudhury Ananya, Bristow Robert G, Dubec Michael J
Аннотация
PURPOSE: Quantitative MRI biomarkers require validation before being used to assess treatment response or inform biological image-guided adaptive radiotherapy on MRI-linacs. This work contributes to the technical validation of prostate apparent diffusion coefficient (ADC) measurements by evaluating phantom accuracy, intra-scanner repeatability, and inter-scanner reproducibility, and contributes to biological validation by evaluating correlations with histology.
METHODS: Phantom ADC was measured on a 1.5 T MRI-linac (MRL) and 1.5 T diagnostic MR (dMR). ADC in non-lesion tissue (ADCNL) and in the dominant intraprostatic lesion (ADCDIL) was measured twice in 16 patients on MRL and/or dMR before prostatectomy. Repeatability was quantified through Bland-Altman analysis and within-subject coefficients of variation (wCV). Reproducibility was quantified through Bland-Altman analysis and comparison with diffusion microstructural model simulations. Tissue samples were analysed using haematoxylin and eosin (H&E) and immunohistochemistry (IHC). Spearman's ρ quantified relationships between ADC and histology-derived epithelial (EF) and stroma (SF) fraction.
RESULTS: Phantom mean bias was 0.024 (MRL) and -0.019 (dMR) µm2/ms. Patient ADCs pooled across MRL and dMR exhibited excellent repeatability: wCVNL = 1.4%, wCVDIL = 4.6%. ADCNL was higher on MRL than dMR: mean bias [95% confidence interval] = 0.20 [0.14, 0.26] µm2/ms, consistent with simulations. Correlations between ADCDIL and histology-derived metrics were consistent in magnitude and direction for both scanners. Pooled data showed ADCDIL and EFH&E were negatively correlated (ρ = -0.69, p = 0.003); ADCDIL and SFH&E were positively correlated (ρ = 0.70, p = 0.003).
CONCLUSION: Systematic differences exist between MRI-linac and diagnostic MR measurements. ADCDIL from both systems showed similar correlations with tissue microstructure. This study contributes to the technical and biological validation of diagnostic MR and MRI-linac prostate ADC.
METHODS: Phantom ADC was measured on a 1.5 T MRI-linac (MRL) and 1.5 T diagnostic MR (dMR). ADC in non-lesion tissue (ADCNL) and in the dominant intraprostatic lesion (ADCDIL) was measured twice in 16 patients on MRL and/or dMR before prostatectomy. Repeatability was quantified through Bland-Altman analysis and within-subject coefficients of variation (wCV). Reproducibility was quantified through Bland-Altman analysis and comparison with diffusion microstructural model simulations. Tissue samples were analysed using haematoxylin and eosin (H&E) and immunohistochemistry (IHC). Spearman's ρ quantified relationships between ADC and histology-derived epithelial (EF) and stroma (SF) fraction.
RESULTS: Phantom mean bias was 0.024 (MRL) and -0.019 (dMR) µm2/ms. Patient ADCs pooled across MRL and dMR exhibited excellent repeatability: wCVNL = 1.4%, wCVDIL = 4.6%. ADCNL was higher on MRL than dMR: mean bias [95% confidence interval] = 0.20 [0.14, 0.26] µm2/ms, consistent with simulations. Correlations between ADCDIL and histology-derived metrics were consistent in magnitude and direction for both scanners. Pooled data showed ADCDIL and EFH&E were negatively correlated (ρ = -0.69, p = 0.003); ADCDIL and SFH&E were positively correlated (ρ = 0.70, p = 0.003).
CONCLUSION: Systematic differences exist between MRI-linac and diagnostic MR measurements. ADCDIL from both systems showed similar correlations with tissue microstructure. This study contributes to the technical and biological validation of diagnostic MR and MRI-linac prostate ADC.