Clinical impact of magnetic resonance imaging distortions on gamma knife radiosurgery

Introduction: Magnetic resonance imaging (MRI) is the preferred imaging modality for Leksell Gamma Knife® (LGK) stereotactic radiosurgery (SRS) treatment planning (TP) due to superior soft tissue definition compared to computed tomography (CT). However, inherent distortions in MRI can affect treatment accuracy. The aim of this study was to develop a model to visualise the effect of MRI distortion on LGK SRS target coverage. Methods: A model was developed using MR images of a QUASARTM GRID3D QA phantom. One hundred and twenty-five points were compared against known phantom geometry. Using linear interpolation, the model was applied retrospectively to 10 brain metastases patient data sets treated with LGK. The model estimated the corrected shot position accounting for distortion. A total of 44 metastases were investigated regarding the effects of MRI distortion on target coverage. Results: The model indicated significantly reduced mean error by 0.30 mm and variance by 0.09 mm (P = 0.008). After model application, 23 (53%) metastases showed reduced coverage. Six of the 23 metastases were deemed to be potentially clinically significant changes. Results indicated MRI distortion had a greater effect on smaller targets (mean 0.06cc) located further away from the image isocentre (mean 64.88 mm). Conclusion: This study developed a model to visualise the effect of MRI distortion on LGK SRS target coverage. Results suggest that MRI distortion can affect target coverage and the developed model may be one method to assess its impact. These results indicate that MRI distortion may have a greater effect on smaller targets located at the image periphery.