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. 2025 May 25;16(1):919.
doi: 10.1007/s12672-025-02697-8.

GTV delineating for patients with postoperative glioma based on enhanced T2-FLAIR sequence instead of enhanced T1-TFE sequence: a feasibility study

Yuanyuan Li  1 , Qingqing Yuan  1 , Hengbing Jiang  1 , Yin Zhang  2 , Xingru Sun  3
Affiliations

GTV delineating for patients with postoperative glioma based on enhanced T2-FLAIR sequence instead of enhanced T1-TFE sequence: a feasibility study

Yuanyuan Li et al. Discov Oncol. .

Abstract

Objective: To investigate the comparison of MRI Enhanced T2-Fluid Attenuated Inversion Recovery(T2-FLAIR+C) sequence and Enhanced T1-Turbo Field Echo(T1-TFE+C) sequence in delineating Gross Tumor Volume (GTV) of postoperative glioma.

Method: Twenty patients with postoperative glioma underwent MRI simulation(MRI-sim) were enrolled. The T1-TFE+C sequence and T2-FLAIR+C sequence were separately registered with CT simulation(CT-sim). GTV was delineated by the same physician based on CT/T1 and CT/T2, respectively. Subsequently, the number, volume and overlapping ratio(OR) of GTV between the two groups were quantified and analyzed statistically. The signal intensity(SI) of the tumor area, normal gray matter and white matter (background of normal brain tissue)were measured on T1-TFE+C and T2-FLAIR+C sequences, respectively. The contrast ratio(CR) of the tumor in the two sequences were calculated and statistically analyzed.

Results: The volumes of GTV delineated based on CT/T1 and CT/T2 were (55.89 ± 30.20) cm3 and (56.75 ± 30.52) cm3, respectively. There was no statistically significance between the two groups of GTV volumes (P > 0.05). The maximum OR, minimum OR and average OR of GTV volumes between the two groups were 99.77%, 86.90%, and 94.51%, respectively. The CR of tumor/white matter and tumor/gray matter in T2-FLAIR+C were significantly higher than those in the T1-TFE+C sequence (P < 0.05).

Conclusion: The volume of GTV delineated by T2-FLAIR+C was slightly larger compared to that by T1-TFE+C, and T2-FLAIR+C could provide a more comprehensive range of GTV delineation. CR was statistically significant between the two groups (P < 0.05), and T2-FLAIR+C demonstrated the ability to accurately depict changes in tumor boundaries and surrounding edema with a higher tumor enhancement signal. Therefore, GTV delineation of gliomas based on T2-FLAIR+C may offer certain advantages and could potentially serve as a complete replacement for T1-TFE+C in future clinical applications.

Keywords: GTV; MRI-sim; Postoperative glioma; T1-TFE+C; T2-FLAIR+C.

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Conflict of interest statement

Declarations. Conflict of interests: The authors declare no competing interests. Consent for publication: All authors were consent for publication. Ethical Approval: We state that the study was approved by the institutional review board of National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital and informed consent to participate was waived by the Institu- tional Review Board(NO. SZCHY2023069). We confirm that all methods were carried out in accordance with relevant guidelines and regulations.

Figures

Fig. 1
Fig. 1
Volumes and OR of GTVT 1−TF E and GTVT 2−FLAIR
Fig. 2
Fig. 2
An example of GTVT 1−TFE（a） and GTVT 2−FLAIR（b） and their overlapping display（c）
Fig. 3
Fig. 3
CRtumor/white and CRtumor/gray of T1-TFE+C and T2-FLAIR+C (e.g. T1 CRT/G represents SItumor/SIgray based on T1-TFE+C)
Fig. 4
Fig. 4
Heatmap display of the same patient in T1-TFE+C(a) and T2-FLAIR+C(b)
See this image and copyright information in PMC

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