S2463
Physics - Radiomics, functional and biological imaging, and outcome prediction
ESTRO 2026
References: 1. Borggreve, A. S., et al. (2020). Preoperative Prediction of Pathologic Response to Neoadjuvant Chemoradiotherapy in Patients With Esophageal Cancer Using 18F-FDG PET/CT and DW-MRI: A Prospective Multicenter Study. IJROBP, 106(5), 998– 1009. https://doi.org/https://doi.org/10.1016/j.ijrobp.2019.12 .0382. Weller, A., et al. (2017). Diffusion-weighted (DW) MRI in lung cancers: ADC test-retest repeatability. European Radiology, 27(11), 4552–4562. https://doi.org/10.1007/s00330-017-4828-6 Keywords: ADC; Esophageal cancer; Measurement uncertainty Digital Poster Highlight 3408 Morphometric Analysis of Black Bone MRI: A Tool for Detection and Monitoring of Osteoradionecrosis Following Head and Neck Cancer Treatment Natalie A. West 1,2 , Lucas McCullum 1,2 , Samuel Mulder 1,2 , Travis Salzillo 3 , Renjie He 1 , Yao Ding 3 , Jihong Wang 3,2 , Komal Shah 4 , Kim Learned 4 , Melissa Chen 4 , Stephen Y. Lai 5,1 , Clifton D. Fuller 1,2 1 Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 2 Graduate School of Biomedical Sciences, The University of Texas MD Anderson Cancer Center UTHealth Houston, Houston, TX, USA. 3 Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 4 Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 5 Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA Purpose/Objective: Head and neck cancer (HNC) patients often receive radiation therapy (RT), which can lead to RT-induced toxicities, such as osteoradionecrosis (ORN). ORN is historically diagnosed subjectively via visible symptoms, such as exposed bone. Recent guidelines demonstrate ORN can be detected and monitored by imaging-derived bony assessment1. While HNC patients routinely receive follow-up magnetic resonance imaging (MRI) to monitor RT-induced toxicities, standard MRI methods inadequately visualize bone. Thus, separate CT imaging is needed, requiring registration between modalities, reducing accuracy of the native acquisition. We propose black bone MRI, a CT-like low-flip angle sequence2 with sub- millimeter resolution to capture minor changes in cortical bone correlative to ORN.
substantially between patients and remained high for some (maximum IQR = 34 %pt), despite the large number of measurements.The cranial-caudal length of the volume-of-interest correlated negatively with the IQR (r=–0.53, p=0.039). No significant differences in IQR were found between tumor locations or histology types (p=0.44 and p=1.00, respectively).
Conclusion: There is substantial inter-patient variability in the uncertainty of ADC change measurements during chemoradiation for esophageal cancer. Beyond enabling potentially more precise ADC change estimations, daily MR-linac measurements also allow patient-specific uncertainty assessment, helping identify patients with reliable ADC changes. This patient-level insight could support selective clinical use of ADC as a biomarker, despite the overall high measurement uncertainty.
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