Recommendations for MRI-based contouring of gross tumor volume and organs at risk for radiation therapy of pancreatic cancer H.D. Heerkens, MD, W.A.

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Recommendations for MRI-based contouring of gross tumor volume and organs at risk for radiation therapy of pancreatic cancer H.D. Heerkens, MD, W.A. Hall, MD, X.A. Li, PhD, P. Knechtges, MD, E. Dalah, PhD, E.S. Paulson, PhD, C.A.T. van den Berg, PhD, G.J. Meijer, PhD, E.J. Koay, MD, PhD, C.H. Crane, MD, K. Aitken, MD, M. van Vulpen, MD, PhD, B.A. Erickson, MD Practical Radiation Oncology Volume 7, Issue 2, Pages 126-136 (March 2017) DOI: 10.1016/j.prro.2016.10.006 Copyright © 2016 The Authors Terms and Conditions

Figure 1 pre contrast T1-weighted image (A) and arterial phase T1-weighted image (B) of the normal pancreas case showing enhancement of the pancreatic tissue and the visibility of the duodenal bulb. Practical Radiation Oncology 2017 7, 126-136DOI: (10.1016/j.prro.2016.10.006) Copyright © 2016 The Authors Terms and Conditions

Figure 2 Resectable pancreas case with contouring of tumor and critical structures. Red: GVT, turquoise: duodenum, blue: liver, pink: right kidney, orange: left kidney, bright green: aorta, violet: bowel loops, orange: celiac axis, deep pink: superior mesenteric vein, yellow: portal vein. Note the hypointense area of the GTV on the pre contrast (A) and on the arterial phase (B) images. (Color version of figure is available online.) Practical Radiation Oncology 2017 7, 126-136DOI: (10.1016/j.prro.2016.10.006) Copyright © 2016 The Authors Terms and Conditions

Figure 3 A: Visualization of cystic areas (A) and pancreatic duct (B) on T2-weighted imaging at 1.5T. Practical Radiation Oncology 2017 7, 126-136DOI: (10.1016/j.prro.2016.10.006) Copyright © 2016 The Authors Terms and Conditions

Figure 4 T2-weighted image, an example of gross tumor volume in red and duodenum in turquoise. (Color version of figure is available online.) Practical Radiation Oncology 2017 7, 126-136DOI: (10.1016/j.prro.2016.10.006) Copyright © 2016 The Authors Terms and Conditions

Figure 5 Unresectable pancreas case with contouring of tumor on arterial T1-weighted image (A) and on DWI (B). Red line: GVT. Note the hypointense area on the T1-weighted image and the diffusion restriction on the DWI. (Color version of figure is available online.) Practical Radiation Oncology 2017 7, 126-136DOI: (10.1016/j.prro.2016.10.006) Copyright © 2016 The Authors Terms and Conditions

Figure 6 Contouring of an unresectable pancreatic tumor in the pancreatic body on pre contrast T1-weighted (A), arterial T1-weighted (B), T1-weighted (C), T2-weighted (D). Red: GVT, turquoise: duodenum, dark green: pancreatic head, purple: stomach. (Color version of figure is available online.) Practical Radiation Oncology 2017 7, 126-136DOI: (10.1016/j.prro.2016.10.006) Copyright © 2016 The Authors Terms and Conditions

Figure 7 Contouring of an unresectable pancreatic tumor in the pancreatic head on arterial T1-weighted (A), and DWI (b-value 800s/mm2) (B). Red: GTV, turquoise: duodenum, blue: liver, pink: right kidney, orange: left kidney, red: gall bladder, bright green: aorta, violet: bowel loops, orange: celiac axis, yellow: portal vein, red-orange: inferior vena cava. (Color version of figure is available online.) Practical Radiation Oncology 2017 7, 126-136DOI: (10.1016/j.prro.2016.10.006) Copyright © 2016 The Authors Terms and Conditions

Figure 8 Normal pancreas case with contouring of pancreas and critical structures on T1-weighted image, precontrast (A) and arterial phase (B). Dark green: pancreatic head, turquoise: duodenum, purple: stomach, blue: liver, pink: right kidney, orange: left kidney, bright green: aorta, violet: bowel, orange: celiac axis. (Color version of figure is available online.) Practical Radiation Oncology 2017 7, 126-136DOI: (10.1016/j.prro.2016.10.006) Copyright © 2016 The Authors Terms and Conditions