Recommendation for the contouring of limbic system in patients receiving radiation treatment: A pictorial review for the everyday practice and education

Claudia Sorce, Agnieszka Chalaszczyk, Francesca Rossi, Letizia Ferella, Gianmarco Grimaldi, Alessandra Splendiani, Domenico Genovesi, Francesco Marampon, Ester Orlandi, Alberto Iannalfi, Carlo Masciocchi, Giovanni Luca Gravina
Critical Reviews in Oncology/hematology 2021 January 19, : 103229

AIMS: The limbic circuit (LC) is devoted to linking emotion to behavior and cognition. The injury this system results in post-RT cognitive dysfunction. The aim of this study is to create the first radiation oncologist's practical MR-based contouring guide for the delineation of the LC for the everyday clinical practice and education.

METHODS: An anonymized diagnostic 3.0 T T1-weighted BRAVO MRI sequence from a healthy patient with typical brain anatomy was used to delineate LC. For each structure key anatomical contours were completed by radiation oncologists, along with a neuro-radiologist to generate the final version of the LC atlas.

RESULTS: a step-by-step MR-based atlas of LC was created. Key structures of the LC, such as, cingulate gyrus, fornix, septal region, mammillary bodies, thalamus and the hippocampal-amygdala formation were contoured.

CONCLUSIONS: This article provides the recommendations for the first contouring atlas of LC in the setting of patients receiving RT and education.

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