The Role of Free-breathing GRASP MRI in Accurate Phase Matching with 4D-CT for Motion Representation in Liver Cancer Radiotherapy

arXiv:2606.08065v1 Announce Type: new Abstract: Objective: To determine whether free-breathing golden-angle radial sparse parallel (GRASP) magnetic resonance imaging (MRI) can represent respiratory-induced organ motion in patients with liver malignancies undergoing stereotactic body radiation therapy (SBRT). Methods: A retrospective analysis of 54 patients undergoing liver SBRT was conducted. Four-dimensional computed tomography (4D-CT), the gold standard for motion assessment, was used to characterize liver tumor motion. Image fusion was performed between free-breathing GRASP MRI and each respiratory phase of 4D-CT using an in-house registration program, with fusion quality quantified by maximum cross-correlation coefficient (MCC). Validation involved two blinded radiation oncologists: one repeated image fusion using the Eclipse-built-in module, while the other evaluated clinical relevance on a five-point scale. Results: The 50% respiratory phase of 4D-CT achieved the highest fusion quality with GRASP MRI, showing no significant differences compared to the 30% (P = 0.106), 40% (P = 0.632), and 60% (P = 0.792) phases. In contrast, fusion quality declined significantly beyond the mid-respiratory window (30%-60%), with poor fusion at the 0%, 10%, 20%, 80%, and 90% phases (P < 0.001). Validation by radiation oncologists corroborated these findings, with the 50% phase achieving the highest score. Subjective scores remained above 4 for phases 30%-70%, while scores for the remaining phases fell below 4. Conclusion: Free-breathing GRASP MRI cannot independently represent organ motion across all respiratory phases; it accurately characterizes motion only within the mid-respiratory phases (30%-60%), with optimal performance at the 50% phase. When used as a delineation standard in liver SBRT, GRASP MRI should be combined with 4D-CT or dynamic imaging modalities to ensure comprehensive motion assessment and accurate target volume definition.