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Comprehensive 3.0T MRI exam of prostate for radiation therapy planning

Case Study
Philippens, Marielle, Dr. Ir. UMC Utrecht • Netherlands

Patient history

A 70-year-old male was diagnosed with prostate cancer, cT3bNxM, Gleason 6, PSA 7.9 mg/L after biopsies, ultrasound and PSA blood measurements.

Treatment strategy

Treatment strategy included radiotherapy and both CT and MR simulation scans were requested.

MR imaging in treatment position

The patient was imaged at Ingenia MR-RT 3.0T using FlexCoverage Anterior Coil in combination with the integrated Posterior Coil.

The bTFE sequence with SPAIR fat suppression shows the outline of the prostate as well as the gold fiducials. It is important that both are defined in the same, high resolution image, since the positioning of the patient during radiotherapy treatment is based on the position of the gold fiducials.

 

The transverse and sagittal T2W TSE images help us to idenify the prostate tumor foci, which typically have lower signal intensity than normal prostate. For patients that are referred for brachytherapy the T2W image is used to identify the presence of extracapsular extensions as these are a contraindication for brachytherapy.

 

The 3D T1 mDIXON FFE is used to identify abnormalities that could be hemorrhages due to biopsies or insertion of fiducial markers. These hemorrhages may look similar to tumor foci on T2-weighted images and ADC map. Transverse DWI with SPAIR and 6 b-values is used to visualize the tumor foci (bright appearance), which mostly have a low ADC.

 

Dynamic T1 FFE with 120 dynamics and 2.4 sec temporal resolution is also used to visualize the tumor foci, which often show a high perfusion.

 

MR images

 bTFE SPAIR T2W TSE transverse T2W TSE sagittal
bTFE SPAIR
T2W TSE transverse
T2W TSE sagittal
 3D T1 mDIXON FFE water DWI b1000 ADC
3D T1 mDIXON FFE water
DWI b1000
ADC



Reference

FieldStrength article: Approaches for including MRI in radiation therapy planning

 

 

 

 

Results from case studies are not predictive of results in other cases. Results in other cases may vary.



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Oct 31, 2017

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Case Study
Ingenia 3.0T, Ingenia MR-RT
Body, MR simulation, MR-RT, Oncology, Prostate, radiation oncology, radiation therapy, radiation therapy planning, RT planning
 

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