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3.0T MRI of head and neck for radiation therapy planning

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

Patient history

A 75-year-old male with oropharynx squamous cell carcinoma in the left tonsil region with extension into the soft palate, caudal border lower tonsil region, no midline crossing. On the left side in the neck there are also three enlarged lymph nodes on level 2 and 3 with central necrosis and signs of limited extracapsular extension, T2N2b.

Treatment strategy

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

MR imaging in treatment position

The patient underwent MRI in the radiotherapy (5-point) positioning mask in Ingenia MR-RT 3.0T, using the Flex coils in combination with integrated Posterior FlexCoverage coil.

DWI with SPIR is used to visualize the extension of the tumor and lymph nodes, especially retropharyngeal. Transverse T1W and T2W TSE mDIXON water and in-phase images (2 mm thick slices) help to visualize the tumor size and its extension into fatty tissue. The post-contrast T1W TSE mDIXON also shows this.

 

Dynamic 3D T1W FFE with 45 dynamics and temporal resolution of 2.5 seconds is performed to follow contrast agent distribution. Contrast agent distribution is modeled after conversion of the signal to T1 relaxation times using the small flip angle method.

 

MR images

 T2 TSE mDIXON water T2W TSE mDIXON in phase
T2 TSE mDIXON water
T2W TSE mDIXON in phase
 T1 TSE mDIXON water T1 TSE mDIXON water post contrast
T1 TSE mDIXON water
T1 TSE mDIXON water post contrast
 T1 TSE mDIXON in phase T1 TSE mDIXON in phase post contrast
T1 TSE mDIXON in phase
T1 TSE mDIXON in phase post contrast
 DWI b0<br><br> DWI b800 ADC
DWI b0

DWI b800
ADC

Clinical value of MRI simulation

Using different contrast (T1, T2, diffusion, post-contrast T1) in MRI allows us to appreciate contrast changes in the tumor and in the vicinity of the tumor. This helps to delineate the tumor. MRI and especially DWI also helps to visualize the retropharyngeal lymph nodes.

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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Case Study
Ingenia 3.0T, Ingenia MR-RT
HeadNeck, MR simulation, MR-RT, Neuro, Oncology, radiation oncology, radiation therapy, radiation therapy planning, RT planning
 

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