MR appearance of the normal and abnormal vagina after hysterectomy.

Brown, Jeffrey J.; Gutierrez, E. D.; Lee, Joseph K.

doi:10.2214/ajr.158.1.1727367

Cited by 24 publications

(1 citation statement)

References 4 publications

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“…VC can be visualized using T2-weighted (T2W) magnetic resonance imaging (MRI) (10, 11), which provides better soft tissue contrast than CT (12) and is already used in other gynecologic cancers for defining gross disease (13, 14). This supports a novel application in endometrial cancer treatment.…”

Section: Introductionmentioning

confidence: 99%

MRI-Based Evaluation of the Vaginal Cuff in Brachytherapy Planning: Are We Missing the Target?

Chapman

Prisciandaro

Maturen

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

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Purpose Although recurrences and toxicity occur after vaginal cuff (VC) brachytherapy, little is known about dosimetry due to the inability to clearly visualize the VC on computed tomography (CT). T2-weighted (T2W) magnetic resonance imaging (MRI) is superior to CT in this setting, and we hypothesized that it could provide previously unascertainable dosimetric information. Methods and Materials In a cohort of 32 patients who underwent cylinder-based brachytherapy for endometrial cancer with available MR simulation images, the VC was retrospectively contoured on T2W images, and cases were replanned to treat the upper VC to a dose of 7 Gy/fraction prescribed to 5 mm. Relevant dose-volume parameters for the VC were calculated. Results T2W MRI identified significant underdosing not observed on CT or T1-weighted imaging. Over two-thirds (69%) of patients had at least 1 cm3 of VC that received less than 75% of the prescription dose and half (50%) of patients had a least 1 cm3 of VC that received less than 50% of the prescription dose. The mean minimum point dose to the VC was 2.4 Gy, or 34% of the intended prescription dose (range: 0.53–6.4 Gy). Conclusions We identified previously unreported VC underdosing in over two-thirds of our patients, with most of these patients having volumes of undistended VC that received less than half of the prescription dose. The maximum dimension was along the craniocaudal axis in some patients or left-right/anterior-posterior axis in others, suggesting that suture material may be restricting access to the vaginal apex and that alternative applicators may be needed when the diameter of the apex is larger than the introitus. Additional follow-up will be needed to determine whether underdosing is associated with isolated VC failure or whether low failure rates across the cohort suggest that some patients are being exposed to excessive dose and unnecessary risk of toxicity.

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