Magnetic resonance imaging (MRI) markers for MRI-guided high-dose-rate brachytherapy: Novel marker-flange for cervical cancer and marker catheters for prostate cancer - Abstract

PURPOSE: To present a novel marker-flange, addressing source-reconstruction uncertainties due to the artifacts of a titanium intracavitary applicator used for magnetic resonance imaging (MRI)-guided high-dose-rate (HDR) brachytherapy (BT); and to evaluate 7 different MRI marker agents used for interstitial prostate BT and intracavitary gynecologic HDR BT when treatment plans are guided by MRI.

METHODS AND MATERIALS:Seven MRI marker agents were analyzed: saline solution, Conray-60, copper sulfate (CuSO4) (1.5 g/L), liquid vitamin E, fish oil, 1% agarose gel (1 g agarose powder per 100 mL distilled water), and a cobalt-chloride complex contrast (C4) (CoCl2/glycine = 4:1). A plastic, ring-shaped marker-flange was designed and tested on both titanium and plastic applicators. Three separate phantoms were designed to test the marker-flange, interstitial catheters for prostate BT, and intracavitary catheters for gynecologic HDR BT. T1- and T2-weighted MRI were analyzed for all markers in each phantom and quantified as percentages compared with a 3% agarose gel background. The geometric accuracy of the MR signal for the marker-flange was measured using an MRI-CT fusion.

RESULTS: The CuSO4 and C4 markers on T1-weighted MRI and saline on T2-weighted MRI showed the highest signals. The marker-flange showed hyper-signals of >500% with CuSO4 and C4 on T1-weighted MRI and of >400% with saline on T2-weighted MRI on titanium applicators. On T1-weighted MRI, the MRI signal inaccuracies of marker-flanges were measured < 2 mm, regardless of marker agents, and that of CuSO4 was 0.42 ± 0.14 mm.

CONCLUSION: The use of interstitial/intracavitary markers for MRI-guided prostate/gynecologic BT was observed to be feasible, providing accurate source pathway reconstruction. The novel marker-flange can produce extremely intense, accurate signals, demonstrating its feasibility for gynecologic HDR BT.

Written by:
Schindel J, Muruganandham M, Pigge FC, Anderson J, Kim Y.   Are you the author?
Department of Radiation Oncology, University of Iowa, Iowa City, Iowa.

Reference: Int J Radiat Oncol Biol Phys. 2013 Feb 20. pii: S0360-3016(13)00005-9.
doi: 10.1016/j.ijrobp.2012.12.026

PubMed Abstract
PMID: 23433797 Prostate Cancer Section