Tracking acute & chronic RT-induced fibrosis in cervical cancer using native & Late-Gadolinium-Enhancement Short-Inversion-Time (STIR) UTE
Khadija Sheikh1, Junghoon Lee2, Marc Morcos2, Mohammad Rezae2, Ravi T. Seethamraju3, Thomas Benkert4, Himanshu Bhat3, Henry R Halperin5, Bruce L. Daniel6, Akila N Viswanathan2, and Ehud J Schmidt2,5
1Johns Hopkins School of Medicine, Washington, DC, United States, 2Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States, 3Siemens Medical Solutions, Boston, MA, United States, 4MR Applications Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany, 5Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, United States, 6Radiology, Stanford University, Stanford, CA, United States
Imaging the temporal evolution of post-radiation fibrosis, which forms in irradiated tissues, supports quantifying tumor response and estimating surrounding-tissue injury. Five cervical cancer patients were scanned pre-external-beam-radiotherapy (EBRT), during and after EBRT, and 3-months post-EBRT and High-Dose-Rate (HDR) brachytherapy. A novel stack-of-spirals STIR-UTE sequence (TI=60ms) was used to image acute-fibrosis, utilizing collagen-bound-water’s short T2* and T1, and Late-Gadolinium-Enhancement (11-15min post-contrast) IR-UTE sequence (TI=200ms) to image chronic-fibrosis, utilizing scar’s slow-contrast-perfusion. Acute-fibrosis spatial-distribution followed EBRT and brachytherapy dose distributions. Over time, acute-fibrosis was converted into chronic-fibrosis. This is important as it forms the basis to guide radiation-therapy for re-irradiation and adaptive-planning.
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