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Brachytherapy for prostate cancer: endorectal MR imaging of local treatment-related changes
F V Coakley1, H Hricak, A E Wefer
1Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA. coakleyf@mskcc.org
Purpose:
To determine the local treatment-related endorectal magnetic resonance (MR) imaging findings after brachytherapy for prostate cancer.
Materials And Methods:
Endorectal MR imaging was performed in 35 consecutive patients at a mean interval of 12 months (range, 1-31 months) after brachytherapy for prostate cancer. Transverse T1-weighted and high-spatial-resolution transverse and coronal T2-weighted images were acquired. Two readers reviewed MR image quality and findings, with discrepancies resolved by consensus. Posttreatment urinary symptoms in patients (n = 24) were documented by using chart review.
Results:
All studies were of diagnostic quality. On T2-weighted images, prostatic findings consisted of diffuse low signal intensity (n = 35) and indistinct zonal anatomy (n = 34). Intra- and extraprostatic seed locations could be distinguished. The most common extraprostatic site of seed implantation was the neurovascular bundles (n = 35, bilateral in 32). The most common extraprostatic tissue finding was increased signal intensity on T2-weighted images in the levator ani muscle (n = 34) and the genitourinary diaphragm (n = 28). Postbrachytherapy urinary symptoms showed no demonstrable correlation with periurethral or genitourinary diaphragm seed implantation or with signal intensity change in the genitourinary diaphragm.
Conclusion:
Endorectal MR imaging can be used to evaluate seed distribution and to demonstrate treatment-related changes after brachytherapy for prostate cancer.
