Contouring the prostate on T2-weighted MRI

Elekta Medical Affairs

Elekta AB

1 | Focus where it matters.

The prostate

• TG 263 Terminology:
- FMAID prostate: 9600

• Description: a walnut-sized gland - secretor of prostate fluid - located between the bladder
• and the penis, just in front of the rectum, through which runs the urethra.
• TSG CTP description: Extends to superior aspect of the gland and abuts the seminal
• vesicle; include borderline tissue in the prostate volume. Extends to anterior aspect of gland
• including the anterior fibromuscular stroma, include 2-3mm of prostatic fibromuscular stroma unless
• it is clearly involved by or abutting tumor. Extends to posterior aspect of the gland and abuts loose
• connective tissue Denonvillier’s fascia and anorectum. Neurovascular bundles should not be
• included unless involved by or abutting tumor. Extends to lateral aspect of the gland. At the prostate
• apex, the point above the hourglass or slit shape that results from the in-bowing of the levator ani.
• The apex is approximately 1cm above the penile bulb or at the start of the high signal prostate on T2
• weighted MRI. If the capsule is visible, the muscles and soft tissues abutting the capsule are not included as “prostate”.

2 | Focus where it matters.

https://images.app.goo.gl/WXNwB17i1bvmbBBX7
Gross and cross sectional anatomy of the prostate

https://images.app.goo.gl/HWehhTXZdyxrMmoL9
3 | Focus where it matters. https://images.app.goo.gl/wicwqpZU7RKhgzFb8
Cross sectional anatomy of the prostate on CT

https://images.app.goo.gl/VKqgd8xBFJZ9sGsj6
4 | Focus where it matters. https://images.app.goo.gl/Y36PV35XBhD1XKcC8
Cross sectional appearance on T1w and T2w MR

T1W MRI

T2W MRI

http://www.radiologyassistant.nl/en/p56195b237699d/rectal-cancer-mr-staging-20.html
5 | Focus where it matters. https://images.app.goo.gl/vsUcydRJzgiYrjpv5
Cross sectional anatomy of the prostate on T2w MRI

https://images.app.goo.gl/fue9Xu2TgN4wUaUV8
6 | Focus where it matters.
Contouring the prostate on T2w MRI

7 | Focus where it matters.

Prostate cancer on CT and PET CT

https://images.app.goo.gl/5rZXTYNiBMirRFCe7
8 | Focus where it matters. https://images.app.goo.gl/5461bN2uwrxTy4Kf8
 Prostate cancer on multi parametric MRI
T4 prostate cancer

T2w MRI showing T4 prostate cancer invading bladder and seminal

vesicles (arrow)

https://images.app.goo.gl/7CT2Bq4rg25Ryjpn9
9 | Focus where it matters.
https://images.app.goo.gl/gJhRPSresUafmkvU6
Contouring a prostate cancer on T2w MRI

E: T2W MRI
F: planning CT
Red arrow: fiducial
Red contour: GTV
Purple contour: prostate CTV

CTV: Clinical Target Volume 1 (CTV1): prostate and up to 1cm of the proximal seminal vesicles (SV) depending on risk
group. SV coverage may not be necessary in low risk patients. Include up to 1cm in intermediate risk patients. The
proximal 1cm is defined by including the SV that are encompassed by expanding the prostate volume by 1cm, radially.

https://images.app.goo.gl/YhtFeowE7bJezPF89
10 | Focus where it matters.
Contouring a prostate cancer on T2w MRI

Red: CTV prostate

Orange: Rectum
Green: Seminal vesicles
Purple: Bladder
11 | Focus where it matters.