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Review
. 2016 Dec;89(1068):20160348.
doi: 10.1259/bjr.20160348. Epub 2016 Oct 17.

Simple diagrammatic method to delineate male urethra in prostate cancer radiotherapy: an MRI based approach

Tejinder Kataria  1 , Deepak Gupta  1 , Shikha Goyal  1 , Shyam S Bisht  1 , Ravi Chaudhary  2 , Kushal Narang  1 , Susovan Banerjee  1 , Trinanjan Basu  1 , Ashu Abhishek  1 , Sasikumar Sambasivam  1 , Nisha T Vishnu  1
Affiliations
Review

Simple diagrammatic method to delineate male urethra in prostate cancer radiotherapy: an MRI based approach

Tejinder Kataria et al. Br J Radiol. 2016 Dec.

Abstract

Stereotactic body radiotherapy (SBRT) is being increasingly utilized in the treatment of prostate cancer. With the advent of high-precision radiosurgery systems, it is possible to obtain dose distributions akin to high-dose rate brachytherapy with SBRT. However, urethral toxicity has a significant impact on the quality of life in patients with prostate cancer. Contouring the male urethra on a CT scan is difficult in the absence of an indwelling catheter. In this pictorial essay, we have used the MRI obtained for radiotherapy planning to aid in the delineation of the male urethra and have attempted to define guidelines for the same.

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Figures

Figure 1.
Figure 1.
An axial T2 weighted sequence showing the stepwise delineation of the prostatic urethra: the prostatic urethra has been marked as a tubular structure in red–green. (a) Identifying the bladder neck: the hyperintense signal is representing the urine in the bladder. (b–d) It is traced further into the parenchyma of the prostate. This is representing the prostatic urethra. (e–g) The sagittal sectional correlation to aid in delineation: the urethra as a whole has been depicted. (g) The prostatic, bulbar and penile parts of the urethra are shown. (h) A coronal section is illustrating the complete prostatic urethra. Bl, bladder; F, femur; Pr, prostate; R, rectum.
Figure 2.
Figure 2.
The axial T2 weighted sequence showing the stepwise delineation of the prostatic urethra: the membranous urethra (MU) has been marked as a tubular structure in green. (a–c) Urogenital diaphragm: the MU is traversing through it and ending at its inferior portion, beyond which it is continuing as the bulbar part. (d) The coronal section with an arrow is denoting the MU. Pr, prostate; R, rectum.
Figure 3.
Figure 3.
Axial T2 MRI: the penile bulb (corpus spongiosum) has been identified and the bulbar urethra is starting at the inferior border of the urogenital diaphragm. It is delineated in green. (a) The penile bulb has been marked in purple, with the bulbar urethra marked in green. (b, c) The bulbar urethra is continuing as the penile urethra.
Figure 4.
Figure 4.
Sagittal T2 MRI: for correlating with the axial sections, (a–d) the penile bulb has been marked in purple. The bulbar urethra and penile urethra have been marked in green. Bl, bladder; Pr, prostate.
Figure 5.
Figure 5.
Axial and sagittal CT scans with catheter in situ: (a–c) An axial CT scan—the bulb of Foley's catheter is seen in the bladder. The bladder neck has been delineated in pink, the prostate in yellow. The prostatic urethra is traced along the catheter (red). (d–f) The prostatic urethra is continuing as the membranous part, delineated in yellow. (g) The coronal section is correlating the delineation. (h, i) Sagittal sections for correlating the course of the urethra along Foley's catheter. Bl, bladder; R, rectum.
Figure 6.
Figure 6.
Axial CT scan with catheter in situ: (a–c) the bulbar urethra has been contoured in blue. (d–f) The penile urethra is traced till the meatus (green). R, rectum.
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