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Review
. 2023 Dec;96(1152):20230717.
doi: 10.1259/bjr.20230717. Epub 2023 Oct 24.

SpaceOAR hydrogel complications in prostate cancer

Harpreet Grewal  1 , Rajendra Kedar  2 , Gagandeep Dhillon  3 , Gurmanpreet Sidhu  4 , Rahul Kashyap  5   6   7   8 , Kiran Sailagundala  1
Affiliations
Review

SpaceOAR hydrogel complications in prostate cancer

Harpreet Grewal et al. Br J Radiol. 2023 Dec.

Abstract

SpaceOAR hydrogel, a novel biodegradable spacer, is increasingly used in managing prostate cancer patients undergoing radiation therapy to minimize rectal radiation dose and associated complications. However, its use has raised new concerns regarding its potential complications and impact on subsequent imaging interpretation. This article provides a pictorial review of the imaging complications of using SpaceOAR hydrogel in prostate cancer patients. We present multiple examples demonstrating the types of complications that can occur, potential underlying mechanisms, and their impact on patient outcomes and imaging interpretation. This review aims to provide radiologists and oncologists with an updated understanding of these complications, guiding better patient management and interpretation of imaging studies.

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Figures

Figure 1.
Figure 1.
Sagittal and axial T 2 weighted images demonstrate the ideal placement of the gel in the rectoprostatic fossa (straight arrow).
Figure 2.
Figure 2.
Sagittal and axial T 2 weighted images demonstrate the ideal placement of the gel in the rectoprostatic fossa (straight arrow).
Figure 3.
Figure 3.
Axial CT and axial T 2 weighted FAT SAT images demonstrate radiodense SpaceOAR gel in the rectal wall, in a semi-circular manner along the anterior wall (white straight arrows). No extension into the rectal lumen.
Figure 4.
Figure 4.
Axial CT and axial T 2 weighted FAT SAT images demonstrate radiodense SpaceOAR gel in the rectal wall, in a semi-circular manner along the anterior wall (white straight arrows). No extension into the rectal lumen.
Figure 5.
Figure 5.
Sagittal T 2 weighted and axial T 2 weighted imaging shows the focal rectal perforation, with the extension of the SpaceOAR gel into the rectal lumen (straight arrows).
Figure 6.
Figure 6.
Sagittal T 2 weighted and axial T 2 weighted imaging shows the focal rectal perforation, with the extension of the SpaceOAR gel into the rectal lumen (straight arrows).
Figure 7.
Figure 7.
Axial non-contrast CT images demonstrate the mildly radiodense SpaceOAR gel at the base of the penis (straight arrow).
Figure 8.
Figure 8.
Axial T 2WIs demonstrate the old SpaceOAR gel in the rectoprostatic fossa with low signal on T 2WI (straight arrows) and mild adjacent fibrosis and scarring. T 2WI, T 2 weighted image.
Figure 9.
Figure 9.
Axial T 2WIs demonstrate the old SpaceOAR gel in the rectoprostatic fossa with low signal on T 2WI (straight arrows) and mild adjacent fibrosis and scarring. T 2WI, T 2 weighted image.
Figure 10.
Figure 10.
Axial CT images show faint hyperdensity in the corresponding region in the rectoprostatic fossa, confirming the signal to be old SpaceOAR gel (straight white arrows).
Figure 11.
Figure 11.
Axial CT images show faint hyperdensity in the periprostatic venous plexus, more so on the right side (straight arrows).
Figure 12.
Figure 12.
Axial CT images show faint hyperdensity in the periprostatic venous plexus, more so on the right side (straight arrows).
See this image and copyright information in PMC

References

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