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Given the preponderance of gray matter in the hippocampus, focus contouring on the T1-hypointense signal medial to the temporal horn.īegin contouring at the most caudal (inferior) extent of the crescentic-shaped floor of the temporal horn of the lateral ventricle and contour the hypointense grey matter located medial to the CSF hypointensity, not the white, bright white matter. MRI-CT Fusion: Fuse the 3D-SPGR MRI and the treatment-planning CT.ģ General Principles Please note that we are not contouring the entire hippocampus, but focusing mostly on the subgranular zone (SGZ) Contour the hippocampus on T1-weighted MRI axial sequences. Treat patients in the immobilization device. Immobilize patient in supine position using an immobilization device such as an Aquaplast mask over the head. Slice thickness of 2.5mm or less is permitted. mm slice thickness is preferred for accurate hippocampal sparing planning. CT Simulation: Non-contrast treatment-planning CT scan of the entire head region.
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Obtain in supine position immobilization devices used for CT simulation and daily radiation treatments not necessary. Slice thickness of 1.5mm or less is permitted. 1.25mm slice thickness is preferred to contour the hippocampus accurately. Three-dimensional spoiled gradient (3D-SPGR) axial MRI scan of the head with standard axial and coronal FLAIR, axial T2-weighted and gadolinium contrast-enhanced T1-weighted sequence acquisitions.
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3 Departments of 1Human Oncology and 2Neuroradiology, University of Wisconsin Comprehensive Cancer Center 3Department of Radiation Oncology, Northwestern University Feinberg School of MedicineĢ MRI-CT Fusion MRI: CT Simulation: MRI-CT Fusion: 1 Hippocampal Contouring: A Contouring Atlas for RTOG 0933