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MR images were acquired at three time-points; pre-RT, post-WPRT\/pre-BT, and 3\u20136 months post-BT. Diffuse-fibrosis (F<jats:sub>Diffuse<\/jats:sub>) was imaged with a non-contrast dual-echo IR (inversion time [TI]\u2009=\u200960 ms) UTE research application, with image-subtraction of the later echo, only retaining the ultrashort-echo SI. Dense-fibrosis (F<jats:sub>Dense<\/jats:sub>) imaging utilized single-echo Late-Gadolinium-Enhanced IR-UTE, acquired\u2009\u223c\u200915\u00a0min post-Gadavist injection. Resulting F<jats:sub>Diffuse<\/jats:sub> and F<jats:sub>Dense<\/jats:sub> SI were normalized to the corresponding gluteal-muscle SI. Images were deformably registered between time-points based on normal tissue anatomy. The remnant tumor at both time-points was segmented using multi-parametric MRI. Contours corresponding to the 50%, 100%, 150%, and 200% isodose lines (IDLs) of the prescription BT-dose were created. Mean F<jats:sub>Diffuse<\/jats:sub> and F<jats:sub>Dense<\/jats:sub> SI within (i) each IDL contour and (ii) the remnant tumor were calculated. Post-BT F<jats:sub>Diffuse<\/jats:sub> and F<jats:sub>Dense<\/jats:sub> SI were correlated with prescribed BT-dose. To determine the relationship between BT-dose and IR-UTE SI, the differences in the post-BT F<jats:sub>Dense<\/jats:sub> across IDLs was determined using paired t-tests with Bonferroni correction.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>F<jats:sub>Dense<\/jats:sub> was higher in regions of higher dose for 6\/7 patients, with mean\u2009\u00b1\u2009SD values of 357\u2009\u00b1\u2009103% and 331\u2009\u00b1\u200997% (<jats:italic>p<\/jats:italic>\u2009=\u2009.03) in the 100% and 50% IDL, respectively. F<jats:sub>Dense<\/jats:sub> was higher in regions of higher dose in the responsive regions with mean\u2009\u00b1\u2009SD values of 380\u2009\u00b1\u2009122% and 356\u2009\u00b1\u2009135% (<jats:italic>p<\/jats:italic>\u2009=\u2009.03) in the 150% and 50% IDL, respectively. Within the segmented remnant tumor, an increase in prescribed dose correlated with an increase in F<jats:sub>Dense<\/jats:sub> post-BT (<jats:italic>n<\/jats:italic>\u2009=\u20095, <jats:italic>r<\/jats:italic>\u2009=\u2009.89, <jats:italic>p<\/jats:italic>\u2009=\u2009.04). Post-BT F<jats:sub>Diffuse<\/jats:sub> inversely correlated (<jats:italic>n<\/jats:italic>\u2009=\u20097, <jats:italic>r<\/jats:italic> = -.83, <jats:italic>p<\/jats:italic>\u2009=\u2009.02) with prescribed BT-dose within the 100% IDL.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Results suggest that F<jats:sub>Dense<\/jats:sub> SI 3\u20136 months post-BT is a sensitive measure of tissue response to heterogeneous BT radiation-dose. Future studies will validate whether F<jats:sub>Diffuse<\/jats:sub> and F<jats:sub>Dense<\/jats:sub> are accurate biomarkers of fibrotic radiation response.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13014-024-02499-2","type":"journal-article","created":{"date-parts":[[2024,8,6]],"date-time":"2024-08-06T12:03:14Z","timestamp":1722945794000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Inversion-recovery ultrashort-echo-time (IR-UTE) MRI-based detection of radiation dose heterogeneity in gynecologic cancer patients treated with HDR brachytherapy"],"prefix":"10.1186","volume":"19","author":[{"given":"Khadija","family":"Sheikh","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bruce L.","family":"Daniel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Roumeliotis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junghoon","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William T.","family":"Hrinivich","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Benkert","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Himanshu","family":"Bhat","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ravi T.","family":"Seethamraju","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akila N.","family":"Viswanathan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ehud J.","family":"Schmidt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,8,6]]},"reference":[{"issue":"3","key":"2499_CR1","doi-asserted-by":"publisher","first-page":"614","DOI":"10.1148\/radiol.2213992043","volume":"221","author":"II Rosen","year":"2001","unstructured":"Rosen II, Fischer TA, Antolak JA, Starkschall G, Travis EL, Tucker SL, et al. 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