Radiation-induced liver disease as a mimic of liver metastases at serial PET/CT during neoadjuvant chemoradiation of distal esophageal cancer
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To determine the frequency and appearance of radiation-induced liver disease on PET/CT in patients undergoing serial imaging during neoadjuvant chemoradiation of distal esophageal cancer.
Materials and methods
In this IRB-approved, HIPAA–compliant retrospective analysis, we identified 112 patients with distal esophageal cancer treated by neoadjuvant chemoradiation who had serial PET/CT imaging available for review. Two readers reviewed all studies in consensus and recorded those cases where new foci of visually detectable increased FDG avidity appeared in the liver during therapy. The etiology of such foci was determined from corresponding findings at CT or MRI, by hepatic biopsy during surgery, by characteristic evolution on post-operative imaging, or by a combination of these methods.
New foci of FDG avidity developed in the liver during neoadjuvant therapy in 10 of 112 (9%) patients, of whom nine (8%) were determined to have radiation-induced liver disease based on further imaging and/or biopsy and one of whom had developed interval metastatic disease based on biopsy. In the cases of radiation-induced liver disease, the abnormal foci were found only in the caudate and left hepatic lobes, near the primary tumor, while the patient who developed interval metastatic disease had involvement of the inferior right hepatic lobe, remote from the radiation therapy field.
New foci of increased FDG avidity are commonly seen in the caudate and left hepatic lobes of the liver during neoadjuvant chemoradiation of distal esophageal cancer, and these findings generally reflect radiation-induced liver disease rather than metastatic disease.
KeywordsRadiation-induced liver disease Esophageal cancer PET/CT
RAD supported by NIBIB grant 1R25EB016671.
- 1.Alteri R, Anderson K, Barnes C, et al. (2013). Estimated number of new cancer cases and deaths by sex, US, 2013. American Cancer Society: Cancer Facts and Figures 2013. http://www.cancer.org/research/cancerfactsstatistics/cancerfactsfigures2013/. Accessed 21 Oct 2013
- 12.Levine EA, Farmer MR, Clark P, et al. (2006) Predictive value of 18-fluoro-deoxy-glucose-positron emission tomography (18F-FDG PET) in the identification of responders to chemoradiation therapy for the treatment of locally advanced esophageal cancer. Ann Surg 243:472–478PubMedCrossRefPubMedCentralGoogle Scholar
- 17.Lee JKT, Sagel SS, Stanley RJ, et al. Computed Tomography with MRI Correlation.Google Scholar
- 19.Suto YS, Kato T, Yoshida K (1996) MRI Findings in Radiation-Induced Hepatic Injuries. Yonago Acta Medica 39:127–134Google Scholar
- 21.Gazelle GS, Saini S, Mueller PR (1997) Hepatobiliary and Pancreatic Radiology: Imaging and Intervention. New York: Thieme Medical Publishers, Inc.; pp. 289.Google Scholar
- 22.Eisenberg RL (1996) Gastrointestinal radiology: a pattern approach. Hagerstown: Lippincott-Raven Publishers, p 1118Google Scholar
- 26.Feldman M, Friedman LS, Brandt LJ (2010) Sleisenger & Fordtran’s gastrointestinal and liver disease, 9th edn. Philadelphia: Saunders, pp 745–767Google Scholar
- 27.Domachevsky L, Jacene HA, Sakellis CG, Kim CK. Postradiation Changes in Tissues: Evaluation by Imaging Studies with Emphasis on Fluorodeoxyglucose-PET/Computed Tomography and Correlation with Histopathologic Findings. PET Clinics. DOI: 10.1016/j.cpet.2013.10.005. Review article (In Press Corrected Proof) 12 December 2013
- 30.DeLappe EM, Truong MT, et al. (2009) Hepatic radiation injury mimicking a metastasis on positron-emission tomography/computed tomography in a patient with esophageal carcinoma: a case report. J Thorac Oncol 37(7):709–711Google Scholar
- 35.Mettler FA, Guiberteau MJ (2012) Essentials of Nuclear Medicine, 6th edn. Philadelphia: Elsevier Saunders, pp 373–374Google Scholar