CT appearance of acute radiation-induced injury in the lung

Ikezoe, Junpei; Takashima, S; Morimoto, S; Kadowaki, K; Takeuchi, Noriyuki; Yamamoto, Tokihiro; Nakanishi, Katsuyuki; Isaza, M.; Arisawa, J; Ikeda, Hiroyuki; et, al

doi:10.2214/ajr.150.4.765

Cited by 116 publications

(61 citation statements)

References 14 publications

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“…Clinically, radiation-induced lung injury is divided into two phases: the early phase of RP and the late phase of radiation-induced fibrosis. However, the most sensitive radiodiagnostic method in order to follow its development from one phase to the next is the computed axial tomography (CT) (Libshitz and Shuman, 1984;Ikezoe et al, 1988).…”

Section: Discussionmentioning

confidence: 99%

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Suggestion for a New Grading Scale for Radiation Induced Pneumonitis Based on Radiological Findings of Computerized Tomography: Correlation with Clinical and Radiotherapeutic Parameters in Lung Cancer Patients

Kouloulias

Zygogianni²,

Efstathopoulos³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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Background: The objective of this research is the computed axial tomography (CT) imaging grading of radiation induced pneumonitis (RP) and its correlation with clinical and radiotherapeutic parameters. Materials and Methods: The chest CT films of 20 patients with non-small cell lung cancer who have undergone threedimensional conformal radiation therapy were reviewed. The proposed CT grading of RP is supported on solely radiological diagnosis criteria and distinguishes five grades. The manifestation of RP was also correlated with any positive pre-existing chronic obstructive pulmonary disease (COPD) history, smoking history, the FEV1 value, and the dosimetric variable V20. Results: The CT grading of RP was as follows: 3 patients (15%) presented with ground glass opacity (grade 1), 9 patients (45%) were classified as grade 2, 7 patients (35%) presented with focal consolidation, with or without elements of fibrosis (grade 3), and only one patient (5%) presented with opacity with accompanying atelectasis and loss of pulmonary volume (grade 4). Both univariate and multivariate analysis revealed as prognostic factors for the radiological grading of RP the reduction of FEV1 and the V20 (P=0.026 and P=0.003, respectively). There was also a significant (P<0.001) correlation of radiological grading of RP with FEV1 and V20 (spearman rho 0.92 and 0.93, respectively). Conclusions: The high correlation of the proposed radiological grading with the FEV1 and the V20 is giving a satisfactory clinical validity. Although the proposed grading scale seems relevant to clinical practice, further studies are needed for the confirmation of its validity and reliability.

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Section: Discussionmentioning

confidence: 99%

“…This development of the radiological image conforms to other studies as well. In effect, Aoki et al (2004) identified elements of radiation-induced injury in the chest CT in 2 to 6 months following radiation therapy, Ikezoe et al (1988) in 16 weeks, and Koenig et al (2002) from the 3 rd month following the chest wall's radiation.…”

Section: Discussionmentioning

confidence: 99%

Suggestion for a New Grading Scale for Radiation Induced Pneumonitis Based on Radiological Findings of Computerized Tomography: Correlation with Clinical and Radiotherapeutic Parameters in Lung Cancer Patients

Kouloulias

Zygogianni²,

Efstathopoulos³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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“…RP was classified into five patterns based on Ikezoe et al's report: 23 (1) diffuse consolidation, (2) patchy consolidation and ground-glass opacities (GGOs), (3) diffuse GGO, (4) patchy GGO and (5) coupled with an 18F-FDG/PET-CT scan. Local failure was defined as growing tumour in the same lobe including growth within or at the margin of the PTV, whereas in another lobe or extrathoracic disease, it was defined as distant failure.…”

Section: Follow-up and Statisticsmentioning

confidence: 99%

Treatment outcomes and patterns of radiologic appearance after hypofractionated image-guided radiotherapy delivered with helical tomotherapy (HHT) for lung tumours

Arcangeli

Falcinelli²,

Bracci

et al. 2017

The British Journal of Radiology

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Cite this article as: Arcangeli S, Falcinelli L, Bracci S, Greco A, Monaco A, Dognini J, et al. Treatment outcomes and patterns of radiologic appearance after hypofractionated image-guided radiotherapy delivered with helical tomotherapy (HHT) for lung tumours. Objective: To evaluate treatment outcomes and patterns of CT lung injury after hypofractionated image-guided radiotherapy delivered with helical tomotherapy (HHT) in a series of inoperable lung lesions. Methods: 68 patients who were medically inoperable (69 lesions) without evidence of viable extrathoracic disease were included. Dose prescription was driven by tumour location (hilar/pericentral vs peripheral) and/or target volume.

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“…7 The initially observed ground glass changes could have represented subacute radiation-induced lung injury. 8 However, the temporal relationship between the breath-hold dive and the occurrence of symptoms that did not recur with cessation of diving and swimming practice, as well as the resolution of ground glass opacification over the next months, implicate cold water immersion and breath-hold diving as the major inciting factors in this clinical scenario, rather than subacute radiation-induced lung injury alone.…”

Section: Discussionmentioning

confidence: 96%

Hemoptysis Due to Breath-Hold Diving Following Chemotherapy and Lung Irradiation

Gutsche

Kuschner

2012

Clinical Medicine & Research

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A male patient, age 60 years, presented with a chief complaint of coughing up blood. He had been in his usual state of health until the day of admission, when he went breath-hold diving in Monterey Bay, off the coast of northern California. At the time of his dives, the water temperatures usually average around 55˚F. The patient completed five dives, each to a depth of approximately 13 meters (~ 40 feet) and each lasting approximately 90 seconds. Hyperventilation preceded each dive, but no other maneuvers, such as glossopharyngeal insufflation ("lung packing"), were performed. The patient was unsure about diaphragmatic contractions performed against a closed glottis during immersion. After his fifth dive, he noted "slight irritation" in his chest that was immediately followed by a series of five coughs, over a period of 5 minutes. He expectorated an estimated 1 /2 to 1 tablespoon of blood with each cough; approximately, 4 tablespoons of blood in total. He noted wheezing but did not feel short of breath.The patient's past medical history was significant for T2N3M0 stage IIIc invasive ductal carcinoma of the left breast, for which he had undergone a left modified radical mastectomy and axillary lymph node dissection 10 months prior to presentation. He had been treated with adjuvant chemotherapy 6 months prior to presentation that included doxorubicin, cyclophosphamide, and paclitaxel followed by adjuvant radiation therapy administered in 1.8 Gray (Gy) fractions, Breath-hold diving, also known as free-diving, describes the practice of intentional immersion under water without an external supply of oxygen. Pulmonary hemorrhage with hemoptysis has been reported as a complication of immersion and breath-hold diving in young healthy athletes. We report the case of a 60-year-old man with a history of radiation and chemotherapy for breast carcinoma, who developed the abrupt onset of hemoptysis in the setting of swimming and breath-hold diving. A computed tomography (CT) scan of the chest demonstrated an area of ground glass opacification, suggestive of pulmonary hemorrhage, superimposed on a background of reticular opacities within the prior radiation field. A follow-up CT scan of the chest, obtained 2 months after presentation, demonstrated resolution of the ground glass opacification, but persistence of fibrotic features attributable to prior radiation therapy. We postulate that prior irradiation of the chest resulted in lung injury and fibrosis which, in turn, rendered the affected region of the lung susceptible to "stress failure," due to an increase in the transcapillary pressure gradient arising from immersion and breath-hold diving. Patients with a history of lung injury resulting from chest irradiation should be cautioned about pulmonary hemorrhage and hemoptysis as a potential complication of swimming and breath-hold diving.

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CT appearance of acute radiation-induced injury in the lung

Cited by 116 publications

References 14 publications

Suggestion for a New Grading Scale for Radiation Induced Pneumonitis Based on Radiological Findings of Computerized Tomography: Correlation with Clinical and Radiotherapeutic Parameters in Lung Cancer Patients

Suggestion for a New Grading Scale for Radiation Induced Pneumonitis Based on Radiological Findings of Computerized Tomography: Correlation with Clinical and Radiotherapeutic Parameters in Lung Cancer Patients

Treatment outcomes and patterns of radiologic appearance after hypofractionated image-guided radiotherapy delivered with helical tomotherapy (HHT) for lung tumours

Hemoptysis Due to Breath-Hold Diving Following Chemotherapy and Lung Irradiation

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