CT Evaluation of Hepatic Injury Following Proton Beam Irradiation: Appearance, Enhancement, and 3D Size Reduction Pattern

Abstract

Early appearance of radiation-induced hepatic injury was found only to be gender dependent, with a tendency to occur with higher irradiated doses; no other parameters affected this phenomenon in our cases. Disappearance of the injured areas, if present, takes a long time (at least 42 months).

CT evaluations of focal liver reactions following stereotactic body radiotherapy for small hepatocellular carcinoma with cirrhosis: relationship between imaging appearance and baseline liver function

“…Gender was an insignificant factor (p50.70) in our study, although Ahmadi et al [16], who investigated imaging appearances of hepatic injury following proton beam irradiation in 46 patients, claimed that the early appearance of radiation-induced hepatic injury was gender dependent, with a tendency to occur with higher irradiated doses. The underlying mechanism of radiation-induced liver change and the associated findings on imaging have not yet been fully investigated, but severe congestion of the sinusoids in the central portion of the lobules and decreasing flow towards the portal areas, referred to as a form of ''veno-occlusive disease (VOD)'', is suggested as a possible mechanism of pathology.…”

“…In terms of high-dose irradiation to the liver, a typical appearance is a low-attenuation area identical to the irradiated volume on the non-contrast phase scan and highly enhanced areas on delayed scans [12,14,16]. MRI shows that the low-density area on CT has high signal on the T 2 weighted image, indicating necrotic liver parenchyma or oedema [26,27].…”

“…Some reports have described radiographic findings of radiation-induced hepatic injury resulting from treatments involving conventional doses and fractionation [14,16,17], and a few reports have described radiographic findings after SBRT for patients with liver metastasis who have normal liver function [10,12,13,16,18]. There are few detailed reports, however, especially relating to patients with HCC who have liver cirrhosis.…”

Sequential evaluation of hepatic functional reserve by99mTechnetium-galactosyl human serum albumin scinitigraphy after proton beam therapy: a report of three cases and a review of the literatures

“…Clinically, hepatic regeneration is induced by hepatectomy or hepatic irradiation [15,21,22]. Upregulation of hepatocyte growth factor (HGF) expression is observed soon after hepatectomy [23,24] or irradiation [25].…”

“…Six months after the proton beam therapy, the tumor stain became vague, which suggested decreased tumor vascularity and viability after proton beam therapy, with a sign of radiation hepatitis in the surrounding irradiated normal liver tissue, and compensatory hypertrophy of the left lobe of the liver was observed in CT images ( Figure 1C) [15]. CT findings of radiation hepatitis were also seen one year after the proton beam therapy.…”