Evaluation of acute esophageal radiation-induced damage using magnetic resonance imaging: a feasibility study in mice

Abstract

BackgroundThoracic and head and neck cancer radiation therapy (RT) can cause damage to nearby healthy organs such as the esophagus, causing acute radiation-induced esophageal damage (ARIED). A non-invasive method to detect and monitor ARIED can facilitate optimizing RT to avoid ARIED while improving local tumor control. Current clinical guidelines are limited to scoring the esophageal damage based on the symptoms of patients. Magnetic resonance imaging (MRI) is a non-invasive imaging modality that may potentially visualize radiation-induced organ damage. We investigated the feasibility of using T2-weighted MRI to detect and monitor ARIED using a two-phased study in mice.MethodsThe first phase aimed to establish the optimal dose level at which ARIED is inducible and to determine the time points where ARIED is detectable. Twenty four mice received a single dose delivery of 20 and 40 Gy at proximal and distal spots of 10.0 mm (in diameter) on the esophagus. Mice underwent MRI and histopathology analysis with esophageal resection at two, three, and 4 weeks post-irradiation, or earlier in case mice had to be euthanized due to humane endpoints. In the second phase, 32 mice received a 40 Gy single dose and were studied at two, three, and 7 days post-irradiation. We detected ARIED as a change in signal intensity of the MRI images. We measured the width of the hyperintense area around the esophagus in all mice that underwent MRI prior to and after irradiation. We conducted a blind qualitative comparison between MRI findings and histopathology as the gold standard.Results/conclusionsA dose of 40 Gy was needed to induce substantial ARIED. MRI detected ARIED as high signal intensity, visible from 2 days post-irradiation. Quantitative MRI analysis showed that the hyperintense area around the esophagus with severe ARIED was 1.41 mm wider than with no damage and MRI-only mice. The overall sensitivity and specificity were 56 and 43% respectively to detect any form of ARIED. However, in this study MRI correctly detected 100% of severe ARIED cases. Our two-phased preclinical study showed that MRI has the potential to detect ARIED as a change in signal intensity and width of enhancement around the esophagus.

Phantom simulation of liver metastasis on a positron emission tomography with computed tomography scan after neoadjuvant chemoradiotherapy for distal esophageal cancer: a case report

“…Decreased signal intensity on T1-weighted images, increased signal intensity on T2-weighted images, and an increased signal intensity on proton spectroscopic imaging of irradiated liver lobes suggests that the irradiated liver has increased water content [28]. MRI produces high-resolution images with good soft tissue contrast, which is ideal for distinguishing organs from surrounding tissue [32]. Various clinical studies have investigated the use of MRI to detect and monitor radiation-induced damage to the liver [33], myocardium [34,35], and bone marrow [36,37].…”

False Liver Metastasis by Positron Emission Tomography/Computed Tomography Scan after Chemoradiotherapy for Esophageal Cancer—Potential Overstaged Pitfalls of Treatment

“…MRI imaging post-liver radiation showcases decreased signal intensity on T1-weighted images, increased T2 intensity, and enhanced proton spectroscopic imaging signals in irradiated lobes, indicating elevated water content [ 60 ]. The high resolution and soft tissue contrast of MRI make it ideal for differentiating organs [ 65 ]. Clinical studies have used MRI to monitor radiation damage in the liver [ 66 ], myocardium [ 67 , 68 ], and bone marrow [ 69 , 70 ].…”

Radiotherapy-Induced Digestive Injury: Diagnosis, Treatment and Mechanisms

“…MRI, as a radiation-free medical imaging technique, is gradually replacing CT scans in clinical applications. MRI works by polarization of hydrogen atoms and has proven to be effective in diagnosing radiation-induced salivary gland injury, esophageal injury, liver injury, and rectal injury (58)(59)(60)(61). MRI images of radiation injury generally manifest as high signal intensity in T2, pathologically based on tissue edema.…”