Hepatic radiation injury mimicking metastasis in distal esophageal cancer

Demey, Karel; Veer, Hans Van; Nafteux, Philippe; Deroose, Christophe M.; Haustermans, Karin; Coolen, Johan; Vandecaveye, Vincent; Coosemans, Willy; Cutsem, Éric Van

doi:10.1080/00015458.2016.1248120

Cited by 3 publications

(4 citation statements)

References 8 publications

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“…RH in this region and central acute RH in segment 2 [46]. The manifestation of MRI T1weighted images of the liver displayed low signal intensity over the caudate lobe (Figure 2C), whereas whole T2-weighted images showed strong signal intensity over the same area (Figure 2D).…”

Section: Mri and Its Sensitivitymentioning

confidence: 88%

“…Thus, radiation fields should be meticulously compared with the nodular lesion’s location, and only lesions outside these fields should be considered highly suspicious of metastases [ 22 ]. Preoperative 18F-FDG-PET-CT proved useful in the reevaluation of patients after nCRT to determine the treatment response and rule out occult metastasis [ 46 ]. Eithne M. DeLappe reported a case of a 61-year-old esophageal cancer patient with increased FDG uptake in the left liver lobe post-50.4 Gy radiation, where no metastasis was found in the biopsy [ 44 ].…”

Section: Rild Inducing False Fdg Pet-ct Interpretationsmentioning

confidence: 99%

“…MRI performed five weeks post-RT revealed a hypointense signal on T1-weighted images and a markedly hyperintense signal on T2-weighted images, alongside facilitated diffusion on diffusion-weighted MR imaging (DWI) images. These findings showed heterogeneous alterations in the entire left liver lobe, attributed to mild RH in this region and central acute RH in segment 2 [ 46 ]. The manifestation of MRI T1-weighted images of the liver displayed low signal intensity over the caudate lobe ( Figure 2 C), whereas whole T2-weighted images showed strong signal intensity over the same area ( Figure 2 D).…”

Section: Rild Inducing False Fdg Pet-ct Interpretationsmentioning

confidence: 99%

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

Shai,

Lai,

Chang

et al. 2024

Cancers

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In patients with esophageal cancer undergoing neoadjuvant chemoradiotherapy (nCRT), subsequent restaging with F-18-fluorodeoxyglucose (18F-FDG) positron emission tomography–computed tomography (PET-CT) can reveal the presence of interval metastases, such as liver metastases, in approximately 10% of cases. Nevertheless, it is not uncommon in clinical practice to observe focal FDG uptake in the liver that is not associated with liver metastases but rather with radiation-induced liver injury (RILI), which can result in the overstaging of the disease. Liver radiation damage is also a concern during distal esophageal cancer radiotherapy due to its proximity to the left liver lobe, typically included in the radiation field. Post-CRT, if FDG activity appears in the left or caudate liver lobes, a thorough investigation is needed to confirm or rule out distant metastases. The increased FDG uptake in liver lobes post-CRT often presents a diagnostic dilemma. Distinguishing between radiation-induced liver disease and metastasis is vital for appropriate patient management, necessitating a combination of imaging techniques and an understanding of the factors influencing the radiation response. Diagnosis involves identifying new foci of hepatic FDG avidity on PET/CT scans. Geographic regions of hypoattenuation on CT and well-demarcated regions with specific enhancement patterns on contrast-enhanced CT scans and MRI are characteristic of radiation-induced liver disease (RILD). Lack of mass effect on all three modalities (CT, MRI, PET) indicates RILD. Resolution of abnormalities on subsequent examinations also helps in diagnosing RILD. Moreover, it can also help to rule out occult metastases, thereby excluding those patients from further surgery who will not benefit from esophagectomy with curative intent.

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Section: Mri and Its Sensitivitymentioning

confidence: 88%

Section: Rild Inducing False Fdg Pet-ct Interpretationsmentioning

confidence: 99%

Section: Rild Inducing False Fdg Pet-ct Interpretationsmentioning

confidence: 99%

See 1 more Smart Citation

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

Shai,

Lai,

Chang

et al. 2024

Cancers

View full text Add to dashboard Cite

show abstract

“…MRI performed five weeks post-RT revealed a hypointense signal on T1-weighted images and a markedly hyperintense signal on T2-weighted images, alongside facilitated diffusion on diffusion-weighted MR imaging (DWI) images. These findings showed heterogeneous alterations in the entire left liver lobe, attributed to mild RH in this region and central acute RH in segment 2 [46]. The manifestation of MRI T1-weighted images of the liver displayed low signal intensity over the caudate lobe (Figure 2C), whereas whole T2-weighted images showed strong signal intensity over the same area (Figure 2D).…”

Section: Mri and Its Sensitivitymentioning

confidence: 94%

False Liver Metastasis by PET/CT Scan After Chemoradiotherapy for Esophageal Cancer- A Potential Overstaged Pitfalls of Treatment

Shai,

Lai,

Chang

et al. 2024

Preprint

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For esophageal cancer patients treated with neoadjuvant chemoradiotherapy (nCRT), restaging using F-18-fluorodeoxyglucose (18F-FDG) positron emission tomography computed tomography (PET-CT) following nCRT can detect interval metastases, including liver metastases, in almost 10% of patients. However, in clinical practice, focal FDG liver uptake, unrelated to liver metastases, is observed after chemoradiotherapy. This radiation-induced liver injury (RILI) can potentially lead to overstaging. Liver radiation damage is also a concern during distal esophageal cancer radiotherapy due to proximity to the left liver lobe, typically included in the radiation field. Post-CRT, if FDG activity appears in the left or caudate liver lobes, thorough investigation is needed to confirm or rule out distant metastases. The increased FDG uptake in liver lobes post-CRT often presents a diagnostic dilemma. Distinguishing between radiation-induced liver disease and metastasis is vital for appropriate patient management, necessitating a combination of imaging techniques and an understanding of the factors influencing radiation response. Diagnosis involves identifying new foci of hepatic FDG avidity on PET/CT scans. Geographic regions of hypoattenuation on CT and well-demarcated regions with specific enhancement patterns on contrast-enhanced CT scan and MRI are characteristic of radiation-induced liver disease (RILD). Lack of mass effect on all three modalities (CT, MRI, PET) indicates RILD. Resolution of abnormalities on subsequent examinations also helps in diagnosing RILD. Moreover, it can also help to rule out occult metastases, thereby excluding those patients from further surgery who will not benefit from esophagectomy with curative intent.

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The impact of infection and inflammation in oncologic 18F-FDG PET/CT imaging

Rahman

Wale

Viglianti

et al. 2019

Biomedicine & Pharmacotherapy

107

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Hepatic radiation injury mimicking metastasis in distal esophageal cancer

Abstract: FDG-PET/CT images should therefore carefully be interpreted and compared with the radiation beams, dose distribution and eventually clarified by DW-MR imaging.

Cited by 3 publications

References 8 publications

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

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

False Liver Metastasis by PET/CT Scan After Chemoradiotherapy for Esophageal Cancer- A Potential Overstaged Pitfalls of Treatment

The impact of infection and inflammation in oncologic 18F-FDG PET/CT imaging

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