Pathology and images of radiation-induced hepatitis: a review article

Takamatsu, Shigeyuki; Kozaka, Kazuto; Kobayashi, Satoshi; Yoneda, Norihide; Yoshida, Kotaro; Inoue, Dai; Kitao, Azusa; Ogi, Takahiro; Minami, Tetsuya; Kouda, Wataru; Kumano, Tomoyasu; Fuwa, Nobukazu; Matsui, Osamu; Gabata, Toshifumi

doi:10.1007/s11604-018-0728-1

Cited by 42 publications

(37 citation statements)

References 57 publications

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“…17 The irradiated parenchyma does not take up gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) and superparamagnetic iron oxide, which can cause difficulty in distinguishing PBT-treated HCCs from the surrounding irradiated parenchyma. 18,19 Thus, dynamic CT or dynamic MRI scans using extracellular contrast agents are suitable for the assessment of tumor contrast enhancement, because they can more accurately distinguish treated HCC from irradiated parenchyma.…”

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confidence: 99%

Indicator for local recurrence of hepatocellular carcinoma after proton beam therapy: analysis of attenuation difference between the irradiated tumor and liver parenchyma on contrast enhancement CT

Takahashi

Sekino

Mori

et al. 2019

The British Journal of Radiology

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Objectives: We aimed to identify dynamic CT features that can be used for prediction of local recurrence of hepatocellular carcinoma (HCC) after proton beam therapy (PBT). Methods: We retrospectively retrieved CT scans of patients with PBT-treated HCC, taken between January 2004 and December 2016. 17 recurrent lesions and 34 non-recurrent lesions were retrieved. The attenuation difference between irradiated tumor and irradiated parenchyma (ADHCC-IP) was compared in the two groups by using the Mann–Whitney U test. Cut-off value of ADHCC-IP was estimated by using the Youden index. Results: The follow-up time after PBT initiation ranged from 374 to 2402 days (median, 1069 days) in recurrent lesions, and 418 to 2923 days (median, 1091.5 days) in non-recurrent lesions (p = 0.892). The time until appearance of local recurrence after PBT initiation ranged from 189 to 2270 days (median, 497 days). ADHCC-IP of recurrent lesions [mean, −21.8 Hounsfield units (HU); from −95 to −31 HU] was significantly greater than that of non-recurrent lesions (mean, −51.7 HU; from −117 to −12 HU) at 1–2 years in portal venous phase (p = 0.039). 5-year local tumor control rates were 0.93 and 0.56 in lesions with ADHCC-IP at 1–2 years in PVP < −55 and ≥ −55 HU, respectively. Conclusion: The attenuation difference between irradiated HCC and irradiated liver parenchyma in portal venous phase at 1-2 years after PBT can predict long-term local recurrence of HCC after treatment. Advances in knowledge: We identified a cut-off value for contrast enhancement of HCC after PBT that could predict future local recurrence.

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confidence: 99%

Indicator for local recurrence of hepatocellular carcinoma after proton beam therapy: analysis of attenuation difference between the irradiated tumor and liver parenchyma on contrast enhancement CT

Takahashi

Sekino

Mori

et al. 2019

The British Journal of Radiology

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“…During angiography-assisted CT, irradiated parenchyma exhibits decreased attenuation on CT arterial portography and increased attenuation on CT arteriography, which is the result of an arterial-predominant blood supply to the irradiated parenchyma (caused by radiation-induced venoocclusive disease) [11–13]. Prolonged enhancement of the irradiated parenchyma is related to contrast agent retention in the fibrous tissue [14]. Furthermore, a previous study demonstrated that the earliest disappearance of radiation-induced hepatic injury on imaging was observed 42 months after the PBT [11–13], which suggests that the irradiated parenchyma might have diminished arterial supply that persists long after the PBT treatment.…”

Section: Discussionmentioning

confidence: 99%

Angiographic Findings in Patients with Hepatocellular Carcinoma Previously Treated Using Proton Beam Therapy

Takahashi

Mori

Sekino

et al. 2019

Journal of Oncology

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Given the growing interest in using proton beam therapy (PBT) for hepatocellular carcinoma (HCC), it is possible that transarterial chemoembolization (TACE) could be used for selected patients who have previously undergone PBT. However, these cases can be technically challenging to treat and require appropriate preparation. Thus, we aimed to identify angiographic findings in this setting. We retrospectively identified 31 patients (28 men and 3 women, mean age: 69 years, range: 43–84 years) who underwent hepatic angiography plus TACE or transarterial infusion chemotherapy (TAI) for HCC that recurred after PBT (July 2007 to June 2018). We discovered four angiographic findings, which we speculate were related to the previous PBT. 18 patients experienced recurrence in the irradiated field, and 13 patients experienced recurrence outside the irradiated field. 29 patients underwent TACE and only 2 patients underwent TAI. The mean number of previous PBT treatments was 1.3 ± 0.6 (range: 1–4). The median interval from the earliest PBT treatment to hepatic angiography was 559 days (range: 34–5,383 days), and the median interval from the latest PBT treatment to hepatic angiography was 464 days (range: 34–5,383 days). Abnormal staining of the irradiated liver parenchyma was observed in 22 patients, which obscured the angiographic tumor staining in 4 patients. Development of a tortuous tumor feeder vessel was observed in 13 patients. Development of an extrahepatic collateral pathway was observed in 7 patients. Development of an arterioportal or arteriovenous shunt was observed in 4 patients. Based on these findings, we conclude that PBT was associated with various angiographic findings during subsequent transarterial chemotherapy for recurrent HCC, and familiarity with these findings will be important in developing appropriate treatment plans.

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“…While exposed to radiation due to a nuclear accident or as an intended treatment for cancer, as a radiosensitive organ, the liver may suffer from radiation-induced liver injury (RILI), resulting in hepatitis, fibrosis, cirrhosis, and cancer. Typical pathological appearances of RILI in humans are perivenular fibrosis, sinusoidal obstruction, and damage to Kupffer cells (KCs) and hepatocytes [ 8 ]. The severity of RILI depends upon the nature of the radiation, the total exposure dose, the dose rate, and the physical area of exposure [ 3 ].…”

Section: Radiationmentioning

confidence: 99%

Radiation-induced liver injury and hepatocyte senescence

Zhu

Zhang

et al. 2021

Cell Death Discov.

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Radiation-induced liver injury (RILI) is a major complication of radiotherapy during treatment for liver cancer and other upper abdominal malignant tumors that has poor pharmacological therapeutic options. A series of pathological changes can be induced by radiation. However, the underlying mechanism of RILI remains unclear. Radiation can induce cell damage via direct energy deposition or reactive free radical generation. Cellular senescence can be observed due to the DNA damage response (DDR) caused by radiation. The senescence-associated secretory phenotype (SASP) secreted from senescent cells can cause chronic inflammation and aggravate liver dysfunction for a long time. Oxidative stress further activates the signaling pathway of the inflammatory response and affects cellular metabolism. miRNAs clearly have differential expression after radiation treatment and take part in RILI development. This review aims to systematically profile the overall mechanism of RILI and the effects of radiation on hepatocyte senescence, laying foundations for the development of new therapies.

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Pathology and images of radiation-induced hepatitis: a review article

Cited by 42 publications

References 57 publications

Indicator for local recurrence of hepatocellular carcinoma after proton beam therapy: analysis of attenuation difference between the irradiated tumor and liver parenchyma on contrast enhancement CT

Indicator for local recurrence of hepatocellular carcinoma after proton beam therapy: analysis of attenuation difference between the irradiated tumor and liver parenchyma on contrast enhancement CT

Angiographic Findings in Patients with Hepatocellular Carcinoma Previously Treated Using Proton Beam Therapy

Radiation-induced liver injury and hepatocyte senescence

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