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

Abstract

Background: Neoadjuvant chemoradiotherapy is currently the gold standard treatment for esophageal cancer prior to surgery. This radiation therapy will sometimes lead to liver damage parallel to esophageal lesions, which mimics liver metastasis visualized by 18 F-fluorodeoxyglucose positron emission tomography with computed tomography. In this report, we publish virtual radiation-induced liver damage images obtained during surgery, along with the coherent pathology, in order to confirm the false-positive result through an optimally decisive radiological examination. Case presentation: We report a case of a Asian male patient with distal esophageal cancer who had undergone neoadjuvant chemoradiotherapy (5000 cGy). Subsequently, a new lesion was discovered during a positron emission tomography with computed tomography scan 6 weeks later, near the left caudate lobe of the liver during tumor restaging. To exclude the possibility of liver metastasis, serial imaging was conducted, which included liver sonography, computed tomography, and magnetic resonance imaging for a more intimate probe. The patient's condition was verified as being liver inflammation change, as seen by the liver magnetic resonance imaging presentation. Thoracoscopic esophagectomy was performed with cervical esophagogastrostomy via the retrosternal route, along with a feeding jejunostomy. The procedure was performed smoothly, with an intraoperative liver biopsy also being conducted 2 weeks later, after positron emission tomography with computed tomography restaging. The pathology report revealed esophageal cancer in the form of poorly differentiated squamous cell carcinoma, pT3N1M0. The liver biopsy revealed obvious inflammation change after radiation therapy, which elucidated sinusoidal congestion with the attenuated hepatic cords and filled with erythrocytes. There was no evidence of liver metastasis. The patient recovered uneventfully and was discharged with his oral intake performing smoothly, and a stable condition was observed during 12 months of outpatient department follow-up.

PET‐CT versus MRI in the diagnosis of lymph node metastasis of cervical cancer: A meta‐analysis

“…MRI and CT have been widely used to assess the para‐aortic and pelvic lymph nodes in patients with cervical cancer. Compared with CT, MRI has advantages in estimating tumor size and detecting local invasion (Shai et al, 2020). Studies (Lindegaard et al, 2020; Mansoori et al, 2020) have pointed out that these methods have only moderate SEN and SPE in detecting cervical cancer lymph node metastasis.…”

Radioembolization-Induced Changes in Hepatic [18F]FDG Metabolism in Non-Tumorous Liver Parenchyma

“…Multiple reports on increased [ 18 F]FDG uptake in the liver after chemoradiation therapy for esophageal cancer have been published, with focal as well as diffuse patterns [ 16 , 21 , 22 , 23 , 24 ]. However, only one publication has touched upon the [ 18 F]FDG uptake pattern in normal liver parenchyma 1 month after radioembolization, with no changes compared to baseline [ 25 ].…”

“…However, the concomitant non-target embolization and radiation of the non-tumorous liver parenchyma (NTLP) may lead to a localized and systemic inflammatory reaction [ 13 , 14 ]. Eventually, changes consistent with sinusoidal obstruction syndrome (SOS) and fibrosis can develop [ 15 , 16 ].…”

Liver Injury in Patients With Distal Esophageal Carcinoma After Precision Radiation Therapy

“…FDG uptake in RILI is the result of inflammation with increased FDG uptake by leukocytes. Radiation and chemoradiation can cause vascular hepatic changes presenting as veno-occlusive disease resulting in differences in blood flow and inflammation in the liver, and this is a possible explanation for the discordance between CT and FDG-PET/CT manifestations 5,14–16…”

“…Radiation and chemoradiation can cause vascular hepatic changes presenting as veno-occlusive disease resulting in differences in blood flow and inflammation in the liver, and this is a possible explanation for the discordance between CT and FDG-PET/CT manifestations. 5,[14][15][16] The presence of increased FDG uptake in the liver secondary to RILI can be confused with hepatic metastases, especially when this manifests as nodular uptake and/or more than 1 region of uptake. In fact, in our study, focal or mass-like uptake of FDG in regions of radiation-induced liver injury was misinterpreted as metastases in 6 patients.…”