The triple-phase CT image appearance of post-irradiated livers

Chiou, Shang-Ming; Lee, R.-C.; Chi, Kwan‐Hwa; Cheng, Jason Chia‐Hsien; Chiang, Jen–Huey; Chang, Cheng-Hsien

doi:10.1034/j.1600-0455.2001.420515.x

Cited by 26 publications

(14 citation statements)

References 20 publications

(45 reference statements)

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“…After several months of follow-up by three-phase enhancement CT scans, we often found a focal liver reaction in an area around the tumour consistent with findings published by others [10,[12][13][14].…”

supporting

confidence: 78%

“…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].…”

Section: Imaging Changes After High-dose Focal Irradiationmentioning

confidence: 99%

“…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.…”

mentioning

confidence: 97%

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

Sanuki

Takeda

Ohashi³

et al. 2010

BJR

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ABSTRACT. This study aimed to assess the imaging appearances of focal liver reactions following stereotactic body radiotherapy (SBRT) for small hepatocellular carcinoma (HCC) and to examine relationships between imaging appearance and baseline liver function. We retrospectively studied 50 lesions in 47 patients treated with SBRT (30-40 Gy in 5 fractions) for HCC, who were followed up for more than 6 months. After SBRT, all patients underwent regular follow-ups with blood tests and dynamic CT scans. At a median follow-up of 18.1 months (range 6.2-43.7 months), all lesions but one were controlled. 3 density patterns describing focal normal liver reactions around HCC tumours were identified in pre-contrast, arterial and portal-venous phase scans: iso/iso/ iso in 4 patients (Type A), low/iso/iso in 8 patients (Type B) and low/iso (or high)/high in 38 patients (Type C). Imaging changes in the normal liver surrounding the treated HCC began at a median of 3 months after SBRT, peaked at a median of 6 months and disappeared 9 months later. Liver function, as assessed by the Child-Pugh classification, was the only factor that differed significantly between reactions to treatment showing ''non-enhanced'' (Type A and B) and ''enhanced'' (Type C) appearances in CT. Hence, liver tissue with preserved function is more likely to be well enhanced in the delayed phase of a dynamic contrast-enhanced CT scan. The CT appearances of normal liver seen in reaction to the treatment of an HCC by SBRT were therefore related to background liver function and should not be misread as recurrence of HCC.

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supporting

confidence: 78%

Section: Imaging Changes After High-dose Focal Irradiationmentioning

confidence: 99%

mentioning

confidence: 97%

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

Sanuki

Takeda

Ohashi³

et al. 2010

BJR

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“…Child-Pugh B patients have poor blood flow in both the portal and venous systems and, therefore, may not demonstrate the enhancement patterns described. Another clue suggesting tumor recurrence or progression is that lesions tend to have a lower density than a radiation reaction plus compresses or displaces vessels [25,26]. A final tip is that the normal halo may increase in size and density until 6 months.…”

Section: Halosmentioning

confidence: 99%

“…Is there a means to distinguish normal radiation-induced enhancement from disease? Based on four primary studies [24][25][26], three types of normal radiation enhancement patterns have been identified based on postradiation change studies of both primary and secondary carcinomas [25]. This understanding is important as these enhancement patterns may be misinterpreted by standard criteria as progression.…”

Section: Halosmentioning

confidence: 99%

Computed Tomography Imaging Assessment of Postexternal Beam Radiation Changes of the Liver

et al. 2016

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Radiation is being used for patients with primary and secondary liver cancers, as a rapidly evolving treatment. However, postradiation imaging changes of the liver are not well understood and therefore challenging to interpret. Distinguishing normal radiation changes from residual or recurrent disease is difficult. Size and contrast enhancement have been used to guide interpretation and clinical recommendations, but normal radiation changes can make interpretation difficult and are not accounted for in available guidelines. Knowledge of dose- and time-dependent changes in addition to imaging findings, such as morphological and enhancement patterns, provides useful differentiating parameters. This paper reviews recent studies using computed tomography that can guide interpretation and help differentiate tumor from benign changes after external beam radiation.

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Monitoring of liver metastases after stereotactic radiotherapy using low-MI contrast-enhanced ultrasound?initial results

et al. 2005

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The purpose of this study was to monitor liver metastases after radiotherapy using contrast-enhanced ultrasound (CEUS). In 15 patients, follow-up examinations after stereotactic, single-dose radiotherapy were performed using CEUS (low mechanical index (MI), 2.4-ml SonoVue) and computed tomography (CT). Besides tumor size, the enhancement of the liver and the metastases was assessed at the arterial, portal venous, and delayed phases. The sizes of the tumor and of a perifocal liver reaction after radiotherapy measured with CEUS significantly correlated with those measured at CT (r=0.93, p<0.001). CEUS found a significant reduction of the arterial vascularization in treated tumors (p<0.05). In the arterial phase, the perifocal liver tissue was hypervascularized compared to the treated tumor (p<0.001); in the late phase, it was less enhanced than the liver (p<0.001) and more than the tumor (p<0.01). The perifocal liver reaction was also seen in CT, but with a variable enhancement at the arterial (50% hyperdense compared to normal liver tissue), venous, or delayed phase (each with 70% hyperdense reactions). CEUS allows for the assessment of tumor and liver perfusion, in addition to morphological tumor examination, which was comparable with CT. Thus, changes of tumor perfusion, which may indicate tumor response, as well as the perifocal liver reaction after radiotherapy, which must be differentiated from perifocal tumor growth, can be sensitively visualized using CEUS.

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The triple-phase CT image appearance of post-irradiated livers

Abstract: The sequential CT appearance and the density changes may indicate correlation with the pathogenesis of veno-occlusive disease.

Cited by 26 publications

References 20 publications

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

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

Computed Tomography Imaging Assessment of Postexternal Beam Radiation Changes of the Liver

Monitoring of liver metastases after stereotactic radiotherapy using low-MI contrast-enhanced ultrasound?initial results

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