Caudate, left hepatic lobes involved in liver injury in distal oesophageal carcinoma patients

A recent study has shown the involvement of the caudate and left hepatic lobes in cases of radiation-induced liver injury (RILI) in patients with distal oesophageal carcinoma. Imaging patterns of RILI on fluorodeoxiglucose-positron emission tomography/computed tomography (FDG-PET/CT) also include one or two regions of increased FDG uptake with a nodular, diffuse, or combined appearance.

“Awareness of this potential complication of radiation therapy and knowledge of the imaging manifestations of RILI [are] important to avoid misinterpretation as a metastasis,” the investigators said.

In this study, 639 patients with locally advanced oesophageal carcinoma who had serial FDG-PET/CTs after neoadjuvant chemoradiation were included in the analysis. Two readers reviewed the imaging studies in consensus and recorded the cases where new foci of increased FDG uptake were found within the radiated liver parenchyma. Follow-up imaging or percutaneous biopsy confirmed RILI.

Of the patients, 39 (6 percent) developed FDG-avid RILI. Both the caudate and left hepatic lobes were involved in all cases. Various patterns of increased FDG uptake were observed: 38 percent of patients had a single focus and 62 percent had two regions of increased FDG uptake, which were either focal nodular or diffuse or a combination of focal nodular and diffuse FDG uptake.

In addition, CT imaging showed a poorly marginated region of low attenuation in 72 percent of patients and a well-defined region of low attenuation with sharp, well-defined linear borders in the location of the radiation, as confirmed by the treatment plan, in 28 percent of patients.