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Shai SE, Lai YL, Chang CI, Hsieh CW. False Liver Metastasis by Positron Emission Tomography/Computed Tomography Scan after Chemoradiotherapy for Esophageal Cancer-Potential Overstaged Pitfalls of Treatment. Cancers (Basel) 2024; 16:948. [PMID: 38473310 DOI: 10.3390/cancers16050948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/16/2024] [Accepted: 02/23/2024] [Indexed: 03/14/2024] Open
Abstract
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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Affiliation(s)
- Sen-Ei Shai
- Department of Thoracic Surgery, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Department of Applied Chemistry, National Chi Nan University, Nantou 545301, Taiwan
- Institute of Clinical Medicine, National Yang-Ming Chiao-Tung University, Taipei 112304, Taiwan
| | - Yi-Ling Lai
- Department of Thoracic Surgery, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Chen-I Chang
- School of Medicine, National Yang-Ming Chiao-Tung University, Taipei 112304, Taiwan
| | - Chi-Wei Hsieh
- School of Medicine, National Cheng Kung University, Tainan 701401, Taiwan
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2
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Ferraciolli SF, Gee MS. Invited Commentary: Cancer-related Hepatic Injury in Children: Review of Imaging Features Guiding Clinical Management. Radiographics 2023; 43:e230195. [PMID: 37616169 DOI: 10.1148/rg.230195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Affiliation(s)
- Suely F Ferraciolli
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit S, AUS-210, Boston, MA 02114; and Department of Radiology, Harvard Medical School, Boston, Mass
| | - Michael S Gee
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit S, AUS-210, Boston, MA 02114; and Department of Radiology, Harvard Medical School, Boston, Mass
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3
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Patil NS, Larocque N, van der Pol CB, Torres C, Raptis DA, Patlas MN. Chemotherapy-Induced Toxicities: An Imaging Primer. Can Assoc Radiol J 2022; 74:432-445. [PMID: 35968850 DOI: 10.1177/08465371221120263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The Coronavirus Disease of 2019 (COVID-19) pandemic has caused significant delays in the delivery of cancer treatments in Canada. As cancer treatment and imaging volumes return to normal, radiologists will encounter more cases of chemotherapy-induced toxicities. These toxicities have varied appearances on imaging, and can affect multiple organ systems. The purpose of this review is to offer a unified resource for general radiologists regarding the imaging appearances of chemotherapy-induced toxicities.
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Affiliation(s)
- Nikhil S. Patil
- Michael DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Natasha Larocque
- Department of Radiology, McMaster University, Hamilton, ON, Canada
| | - Christian B. van der Pol
- Department of Diagnostic Imaging, Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, Canada
| | - Carlos Torres
- Department of Radiology, Radiation Oncology and Medical Physics, University of Ottawa, Ottawa, ON, Canada
| | - Demetrios A. Raptis
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, USA
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4
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Dejanovic D, Specht L, Czyzewska D, Kiil Berthelsen A, Loft A. Response Evaluation Following Radiation Therapy With 18F-FDG PET/CT: Common Variants of Radiation-Induced Changes and Potential Pitfalls. Semin Nucl Med 2022; 52:681-706. [PMID: 35835618 DOI: 10.1053/j.semnuclmed.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/02/2022] [Accepted: 06/06/2022] [Indexed: 11/11/2022]
Abstract
Radiation therapy (RT) is one of the cornerstones in cancer treatment and approximately half of all patients will receive some form of RT during the course of their cancer management. Response evaluation after RT and follow-up imaging with 18F-Fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) can be complicated by RT-induced acute, chronic or consequential effects. There is a general consensus that 18F-FDG PET/CT for response evaluation should be delayed for 12 weeks after completing RT to minimize the risk of false-positive findings. Radiation-induced late side effects in normal tissue can take years to develop and eventually cause symptoms that on imaging can potentially mimic recurrent disease. Imaging findings in radiation induced injuries depend on the normal tissue included in the irradiated volume and the radiation therapy regime including the total dose delivered, dose per fraction and treatment schedule. The intent for radiation therapy should be taken in consideration when evaluating the response on imaging, that is palliative vs curative or neoadjuvant vs adjuvant RT. Imaging findings can further be distorted by altered anatomy and sequelae following surgery within the radiation field. An awareness of common PET/CT-induced changes/injuries is essential when interpreting 18F-FDG PET/CT as well as obtaining a complete medical history, as patients are occasionally scanned for an unrelated cause to previously RT treated malignancy. In addition, secondary malignancies due to carcinogenic effects of radiation exposure in long-term cancer survivors should not be overlooked. 18F-FDG PET/CT can be very useful in response evaluation and follow-up in patients treated with RT, however, variants and pitfalls are common and it is important to remember that radiation-induced injury is often a diagnosis of exclusion.
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Affiliation(s)
- Danijela Dejanovic
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Lena Specht
- Department of Oncology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Dorota Czyzewska
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne Kiil Berthelsen
- Department of Oncology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Annika Loft
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Reginelli A, Sangiovanni A, Vacca G, Belfiore MP, Pignatiello M, Viscardi G, Clemente A, Urraro F, Cappabianca S. Chemotherapy-induced bowel ischemia: diagnostic imaging overview. Abdom Radiol (NY) 2022; 47:1556-1564. [PMID: 33811514 PMCID: PMC9038829 DOI: 10.1007/s00261-021-03024-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 02/19/2021] [Accepted: 02/25/2021] [Indexed: 12/19/2022]
Abstract
Cancer patients need multimodal therapies to treat their disease increasingly. In particular, drug treatment, as chemotherapy, immunotherapy, or various associations between them are commonly used to increase efficacy. However, the use of drugs predisposes a percentage of patients to develop toxicity in multiple organs and systems. Principle chemotherapy drugs mechanism of action is cell replication inhibition, rapidly proliferating cells especially. Immunotherapy is another tumor therapy strategy based on antitumor immunity activation trough agents as CTLA4 inhibitors (ipilimumab) or PD-1/PD-L1 inhibitors as nivolumab. If, on the one hand, all these agents inhibit tumor growth, on the other, they can cause various degrees toxicity in several organs, due to their specific mechanism of action. Particularly interesting are bowel toxicity, which can be clinically heterogeneous (pain, nausea, diarrhea, enterocolitis, pneumocolitis), up to severe consequences, such as ischemia, a rare occurrence. However, this event can occur both in vessels that supply intestine and in submucosa microvessels. We report drug-related intestinal vascular damage main characteristics, showing the radiological aspect of these alterations. Interpretation of imaging in oncologic patients has become progressively more complicated in the context of “target therapy” and thanks to the increasing number and types of therapies provided. Radiologists should know this variety of antiangiogenic treatments and immunotherapy regimens first because they can determine atypical features of tumor response and then also because of their eventual bowel toxicity.
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Affiliation(s)
- Alfonso Reginelli
- Department of Precision Medicine, University of Campania "L. Vanvitelli,", 80138, Naples, Italy.
| | - Angelo Sangiovanni
- Department of Precision Medicine, University of Campania "L. Vanvitelli,", 80138, Naples, Italy
| | - Giovanna Vacca
- Department of Precision Medicine, University of Campania "L. Vanvitelli,", 80138, Naples, Italy
| | - Maria Paola Belfiore
- Department of Precision Medicine, University of Campania "L. Vanvitelli,", 80138, Naples, Italy
| | - Maria Pignatiello
- Department of Precision Medicine, University of Campania "L. Vanvitelli,", 80138, Naples, Italy
| | - Giuseppe Viscardi
- Department of Precision Medicine, University of Campania "L. Vanvitelli,", 80138, Naples, Italy
| | - Alfredo Clemente
- Department of Precision Medicine, University of Campania "L. Vanvitelli,", 80138, Naples, Italy
| | - Fabrizio Urraro
- Department of Precision Medicine, University of Campania "L. Vanvitelli,", 80138, Naples, Italy
| | - Salvatore Cappabianca
- Department of Precision Medicine, University of Campania "L. Vanvitelli,", 80138, Naples, Italy
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Calistri L, Rastrelli V, Nardi C, Maraghelli D, Vidali S, Pietragalla M, Colagrande S. Imaging of the chemotherapy-induced hepatic damage: Yellow liver, blue liver, and pseudocirrhosis. World J Gastroenterol 2021; 27:7866-7893. [PMID: 35046618 PMCID: PMC8678821 DOI: 10.3748/wjg.v27.i46.7866] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/15/2021] [Accepted: 11/29/2021] [Indexed: 02/06/2023] Open
Abstract
The liver is the major drug-metabolizing and drug-detoxifying organ. Many drugs can cause liver damage through various mechanisms; however, the liver response to injury includes a relatively narrow spectrum of alterations that, regardless of the cause, are represented by phlogosis, oxidative stress and necrosis. The combination of these alterations mainly results in three radiological findings: vascular alterations, structural changes and metabolic function reduction. Chemotherapy has changed in recent decades in terms of the drugs, protocols and duration, allowing patients a longer life expectancy. As a consequence, we are currently observing an increase in chemotherapy-associated liver injury patterns once considered unusual. Recognizing this form of damage in an early stage is crucial for reconsidering the therapy regimen and thus avoiding severe complications. In this frontier article, we analyze the role of imaging in detecting some of these pathological patterns, such as pseudocirrhosis, “yellow liver” due to chemotherapy-associated steatosis-steatohepatitis, and “blue liver”, including sinusoidal obstruction syndrome, veno-occlusive disease and peliosis.
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Affiliation(s)
- Linda Calistri
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence 50134, Italy
| | - Vieri Rastrelli
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence 50134, Italy
| | - Cosimo Nardi
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence 50134, Italy
| | - Davide Maraghelli
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence 50134, Italy
| | - Sofia Vidali
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence 50134, Italy
| | - Michele Pietragalla
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence 50134, Italy
| | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence 50134, Italy
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7
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Torri GB, Soldatelli MD, Luersen GF, Almeida Ghezzi CL. Imaging of chemotherapy-induced liver toxicity: an illustrated overview. Hepat Oncol 2021; 8:HEP32. [PMID: 34765105 PMCID: PMC8577512 DOI: 10.2217/hep-2020-0026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 07/16/2021] [Indexed: 01/27/2023] Open
Abstract
Chemotherapy is a potential cause of focal and diffuse hepatobiliary lesions. Many of these lesions may be demonstrated on imaging, especially computed tomography and MRI. Some of these lesions, especially those of steatosis and sinusoidal obstruction syndrome, are associated with a worse prognosis and risk of hepatic failure in the context of surgical management. Notably, some chemotherapy-induced hepatic alterations, such as sinusoidal obstruction syndrome, pseudocirrhosis and focal hepatopathies, may be mistakenly interpreted as signs of cancer progression, misguiding the therapeutic planning for patients receiving chemotherapy.
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Affiliation(s)
| | | | - Gustavo Felipe Luersen
- Department of Radiology, Hospital da Cruz Vermelha Portuguesa, Lisboa, 1549008, Portugal.,Department of Radiology, Hospital CUF Tejo, Lisboa, 1350352, Portugal.,Affidea group, Lisboa, Portugal
| | - Caroline Lorenzoni Almeida Ghezzi
- Department of Radiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS 90035903, Brazil.,Department of Radiology, Hospital Moinhos de Vento, Porto Alegre, RS 90035000, Brazil
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8
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Abou Elkassem AM, Lo SS, Gunn AJ, Shuch BM, Dewitt-Foy ME, Abouassaly R, Vaidya SS, Clark JI, Louie AV, Siva S, Grosu AL, Smith AD. Role of Imaging in Renal Cell Carcinoma: A Multidisciplinary Perspective. Radiographics 2021; 41:1387-1407. [PMID: 34270355 DOI: 10.1148/rg.2021200202] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
With the expansion in cross-sectional imaging over the past few decades, there has been an increase in the number of incidentally detected renal masses and an increase in the incidence of renal cell carcinomas (RCCs). The complete characterization of an indeterminate renal mass on CT or MR images is challenging, and the authors provide a critical review of the best imaging methods and essential, important, and optional reporting elements used to describe the indeterminate renal mass. While surgical staging remains the standard of care for RCC, the role of renal mass CT or MRI in staging RCC is reviewed, specifically with reference to areas that may be overlooked at imaging such as detection of invasion through the renal capsule or perirenal (Gerota) fascia. Treatment options for localized RCC are expanding, and a multidisciplinary group of experts presents an overview of the role of advanced medical imaging in surgery, percutaneous ablation, transarterial embolization, active surveillance, and stereotactic body radiation therapy. Finally, the arsenal of treatments for advanced renal cancer continues to grow to improve response to therapy while limiting treatment side effects. Imaging findings are important in deciding the best treatment options and to monitor response to therapy. However, evaluating response has increased in complexity. The unique imaging findings associated with antiangiogenic targeted therapy and immunotherapy are discussed. An invited commentary by Remer is available online. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Asser M Abou Elkassem
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Simon S Lo
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Andrew J Gunn
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Brian M Shuch
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Molly E Dewitt-Foy
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Robert Abouassaly
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Sandeep S Vaidya
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Joseph I Clark
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Alexander V Louie
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Shankar Siva
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Anca-Ligia Grosu
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Andrew D Smith
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
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Mesenteric panniculitis mimicking early recurrence at end-of-treatment evaluation in malignant lymphoma: Differentiation by active surveillance with F-18 FDG PET/CT imaging. Radiol Case Rep 2020; 15:1006-1010. [PMID: 32426085 PMCID: PMC7226656 DOI: 10.1016/j.radcr.2020.04.062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 04/28/2020] [Accepted: 04/28/2020] [Indexed: 12/23/2022] Open
Abstract
Mesenteric panniculitis is a relatively rare fibro-inflammatory condition of the mesentery. In acute phase, it demonstrates avid uptake on Fluorine-18 FDG PET/CT (PET/CT). Thorough assessment is needed to differentiate from viable or recurrent disease in patients with malignant lymphoma because it mimics active lymphomatous disease on PET/CT. In this article, 3 illustrative cases of malignant lymphoma are presented. PET/CT demonstrated new FDG-avid mesenteric lesions at the end-of-treatment evaluation while the original disease showed significant response. Early recurrence was initially suspected, but together with clinical course and findings, active surveillance was opted. Sequential follow-up PET/CTs showed various patterns of metabolic activity over time; it can persist for months or more, or metabolic activity can fluctuate over time. Eventually benignity was confirmed in these cases. These cases underscore the importance of interpretation with clinical context and awareness of chronological metabolic changes of mesenteric panniculitis to determine proper management.
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Holma R, Laatikainen R, Orell H, Joensuu H, Peuhkuri K, Poussa T, Korpela R, Österlund P. Consumption of Lactose, Other FODMAPs and Diarrhoea during Adjuvant 5-Fluorouracil Chemotherapy for Colorectal Cancer. Nutrients 2020; 12:nu12020407. [PMID: 32033152 PMCID: PMC7071323 DOI: 10.3390/nu12020407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 01/30/2020] [Accepted: 01/31/2020] [Indexed: 02/07/2023] Open
Abstract
Chemotherapy-induced mucosal injury of the small intestine may interfere with the enzymes and transporters responsible for the hydrolysis and absorption of dietary carbohydrates causing diarrhoea, abdominal discomfort and pain. The aim of this study was to investigate the association between the consumption of foods rich in FODMAPs (fermentable oligo-, di- and monosaccharides and polyols) and gastrointestinal symptoms in patients receiving adjuvant therapy for colorectal cancer. The patients (n = 52) filled in a 4-day food diary at baseline and during therapy and kept a symptom diary. The intakes of FODMAP-rich foods were calculated as portions and the intakes were divided into two consumption categories. Patients with high consumption of FODMAP-rich foods had diarrhoea more frequently than those with low consumption (for lactose-rich foods the odds ratio (OR) was 2.63, P = 0.03; and for other FODMAP-rich foods 1.82, P = 0.20). Patients with high consumption of both lactose-rich and other FODMAP-rich foods had an over 4-fold risk of developing diarrhoea as compared to those with low consumption of both (OR, 4.18; P = 0.02). These results were confirmed in multivariate models. Conclusion: Consumption of lactose-rich foods results in an increased risk of diarrhoea during adjuvant therapy for colorectal cancer, especially when the consumption of other FODMAP-rich foods is also high.
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Affiliation(s)
- Reetta Holma
- Faculty of Medicine, Pharmacology, Medical Nutrition Physiology and Human Microbe Research Program, University of Helsinki, P.O. Box 63, FI-00014 Helsinki, Finland; (R.H.); (R.L.); (R.K.)
| | - Reijo Laatikainen
- Faculty of Medicine, Pharmacology, Medical Nutrition Physiology and Human Microbe Research Program, University of Helsinki, P.O. Box 63, FI-00014 Helsinki, Finland; (R.H.); (R.L.); (R.K.)
- Booston Oy Ltd., Viikinkaari 6, FI-00790 Helsinki, Finland
| | - Helena Orell
- Department of Clinical Nutrition Therapy, Helsinki University Hospital, P.O. Box 100, FI-00029 HUS, Finland;
| | - Heikki Joensuu
- Department of Oncology, Helsinki University Hospital and University of Helsinki, P.O. Box 180, FI-00029 HUS, Finland;
| | - Katri Peuhkuri
- Social Services and Health Care Division, P.O. Box 6230, FI-00099 City of Helsinki, Finland;
| | - Tuija Poussa
- STAT-Consulting, Vahverokatu 6, FI-37130 Nokia, Finland;
| | - Riitta Korpela
- Faculty of Medicine, Pharmacology, Medical Nutrition Physiology and Human Microbe Research Program, University of Helsinki, P.O. Box 63, FI-00014 Helsinki, Finland; (R.H.); (R.L.); (R.K.)
| | - Pia Österlund
- Department of Oncology, Helsinki University Hospital and University of Helsinki, P.O. Box 180, FI-00029 HUS, Finland;
- Department of Oncology, Tampere University Hospital and Tampere university, P.O. Box 2000, FI-33521 Tampere, Finland
- Correspondence: or or ; Tel.: +358-9-4711
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Coelho FMA, Rodrigues LBQ, Panizza PSB, Médici CTM, de Mello Ando S, Mauro GP, de Souza Rocha M, Yamauchi FI, Viana PCC. Abdominal Imaging Findings after Radiation Therapy. Radiographics 2020; 40:120-121. [PMID: 31917656 DOI: 10.1148/rg.2020190128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Fernando Morbeck Almeida Coelho
- From the Departments of Radiology (F.M.A.C., L.B.Q.R., S.d.M.A., M.d.S.R., F.I.Y., P.C.C.V.) and Radiation Therapy (C.T.M.M., G.P.M.), University of São Paulo, Rua Dr. Ovídio Pires de Campos 75, 05403-010, Cerqueira César, São Paulo-SP, Brazil; and Department of Radiology, Sírio-Libanês Hospital, São Paulo, Brazil (P.S.B.P.)
| | - Lídia Batista Quintino Rodrigues
- From the Departments of Radiology (F.M.A.C., L.B.Q.R., S.d.M.A., M.d.S.R., F.I.Y., P.C.C.V.) and Radiation Therapy (C.T.M.M., G.P.M.), University of São Paulo, Rua Dr. Ovídio Pires de Campos 75, 05403-010, Cerqueira César, São Paulo-SP, Brazil; and Department of Radiology, Sírio-Libanês Hospital, São Paulo, Brazil (P.S.B.P.)
| | - Pedro Sergio Brito Panizza
- From the Departments of Radiology (F.M.A.C., L.B.Q.R., S.d.M.A., M.d.S.R., F.I.Y., P.C.C.V.) and Radiation Therapy (C.T.M.M., G.P.M.), University of São Paulo, Rua Dr. Ovídio Pires de Campos 75, 05403-010, Cerqueira César, São Paulo-SP, Brazil; and Department of Radiology, Sírio-Libanês Hospital, São Paulo, Brazil (P.S.B.P.)
| | - Carolina Trindade Mello Médici
- From the Departments of Radiology (F.M.A.C., L.B.Q.R., S.d.M.A., M.d.S.R., F.I.Y., P.C.C.V.) and Radiation Therapy (C.T.M.M., G.P.M.), University of São Paulo, Rua Dr. Ovídio Pires de Campos 75, 05403-010, Cerqueira César, São Paulo-SP, Brazil; and Department of Radiology, Sírio-Libanês Hospital, São Paulo, Brazil (P.S.B.P.)
| | - Sabrina de Mello Ando
- From the Departments of Radiology (F.M.A.C., L.B.Q.R., S.d.M.A., M.d.S.R., F.I.Y., P.C.C.V.) and Radiation Therapy (C.T.M.M., G.P.M.), University of São Paulo, Rua Dr. Ovídio Pires de Campos 75, 05403-010, Cerqueira César, São Paulo-SP, Brazil; and Department of Radiology, Sírio-Libanês Hospital, São Paulo, Brazil (P.S.B.P.)
| | - Geovanne Pedro Mauro
- From the Departments of Radiology (F.M.A.C., L.B.Q.R., S.d.M.A., M.d.S.R., F.I.Y., P.C.C.V.) and Radiation Therapy (C.T.M.M., G.P.M.), University of São Paulo, Rua Dr. Ovídio Pires de Campos 75, 05403-010, Cerqueira César, São Paulo-SP, Brazil; and Department of Radiology, Sírio-Libanês Hospital, São Paulo, Brazil (P.S.B.P.)
| | - Manoel de Souza Rocha
- From the Departments of Radiology (F.M.A.C., L.B.Q.R., S.d.M.A., M.d.S.R., F.I.Y., P.C.C.V.) and Radiation Therapy (C.T.M.M., G.P.M.), University of São Paulo, Rua Dr. Ovídio Pires de Campos 75, 05403-010, Cerqueira César, São Paulo-SP, Brazil; and Department of Radiology, Sírio-Libanês Hospital, São Paulo, Brazil (P.S.B.P.)
| | - Fernando Ide Yamauchi
- From the Departments of Radiology (F.M.A.C., L.B.Q.R., S.d.M.A., M.d.S.R., F.I.Y., P.C.C.V.) and Radiation Therapy (C.T.M.M., G.P.M.), University of São Paulo, Rua Dr. Ovídio Pires de Campos 75, 05403-010, Cerqueira César, São Paulo-SP, Brazil; and Department of Radiology, Sírio-Libanês Hospital, São Paulo, Brazil (P.S.B.P.)
| | - Publio Cesar Cavalcante Viana
- From the Departments of Radiology (F.M.A.C., L.B.Q.R., S.d.M.A., M.d.S.R., F.I.Y., P.C.C.V.) and Radiation Therapy (C.T.M.M., G.P.M.), University of São Paulo, Rua Dr. Ovídio Pires de Campos 75, 05403-010, Cerqueira César, São Paulo-SP, Brazil; and Department of Radiology, Sírio-Libanês Hospital, São Paulo, Brazil (P.S.B.P.)
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12
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Reginelli A, Vacca G, Zanaletti N, Troiani T, Natella R, Maggialetti N, Palumbo P, Giovagnoni A, Ciardiello F, Cappabianca S. Diagnostic value/performance of radiological liver imaging during chemoterapy for gastrointestinal malignancy: a critical review. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:51-61. [PMID: 31085973 PMCID: PMC6625573 DOI: 10.23750/abm.v90i5-s.8346] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Indexed: 12/28/2022]
Abstract
This article reviews the main toxic effect, complications and relative imaging findings of the liver that may appear during the oncologic follow up among patients affected by gastrointestinal malignancy. Awareness of the causative chemotherapeutic agent and regimens, pathophysiology and relative characteristic imaging findings of hepatic injuries is critical in order to obtain an accurate diagnosis especially when these parenchymal lesions are focal. An accurate synergic radiological diagnosis with Computed Tomography (CT) and Magnetic Resonance (MR) techniques may induce a potential termination of ineffective/toxic chemotherapy during early phases of treatment, changing the therapeutic plan in order to avoid first unnecessary liver biopsy and then invasive treatment as hepatic resection if not required.
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Affiliation(s)
- Alfonso Reginelli
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy.
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Wei YL, Xu JY, Zhang R, Zhang Z, Zhao L, Qin LQ. Effects of lactoferrin on X-ray-induced intestinal injury in Balb/C mice. Appl Radiat Isot 2019; 146:72-77. [DOI: 10.1016/j.apradiso.2019.01.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 01/03/2019] [Accepted: 01/24/2019] [Indexed: 01/09/2023]
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Birch JC, Khatri G, Watumull LM, Arriaga YE, Leyendecker JR. Unintended Consequences of Systemic and Ablative Oncologic Therapy in the Abdomen and Pelvis. Radiographics 2018; 38:1158-1179. [PMID: 29995613 DOI: 10.1148/rg.2018170137] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Human cancers are genetically complex and diverse. Although advances in oncologic therapy aim to define and target unique steps in carcinogenesis, oncologists often rely on less discriminate anticancer therapies that have consequences for normal tissues. Even many of the so-called targeted therapies currently employed can adversely affect normal cells, leading to complications that necessitate dose reductions or cessation of specific therapies. This article explores the unintended consequences of currently employed systemic and ablative anticancer therapies that might manifest at imaging examinations of the abdomen and pelvis, including cytotoxic, molecular targeted, and immunologic agents; ablation; and hematopoietic stem cell transplant. Each of these treatments can have both major and minor unintended effects in the targeted organ(s), in local or adjacent structures, or at distant sites. Timely detection and reporting of adverse consequences of anticancer therapies by the astute imager can result in critical treatment modifications and/or lifesaving interventions; therefore, knowledge of these unintended effects is paramount for radiologists interpreting the results of imaging examinations in cancer patients. ©RSNA, 2018.
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Affiliation(s)
- Julie C Birch
- From the Department of Radiology (J.C.B., G.K., L.M.W., J.R.L.) and Department of Internal Medicine, Division of Hematology/Oncology (Y.E.A.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - Gaurav Khatri
- From the Department of Radiology (J.C.B., G.K., L.M.W., J.R.L.) and Department of Internal Medicine, Division of Hematology/Oncology (Y.E.A.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - Lori M Watumull
- From the Department of Radiology (J.C.B., G.K., L.M.W., J.R.L.) and Department of Internal Medicine, Division of Hematology/Oncology (Y.E.A.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - Yull E Arriaga
- From the Department of Radiology (J.C.B., G.K., L.M.W., J.R.L.) and Department of Internal Medicine, Division of Hematology/Oncology (Y.E.A.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - John R Leyendecker
- From the Department of Radiology (J.C.B., G.K., L.M.W., J.R.L.) and Department of Internal Medicine, Division of Hematology/Oncology (Y.E.A.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
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15
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Radiation-induced liver injury mimicking liver metastases on FDG-PET-CT after chemoradiotherapy for esophageal cancer. Strahlenther Onkol 2017; 194:156-163. [DOI: 10.1007/s00066-017-1217-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 09/19/2017] [Indexed: 12/21/2022]
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16
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Miccò M, Telesca AM, Gui B, Grimaldi PP, Cambi F, Marini MG, Valentini AL, Bonomo L. Imaging after treatment in uterine malignancies: Spectrum of normal findings and most common complications. J Med Imaging Radiat Oncol 2017; 61:777-790. [PMID: 28517240 DOI: 10.1111/1754-9485.12624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 04/08/2017] [Indexed: 12/12/2022]
Abstract
Uterine malignancies account for the majority of gynaecologic cancers. Different treatment options are available depending on histology, disease grade and stage. Hysterectomy is the most frequent surgical procedure. Chemotherapy and radiation therapy (CRT) represents the preferred therapeutic choice for locally advanced uterine and cervical malignancies. Imaging of the female pelvis following these treatments is particularly challenging due to alteration of the normal anatomy. Radiologists should be familiar with both the expected post-treatment imaging findings and the imaging features of possible complications to make the correct interpretation and avoid possible pitfalls. The purpose of this review is to show the expected computed tomography (CT) and Magnetic Resonance Imaging (MRI) appearances of the female pelvis following surgery and CRT for uterine and cervical cancer, to illustrate the imaging findings of early and delayed most common complications after surgery and CRT, describing the suitable imaging modalities and protocols for evaluation of patients treated for gynaecologic malignancies.
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Affiliation(s)
- Maura Miccò
- Department of Radiological Sciences, Fondazione Policlinico Agostino Gemelli, Rome, Italy
| | - Anna Maria Telesca
- Department of Radiological Sciences, Fondazione Policlinico Agostino Gemelli, Rome, Italy
| | - Benedetta Gui
- Department of Radiological Sciences, Fondazione Policlinico Agostino Gemelli, Rome, Italy
| | - Pier Paolo Grimaldi
- Department of Radiological Sciences, Fondazione Policlinico Agostino Gemelli, Rome, Italy
| | - Francesco Cambi
- Department of Radiological Sciences, Fondazione Policlinico Agostino Gemelli, Rome, Italy
| | - Maria Giulia Marini
- Department of Radiological Sciences, Fondazione Policlinico Agostino Gemelli, Rome, Italy
| | - Anna Lia Valentini
- Department of Radiological Sciences, Fondazione Policlinico Agostino Gemelli, Rome, Italy
| | - Lorenzo Bonomo
- Department of Radiological Sciences, Fondazione Policlinico Agostino Gemelli, Rome, Italy
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Cancer therapy related complications in the liver, pancreas, and biliary system: an imaging perspective. Insights Imaging 2015; 6:665-77. [PMID: 26443452 PMCID: PMC4656242 DOI: 10.1007/s13244-015-0436-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 09/14/2015] [Accepted: 09/18/2015] [Indexed: 02/08/2023] Open
Abstract
UNLABELLED Awareness of cancer therapy-induced toxicities is important for all clinicians treating patients with cancer. Cancer therapy has evolved to include classic cytotoxic agents in addition to newer options such as targeted agents and catheter-directed chemoembolisation. Several adverse affects can result from the wide array of treatments including effects on the liver, pancreas, and biliary system that can be visualised on imaging. These complications include sinusoidal obstruction syndrome, fatty liver, pseudocirrhosis, acute hepatitis, pancreatitis, pancreatic atrophy, cholecystitis, biliary sclerosis, and biliary stasis. Many of these toxicities are manageable and reversible with supportive therapies and/or cessation of cancer therapy. The objective of this review is to discuss the imaging findings associated with cancer therapy-induced toxicity of the liver, biliary system, and pancreas. TEACHING POINTS • Cancer therapy can have adverse effects on the hepatobiliary system and pancreas. • Cancer therapy-induced toxicities can be visualised on imaging. • Knowledge of imaging changes associated with cancer therapy complications can improve treatment.
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