
Abdominal Imaging Findings after Radiation Therapy
2020; Radiological Society of North America; Volume: 40; Issue: 1 Linguagem: Inglês
10.1148/rg.2020190128
ISSN1527-1323
AutoresFernando Morbeck Almeida Coelho, Lídia Batista Quintino Rodrigues, Pedro Sergio Brito Panizza, Carolina Trindade Mello Médici, Sabrina de Mello Ando, Geovanne Pedro Mauro, Manoel de Souza Rocha, Fernando Ide Yamauchi, Públio César Cavalcante Viana,
Tópico(s)Hepatocellular Carcinoma Treatment and Prognosis
ResumoHomeRadioGraphicsVol. 40, No. 1 PreviousNext Gastrointestinal ImagingFree AccessAbdominal Imaging Findings after Radiation TherapyFernando Morbeck Almeida Coelho , Lídia Batista Quintino Rodrigues, Pedro Sergio Brito Panizza, Carolina Trindade Mello Médici, Sabrina de Mello Ando, Geovanne Pedro Mauro, Manoel de Souza Rocha, Fernando Ide Yamauchi, Publio Cesar Cavalcante VianaFernando Morbeck Almeida Coelho , Lídia Batista Quintino Rodrigues, Pedro Sergio Brito Panizza, Carolina Trindade Mello Médici, Sabrina de Mello Ando, Geovanne Pedro Mauro, Manoel de Souza Rocha, Fernando Ide Yamauchi, Publio Cesar Cavalcante VianaAuthor AffiliationsFrom 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.).Address correspondence to F.M.A.C. (e-mail: [email protected]).Fernando Morbeck Almeida Coelho Lídia Batista Quintino RodriguesPedro Sergio Brito PanizzaCarolina Trindade Mello MédiciSabrina de Mello AndoGeovanne Pedro MauroManoel de Souza RochaFernando Ide YamauchiPublio Cesar Cavalcante VianaPublished Online:Jan 9 2020https://doi.org/10.1148/rg.2020190128MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In AbstractThe full digital presentation is available online.Radiation therapy (RT) plays an important role in cancer treatment and is included in several therapeutic approaches. RT can be used with the purpose of curing disease, or it can be used to provide palliative treatment or in combination with other therapies. Dose-delivery techniques have advanced from conventional (two-dimensional) RT to three-dimensional (conformational) RT, intensity-modulated RT, and extracranial or corporeal stereotactic RT, in addition to brachytherapy. However, despite the evolution of dosimetric delivery methods, nontarget tissues inevitably are exposed to ionizing radiation. The online presentation provides a schematic approach to facilitate radiologists’ understanding of abnormal abdominal imaging findings after RT (Fig 1).Figure 1a. RT-induced injury in the liver and female pelvic organs. (a) Illustrations of the liver (left) and cross-sectional view (right) demonstrate the pathogenesis of veno-occlusive disease in radiation-induced liver disease (RILD). Complete obliteration of central vein lumina by erythrocytes results in vascular congestion. Dotted line = location of the cross-sectional view. (b) Sagittal illustration of the female pelvis shows three types of RT-induced lesions (dark purple areas): cervical atrophy with os stenosis, which results in fluid accumulation in the uterus, and rectovaginal and vesicovaginal fistulas.Figure 1a.Download as PowerPointOpen in Image Viewer Figure 1b. RT-induced injury in the liver and female pelvic organs. (a) Illustrations of the liver (left) and cross-sectional view (right) demonstrate the pathogenesis of veno-occlusive disease in radiation-induced liver disease (RILD). Complete obliteration of central vein lumina by erythrocytes results in vascular congestion. Dotted line = location of the cross-sectional view. (b) Sagittal illustration of the female pelvis shows three types of RT-induced lesions (dark purple areas): cervical atrophy with os stenosis, which results in fluid accumulation in the uterus, and rectovaginal and vesicovaginal fistulas.Figure 1b.Download as PowerPointOpen in Image Viewer The sensitivity of tissue to ionizing radiation is variable, but it is known that a high rate of cell regeneration and a low degree of differentiation are associated with higher cell radiosensitivity. Radiation-induced abdominal changes are dependent on multiple factors, such as the size, number, and frequency of RT fractions; irradiated tissue volume; duration of treatment; and method of radiation dose delivery. The acute effects of RT occur frequently within the first 3 months after the initiation of treatment, while late effects usually occur a year after the treatment.RILD occurs in approximately 5%–10% of patients who have been exposed to radiation doses greater than 30–35 Gy. A hallmark pathophysiologic finding of RILD is veno-occlusive disease, which is characterized by the complete obliteration of the lumen of the central vein by erythrocytes trapped in a network of reticulin and collagen fibers.The pancreas may demonstrate atrophy and calcifications in later stages, mimicking the findings of chronic pancreatitis. In some cases, pancreatic fibrosis may mimic a tumoral lesion, and thus findings like fat stranding, vascular involvement, focal enlargement, and contour deformity are suspicious findings that should be accurately evaluated.The kidneys show a diffuse or focal reduction of volume and heterogeneity of the parenchyma (eg, striated nephrogram pattern) (Fig 2). A ureteral radiation-induced lesion is an infrequent finding, and the most typical imaging finding is fibrosis. The bladder is a radiosensitive organ that often manifests acute changes if irradiated with doses above 30 Gy.Figure 2a. Lung cancer and bone metastasis in a 56-year-old man who underwent RT and chemotherapy. (a) Sagittal reformatted CT image shows a pathologic fracture (circle) of the vertebral body. (b, c) Axial (b) and coronal (c) contrast-enhanced CT images show an area of hypoenhancement in the medial aspect of both kidneys (arrowheads in b), related to the irradiated field of the vertebral lesion. Other metastatic lesions are also depicted in the right kidney (arrow in b) and the right adrenal gland (arrow in c).Figure 2a.Download as PowerPointOpen in Image Viewer Figure 2b. Lung cancer and bone metastasis in a 56-year-old man who underwent RT and chemotherapy. (a) Sagittal reformatted CT image shows a pathologic fracture (circle) of the vertebral body. (b, c) Axial (b) and coronal (c) contrast-enhanced CT images show an area of hypoenhancement in the medial aspect of both kidneys (arrowheads in b), related to the irradiated field of the vertebral lesion. Other metastatic lesions are also depicted in the right kidney (arrow in b) and the right adrenal gland (arrow in c).Figure 2b.Download as PowerPointOpen in Image Viewer Figure 2c. Lung cancer and bone metastasis in a 56-year-old man who underwent RT and chemotherapy. (a) Sagittal reformatted CT image shows a pathologic fracture (circle) of the vertebral body. (b, c) Axial (b) and coronal (c) contrast-enhanced CT images show an area of hypoenhancement in the medial aspect of both kidneys (arrowheads in b), related to the irradiated field of the vertebral lesion. Other metastatic lesions are also depicted in the right kidney (arrow in b) and the right adrenal gland (arrow in c).Figure 2c.Download as PowerPointOpen in Image Viewer The gastrointestinal tract shows various degrees of sensitivity to ionizing radiation. The segment that is most radiosensitive is the small bowel. In contrast, the rectum is the most resistant to radiation. However, the rectum is the structure with the highest prevalence of radiation-induced lesions owing to its fixed position and proximity to several pelvic structures that are usually irradiated.In the female pelvis, the uterus usually demonstrates atrophy and loss of zonal anatomy after RT at MRI. The ovaries undergo atrophy, and a number of follicles are reduced. In the male pelvis, the main structures affected are the prostate, seminal vesicles, and testes. The prostate shows loss of zonal anatomy and low signal intensity on T2-weighted MR images. The seminal vesicles and testes may demonstrate volumetric reduction and fibrosis, which can lead to hypogonadism and subfertility.After viewing this presentation, the radiologist should be able to comprehend a wide spectrum of abnormal abdominal changes related to RT on cross-sectional multimodality images.AcknowledgmentsThe authors would like to thank Rodrigo Tonan for his collaboration in preparing the medical illustrations.Presented as an education exhibit at the 2018 RSNA Annual Meeting.All authors have disclosed no relevant relationships.Suggested ReadingsKwek JW, Iyer RB, Dunnington J, Faria S, Silverman PM. Spectrum of imaging findings in the abdomen after radiotherapy. AJR Am J Roentgenol 2006;187(5):1204–1211. Crossref, Medline, Google ScholarMaturen KE, Feng MU, Wasnik AP, et al. Imaging effects of radiation therapy in the abdomen and pelvis: evaluating “innocent bystander” tissues. RadioGraphics 2013;33(2):599–619. Link, Google ScholarViswanathan C, Truong MT, Sagebiel TL, et al. Abdominal and pelvic complications of nonoperative oncologic therapy. RadioGraphics 2014;34(4):941–961. Link, Google ScholarArticle HistoryReceived: Apr 22 2019Revision requested: June 18 2019Revision received: Aug 5 2019Accepted: Aug 9 2019Published online: Jan 09 2020Published in print: Jan 2020 FiguresReferencesRelatedDetailsAccompanying This ArticleAbdominal Imaging Findings after Radiation TherapyJan 9 2020Default Digital Object SeriesRecommended Articles Imaging Manifestations of Genitourinary TuberculosisRadioGraphics2021Volume: 41Issue: 4pp. 1123-1143Case 267: Cecureterocoele Manifesting in a Man with InfertilityRadiology2019Volume: 292Issue: 1pp. 263-266Congenital Anomalies of the Upper Urinary Tract: A Comprehensive ReviewRadioGraphics2021Volume: 41Issue: 2pp. 462-486Hereditary Renal Cystic Disorders: Imaging of the Kidneys and BeyondRadioGraphics2017Volume: 37Issue: 3pp. 924-946Imaging of Nonmalignant Adrenal Lesions in ChildrenRadioGraphics2017Volume: 37Issue: 6pp. 1648-1664See More RSNA Education Exhibits Don't Bleed to Know the Bleeds: Systematic Cased-Based Approach for Correct Localization of Bleeds/HemorrhageDigital Posters2020Pitfalls Of Pregnancy: An Organ-system Review Of Non-obstetric Complications And Emergencies In The Pregnant PatientDigital Posters2021Solving the Maze: Disorders of Sex DevelopmentDigital Posters2020 RSNA Case Collection Lying down adrenal glandRSNA Case Collection2020Metastatic Clear Cell Renal CarcinomaRSNA Case Collection2021Colonic endometriosisRSNA Case Collection2020 Vol. 40, No. 1 Slide PresentationAbbreviationsAbbreviations:RILDradiation-induced liver diseaseRTradiation therapy Metrics Altmetric Score PDF download
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