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Radiation Injury to the Liver After Intensity-Modulated Radiation Therapy in Patients with Mesothelioma: An Unusual CT Appearance

Reginald F. Munden1, Jeremy J. Erasmus1, William R. Smythe2, John E. Madewell1, Kenneth M. Forster3 and Craig W. Stevens3

1 Division of Diagnostic Imaging, Department of Diagnostic Radiology, The University of Texas M.D. Anderson Cancer Center, Box 57, 1515 Holcombe Blvd., Houston, TX 77030.
2 Department of Surgery, The Texas A & M University System, Health Science Center, Temple, TX 76508.
3 Division of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030.



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  		Fig. 1. —55-year-old man with mesothelioma who underwent extrapleural pneumonectomy and intensity-modulated radiation therapy (IMRT). Contrast-enhanced CT scan obtained 7 weeks after completion of IMRT shows peripheral zone (arrows) of radiation injury to liver.

 


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  		Fig. 2A. —63-year-old man with epithelial mesothelioma who underwent extrapleural pneumonectomy and intensity-modulated radiation therapy (IMRT). On IMRT isodose image, green line indicates prescription line within which minimum dose of 45 Gy of radiation was delivered. Zone correlates identically with abnormal liver findings on CT.

 


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  		Fig. 2B. —63-year-old man with epithelial mesothelioma who underwent extrapleural pneumonectomy and intensity-modulated radiation therapy (IMRT). Contrast-enhanced CT scan obtained at same level as A shows zone of low attenuation (arrows) that correlates with dosimetric distribution of maximum radiation. The blue line indicates lower dosage of 30 Gy, and the red line indicates areas of dosage boost to 50 Gy.

 


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  		Fig. 2C. —63-year-old man with epithelial mesothelioma who underwent extrapleural pneumonectomy and intensity-modulated radiation therapy (IMRT). Axial T2-weighted image of liver shows high and low signal within area of radiation injury (arrows) to liver.

 


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  		Fig. 2D. —63-year-old man with epithelial mesothelioma who underwent extrapleural pneumonectomy and intensity-modulated radiation therapy (IMRT). Contrast-enhanced T1-weighted image shows enhancement (arrows) of radiation injury.

 


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  		Fig. 3A. —58-year-old woman with epithelial mesothelioma 11 weeks after intensity-modulated radiation therapy. Contrast-enhanced CT scans of upper liver show peripheral zone of low attenuation (arrows, A) in upper aspect of liver and, more caudally, high attenuation (arrows, B) indicating radiation injury to liver.

 


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  		Fig. 3B. —58-year-old woman with epithelial mesothelioma 11 weeks after intensity-modulated radiation therapy. Contrast-enhanced CT scans of upper liver show peripheral zone of low attenuation (arrows, A) in upper aspect of liver and, more caudally, high attenuation (arrows, B) indicating radiation injury to liver.

 

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