Spectrum of Imaging Findings in the Abdomen After Radiotherapy
Jin-Wei Kwek1,2,
Revathy B. Iyer2,
Joel Dunnington1,
Silvana Faria1 and
Paul M. Silverman1
1 Department of Diagnostic Imaging, Unit 57, University of Texas M. D. Anderson
Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030-4009.
2 Present address: Department of Diagnostic Radiology, Tan Tock Seng Hospital,
Singapore, Republic of Singapore.
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Fig. 1A —39-year-old woman with adenocarcinoma of gastric antrum, She
underwent preoperative neoadjuvant 5-fluorouracil and paclitaxel-based
chemoradiation with 45 Gy of radiation in 25 fractions 1 month ago, followed
by distal gastrectomy and Billroth type II gastrojejunostomy. Irradiated area
of left lobe (A) of liver appears hypodense on unenhanced CT with linear
margin (arrowheads) corresponding to radiation portal.
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Fig. 1B —39-year-old woman with adenocarcinoma of gastric antrum, She
underwent preoperative neoadjuvant 5-fluorouracil and paclitaxel-based
chemoradiation with 45 Gy of radiation in 25 fractions 1 month ago, followed
by distal gastrectomy and Billroth type II gastrojejunostomy. Axial CT scan in
arterial phase of contrast enhancement better shows linear margin
(arrowheads) corresponding to radiation portal.
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Fig. 1C —39-year-old woman with adenocarcinoma of gastric antrum, She
underwent preoperative neoadjuvant 5-fluorouracil and paclitaxel-based
chemoradiation with 45 Gy of radiation in 25 fractions 1 month ago, followed
by distal gastrectomy and Billroth type II gastrojejunostomy. Irradiated area
of left lobe of liver (A) remains hypodense (arrowheads) compared
with adjacent healthy liver in portal venous phase.
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Fig. 1D —39-year-old woman with adenocarcinoma of gastric antrum, She
underwent preoperative neoadjuvant 5-fluorouracil and paclitaxel-based
chemoradiation with 45 Gy of radiation in 25 fractions 1 month ago, followed
by distal gastrectomy and Billroth type II gastrojejunostomy. Follow-up CT 1
year later shows mild atrophy of irradiated left lobe of liver (A).
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Fig. 2A —44-year-old woman with metastatic breast carcinoma and
radiation therapy for T12 metastasis. Unenhanced CT scan shows well-demarcated
band of hyperattenuation in medial portions of left and right lobe of liver
(arrowheads). Adjacent nonirradiated liver is hypoattenuating because
of fatty replacement. This is reversal of density pattern noted in Figures
1A,
1B,
1C, and
1D.
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Fig. 2B —44-year-old woman with metastatic breast carcinoma and
radiation therapy for T12 metastasis. During portal venous phase, increased
enhancement of irradiated portion of liver (arrowheads) is seen
compared with nonirradiated liver.
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Fig. 3A —50-year-old woman with metastatic breast carcinoma. She
underwent left mastectomy and axillary lymph node dissection and was treated
with radiation therapy for metastasis to T12 vertebral body. Axial CT scan
shows sclerotic-treated metastasis at T12 vertebral body (arrow).
Note well-demarcated band of hypoattenuation in right and left lobe of liver
corresponding to radiation portal (arrowheads).
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Fig. 3B —50-year-old woman with metastatic breast carcinoma. She
underwent left mastectomy and axillary lymph node dissection and was treated
with radiation therapy for metastasis to T12 vertebral body. Axial T1-weighted
MR image shows reduced signal intensity within irradiated portion of liver
(arrowheads). Fatty marrow replacement of lower T12 vertebra is noted
(arrow).
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Fig. 3C —50-year-old woman with metastatic breast carcinoma. She
underwent left mastectomy and axillary lymph node dissection and was treated
with radiation therapy for metastasis to T12 vertebral body. Irradiated medial
portion of liver appears hyperintense in axial T2-weighted image, related to
increased water content (arrowheads).
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Fig. 3D —50-year-old woman with metastatic breast carcinoma. She
underwent left mastectomy and axillary lymph node dissection and was treated
with radiation therapy for metastasis to T12 vertebral body. Sagittal
T1-weighted image shows fatty marrow replacement of thoracolumbar spine with
hypointense-treated metastasis at T12 vertebral body (arrows).
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Fig. 4 —65-year-old man with history of gastric lymphoma and
radiation therapy 3 years ago. Axial CT scan shows focal area of splenic
infarct (S), diffuse pancreatic atrophy (arrowheads), and atrophy of
upper pole of left kidney (arrow).
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Fig. 5A —42-year-old woman with ovarian cancer, treated with radiation
therapy for retroperitoneal lymphadenopathy. Excretory urogram obtained before
radiation therapy shows both kidneys with normal size and configuration and
symmetric excretion of contrast material.
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Fig. 5B —42-year-old woman with ovarian cancer, treated with radiation
therapy for retroperitoneal lymphadenopathy. Second excretory urogram obtained
4 years after radiation therapy shows focal atrophy of upper poles of both
kidneys (arrows). Outlines of both kidneys remain smooth.
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Fig. 6A —51-year-old woman with metastatic breast carcinoma to porta
hepatis who underwent 36 Gy of external beam irradiation. Equilibrium phase CT
scan shows well-demarcated band of hyperattenuation in medial portion of right
lobe of liver (arrowheads) corresponding to radiation portal.
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Fig. 6B —51-year-old woman with metastatic breast carcinoma to porta
hepatis who underwent 36 Gy of external beam irradiation. Follow-up CT 53
months later, shows focal atrophy of upper pole of right kidney
(arrow) and focal atrophy of irradiated portion of liver
(arrowheads).
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Fig. 7A —76-year-old woman with locally advanced carcinoma of
pancreas. She underwent preoperative chemoradiation, with dose of 30 Gy at 3
Gy per fraction for 10 fractions. Contrast-enhanced axial CT scan 2 months
later shows focal wall thickening of antropyloric region of stomach
(arrowheads) and gallbladder (curved arrow). Primary tumor
in head of pancreas (short wide arrow) is causing obstruction of
common bile duct, and biliary stent (long thin arrow) has been
inserted to decompress biliary system.
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Fig. 7B —76-year-old woman with locally advanced carcinoma of
pancreas. She underwent preoperative chemoradiation, with dose of 30 Gy at 3
Gy per fraction for 10 fractions. Axial CT scan at lower section shows focal
wall thickening of hepatic flexure of colon (arrow). Colonoscopy and
biopsy proved radiation injury.
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Fig. 8A —63-year-old man with sigmoid colon carcinoma recurrence.
Unenhanced axial CT scan shows retroperitoneal lymphadenopathy
(arrows in A and B) causing right hydroureter
(curved arrow). He was treated palliatively with external beam
irradiation, 30 Gy in 10 fractions.
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Fig. 8B —63-year-old man with sigmoid colon carcinoma recurrence.
Follow-up unenhanced CT scan 1 month later shows wall thickening and edema in
ileal loops (arrowheads) in radiation portal. Ureteric stent is noted
in decompressed right ureter (curved arrow).
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Fig. 9A —47-year-old woman with adenocarcinoma of cervix, treated with
external beam irradiation to retroperitoneal lymphadenopathy 3 years earlier.
Angiogram of abdominal aorta shows marked stenosis of distal aorta and
bilateral common, internal, and external iliac arteries (arrowheads).
Note enlarged collateral lumbar arteries at L3 and L4 (arrows). Tip
of catheter is in distal aorta.
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Fig. 9B —47-year-old woman with adenocarcinoma of cervix, treated with
external beam irradiation to retroperitoneal lymphadenopathy 3 years earlier.
Axial CT scan shows narrowing of distal aorta with calcified atheromatous
plaques (arrow). No surrounding mass, which would suggest tumor
recurrence, is present.
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Fig. 10 —41-year-old woman with history of radiation therapy for
neuroblastoma involving her spine at 15 months old. She developed transitional
cell carcinoma of bladder at age of 37 years and underwent radical cystectomy
with bilateral pelvic lymph node dissection and chemoradiation. Excretory
urogram shows Indiana pouch (P) urinary diversion. Also note atrophy of right
side of lumbar vertebrae with resultant scoliosis with concavity to right,
caused by radiation injury to growing skeleton during childhood.
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Fig. 11A —18-year-old man treated with 34 Gy from T4 to L1 16 years
earlier for neuroblastoma involving lower thoracic and upper lumbar spine.
Anteroposterior (A) and lateral (B) radiographs of spine show
marked kyphoscoliosis of thoracolumbar spine.
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Fig. 11B —18-year-old man treated with 34 Gy from T4 to L1 16 years
earlier for neuroblastoma involving lower thoracic and upper lumbar spine.
Anteroposterior (A) and lateral (B) radiographs of spine show
marked kyphoscoliosis of thoracolumbar spine.
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Fig. 12A —3-year-old boy with Wilms tumor treated with external beam
radiation therapy. Lateral radiograph of lumbar spine obtained 2 years after
radiation therapy appears normal.
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Fig. 12B —3-year-old boy with Wilms tumor treated with external beam
radiation therapy. Lateral radiograph of lumbar spine performed 14 years later
shows wedging of T12-L4 vertebral bodies, which is compatible with compression
fractures.
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Fig. 13A —79-year-old man treated with radiation therapy 25 years ago
presented with radiation-induced rhabdomyosarcoma of erector spinae muscles.
Contrast-enhanced CT scan shows midline soft-tissue mass in erector spinae
muscles (arrows) with involvement of spinous process of adjacent L3
lumbar vertebra.
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Fig. 13B —79-year-old man treated with radiation therapy 25 years ago
presented with radiation-induced rhabdomyosarcoma of erector spinae muscles.
Sagittal contrast-enhanced T1-weighted MRI scan shows tumor mass extension
into spinal canal at L3 with anterior displacement of nerve roots in thecal
sac (arrowheads).
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Copyright © 2006 by the American Roentgen Ray Society.
