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Response of Liver Metastases After Treatment with Yttrium-90 Microspheres: Role of Size, Necrosis, and PET

Frank H. Miller1, Ana L. Keppke1, Denise Reddy1, Jie Huang2, Jianhua Jin2, Mary F. Mulcahy3 and Riad Salem1

1 Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair, Ste. 800, Chicago, IL 60611.
2 Department of Preventive Medicine, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL 60611.
3 Department of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL 60611.


Figure 1
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  		Fig. 1A —84-year-old woman with colon cancer metastatic to liver and refractory to hemicolectomy who had two prior radiofrequency ablation treatments of other lesions. Pretreatment axial contrast-enhanced CT image shows 3.5 x 3.2 cm hypodense lesion (long arrow) with peripheral enhancement in right hepatic lobe and smaller hypodense lesion (short arrow) in left hepatic lobe.

 

Figure 2
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  		Fig. 1B —84-year-old woman with colon cancer metastatic to liver and refractory to hemicolectomy who had two prior radiofrequency ablation treatments of other lesions. Axial contrast-enhanced CT image obtained 4 weeks after 90Y treatment of right lobe shows decrease in enhancement and size of right lobe lesion (long arrow), which now measures 2.6 x 2 cm. Left lobe lesion remains unchanged (short arrow).

 

Figure 3
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  		Fig. 1C —84-year-old woman with colon cancer metastatic to liver and refractory to hemicolectomy who had two prior radiofrequency ablation treatments of other lesions. Pretreatment PET image shows focal lesion (arrow) with increased 18F-FDG uptake in right lobe of liver.

 

Figure 4
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  		Fig. 1D —84-year-old woman with colon cancer metastatic to liver and refractory to hemicolectomy who had two prior radiofrequency ablation treatments of other lesions. PET scan obtained 4 weeks after 90Y treatment shows marked interval improvement in appearance of liver with resolution of lesion hypermetabolism in right lobe. This example emphasizes advantage of PET over CT because CT shows residual lesion, whereas PET shows resolution of activity, suggesting complete response.

 

Figure 5
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  		Fig. 2A —62-year-old man with Zollinger-Ellison syndrome and metastatic liver disease who had previous right hepatic lobectomy. Pretreatment CT image shows several hypodense lesions (arrows) predominantly within medial segment of left lobe. Hepatic parenchyma not affected by tumor shows normal attenuation. Surgical changes from previous right hepatic resection and cholecystectomy are seen.

 

Figure 6
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  		Fig. 2B —62-year-old man with Zollinger-Ellison syndrome and metastatic liver disease who had previous right hepatic lobectomy. CT image obtained 5 weeks after 90Y treatment of medial segment of left lobe shows decrease in size of treated lesions and irregular area of low attenuation (arrows) in treated region of liver, likely representing edema from recent radioembolization. Decrease in size of liver metastases can be difficult to detect because lesions may be partially hidden by edematous area.

 

Figure 7
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  		Fig. 2C —62-year-old man with Zollinger-Ellison syndrome and metastatic liver disease who had previous right hepatic lobectomy. CT image obtained 10 weeks after 90Y treatment shows that low attenuation area seen in B is no longer present, emphasizing transient nature of this abnormality. Air is seen in intrahepatic bile ducts from prior sphincterotomy (arrows).

 

Figure 8
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  		Fig. 3A —45-year-old woman with breast cancer metastatic to brain, liver, and bone. Axial contrast-enhanced CT image obtained 4 weeks after 90Y treatment shows discontinuity (arrow) and thickening of gallbladder wall consistent with cholecystitis, which was likely radiation-induced and eventually required cholecystectomy.

 

Figure 9
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  		Fig. 3B —45-year-old woman with breast cancer metastatic to brain, liver, and bone. Medium power light microscopy of gallbladder shows 90Y microsphere (arrow) in gallbladder wall.

 

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