Localized "radiation hepatitis" as demonstrated by scintillation scanning.

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The liver has usually been considered radiation-resistant. Ingold et al. (1) recently summarized the literature on radiation effects on the liver and added some observations of their own. They noted that in 13 of 40 patients receiving radiation to the entire liver evidence of radiation “hepatitis” developed. A relationship was shown between the dose of irradiation and the incidence of radiation effect on the liver, no effect being observed with doses of less than 3,000 rads. Liver dysfunction was seen in 7 of the 17 patients who received doses in the 3,800–4,000-rad range and in 3 of the 4 patients who received doses in excess of 4,000 rads. On the other hand, they noted that “limited portions of the liver can apparently stand doses as high as 5,500 rads without detectable deleterious effects to the individual.” Ingold et al. also demonstrated alteration in some liver function tests in many of the patients in whom treatment was delivered to the entire liver. They stated that the serum alkaline phosphatase was the most reliable laboratory index of radiation damage when the entire liver was irradiated. Evidence concerning serum biochemical alterations following segmental irradiation of the liver was not presented. Usselman (2) demonstrated by photo-scanning alterations in liver function, using both Au198 and rose bengal I131, in patients who had received segmental irradiation of the liver. Johnson et al. (3) believed that they had demonstrated by scintillation scanning radiation-induced suppression of hepatic reticuloendothelial function in 6 patients who had received therapeutic irradiation of the liver. Our observations indicate that scintillation scanning of the liver following intravenous injection of radioactive colloidal gold may be a more sensitive index of localized radiation hepatitis than that provided by clinical and biochemical data. Evidence of a radiation-induced abnormality of the liver was shown by scintillation scanning in 6 patients with neoplastic disease, in whom a segment of the liver was irradiated. A scintillation scan of the liver was obtained shortly after completion of a course of radiation therapy to an upper abdominal portal in 4 patients with a malignant neoplasm of the testis and in 2 young women with Stage II Hodgkin's disease. Liver scans prior to treatment were available for 3 patients and an additional scan was obtained in two others several months after completion of the radiotherapy. Illustrative Cases Case I: E. K., a 37-year-old white male, underwent a left orchiectomy on Dec. 29, 1965, with a histologic diagnosis of mixed seminoma and teratocarcinoma of the testis. Abdominal exploration on Jan. 18, 1966, confirmed the presence of unresectable retroperitoneal disease. Prior to radiation therapy, a scintillation scan of the liver (Jan. 12, 1966) was normal (Fig. 1,A), as were serum values for bilirubin, alkaline phosphatase, glutamic pyruvate transaminase, and Bromsulphalein retention.