Abstract
PurposeTo evaluate temporal changes in contrast enhancement patterns of non-tumorous hepatic parenchyma with a focus on arterial hypervascularity on multiphase computed tomography (CT) in patients with hepatocellular carcinoma (HCC) treated with stereotactic body radiotherapy (SBRT).MethodsWe retrospectively identified 61 patients who had undergone multiphase contrast-enhanced CT at one, three, and six months after SBRT. Irradiated versus non-irradiated liver parenchyma was delineated by cross-correlation with the dose-volume histogram of SBRT plan. Serial changes in the contrast enhancement patterns of the irradiated versus non-irradiated liver parenchyma were evaluated by two abdominal radiologists in consensus. We compared the frequency of the contrast enhancement patterns according to the follow-up period using the Fisher-Freeman-Halton exact test.ResultsThe irradiated non-tumorous hepatic parenchyma showed that the prevalence of arterial hypervascularity increased during the follow-up period (P<.01): 11.5% (7/61) in one, 45.9% (28/61) in three, and 54.1% (33/61) in six months. Contrast wash-out on the delayed phase was uncommon: 1.6% (1/61) in one, 3.3% (2/61) in three, and 0% in six months.ConclusionThe incidence of arterial hypervascularity of the irradiated hepatic parenchyma gradually increased until six months after SBRT, which could interfere with the accurate evaluation of treatment response. The lack of wash-out on the delayed phase in the hypervascular area would distinguish SBRT-related change from residual/recurred HCC.
Highlights
Hepatocellular carcinoma (HCC) is a major health problem worldwide, with more than half a million new cases yearly [1]
Considering that multiple follow-up computed tomography (CT) scans are generally available following the treatment of HCC, we suggest that temporal changes in the enhancement patterns of the irradiated hepatic parenchyma are important to note
The areas and shapes of hepatic attenuation difference (HAD) corresponded well to the 15-Gy isodose line seen on the dosevolume histogram of the Stereotactic body radiotherapy (SBRT) treatment plan
Summary
Hepatocellular carcinoma (HCC) is a major health problem worldwide, with more than half a million new cases yearly [1]. Many previous imaging studies on radiation-induced changes of the liver reported changes associated with conventional radiotherapy rather than SBRT [9,10,11,12,13,14]. Radiation-induced changes associated with SBRT are expected to differ from those associated with conventional radiotherapy because of the complex and distinct mode of radiation dose delivery of SBRT as well as delivered radiation dose [15]. With the increasing use of SBRT, it is important to be familiar with the radiation-induced changes of the liver after SBRT on multiphase computed tomography [16], as this information will help us to accurately assess treatment responses [17,18,19,20,21]
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