The role of the radiologist in the assessment of thoracic changes after radiotherapy

Radiotherapy plays a central role in the palliative and curative treatment of neoplasms of the chest wall or intrathoracic structures. However, despite technical advances, radiotherapy can alter previously normal organs and tissues, those alterations presenting as various types of imaging findings. Post-radiation alterations must be promptly recognized by radiologists, in order to avoid confusion between complications of radiotherapy and the recurrence of a tumor. This pictorial essay aims to illustrate different thoracic changes after radiotherapy.

Keywords:
Radiotherapy; Tomography, X-ray computed; Magnetic resonance imaging; Diagnostic imaging; Thoracic neoplasms

Authorship

Sabrina de Mello Ando Correspondence: Dra. Sabrina de Mello Ando. Instituto de Radiologia - HC-FMUSP. Rua Doutor Ovídio Pires de Campos, 75, Cerqueira César. São Paulo, SP, Brazil, 05403-010. Email: sabrina.ando78@gmail.com.

Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil.Universidade de São PauloBrazilSão Paulo, SP, BrazilInstituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil.

http://orcid.org/0000-0002-5097-5282

Eduardo Kaiser Ururahy Nunes Fonseca

Departamento de Imagem - Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.Hospital Israelita Albert EinsteinBrazilSão Paulo, SP, BrazilDepartamento de Imagem - Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.

http://orcid.org/0000-0002-0233-0041

Julliana dos Santos Frassei

http://orcid.org/0000-0002-6372-9259

Lucas de Pádua Gomes de Farias

http://orcid.org/0000-0001-5195-9818

Yuri Costa Sarno Neves

http://orcid.org/0000-0002-7861-0963

Rodrigo Caruso Chate

http://orcid.org/0000-0002-4193-7647

Márcio Valente Yamada Sawamura

http://orcid.org/0000-0002-9424-9776

Correspondence: Dra. Sabrina de Mello Ando. Instituto de Radiologia - HC-FMUSP. Rua Doutor Ovídio Pires de Campos, 75, Cerqueira César. São Paulo, SP, Brazil, 05403-010. Email: sabrina.ando78@gmail.com.

SCIMAGO INSTITUTIONS RANKINGS

Figures

Figures (8)

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Figure 1
Axial and sagittal CT slices (A and B, respectively) showing peripheral ground-glass opacities in the region of the irradiated site in a patient who had undergone four weeks of radiotherapy of the right breast for the treatment of breast cancer.

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Figure 2
Coronal CT slice (A) and axial CT slices (B,C), showing signs of architectural distortion, characterized by volume reduction and retractile opacities, together with bilateral cylindrical and varicose bronchiectasis, predominantly in the upper lung fields, in a patient who had undergone chemotherapy and radiotherapy 20 years prior for the treatment of lymphoma.

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Figure 3
CT scan of a patient with a history of thymoma (A), showing ground-glass opacities in the paramediastinal regions, especially on the right. Follow-up CT scan, acquired at 8 months after radiotherapy (B), showing a predominance of retractile opacities and volume reduction, suggesting that the radiation-induced lesion had evolved to the fibrotic phase.

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Figure 4
A: CT scan of a patient with a recurrent pulmonary nodule. B: Follow-up CT scan, acquired at 6 months after stereotactic radiotherapy, showing that the patient had developed a linear atelectatic opacity, with a scarring pattern and adjacent ground-glass opacities, at the radiotherapy site.

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Figure 5
A: CT scan of a patient with an irregularly shaped pulmonary nodule at the right apex, which was diagnosed as pulmonary adenocarcinoma. B: On a follow-up CT scan, acquired at 9 months after stereotactic radiotherapy, the nodule is no longer well-defined, having been replaced by an area of consolidation, with some air bronchograms and distortion of the local pulmonary architecture, findings characteristic of the mass pattern.

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Figure 6
Lung metastasis from an adrenal carcinoma, shown in a CT scan (A), as well as in an 18F-FDG PET/CT scan (B), on which the standardized uptake value (SUV) was 6.1. C,D: Follow-up images acquired at 15 months after treatment with stereotactic radiotherapy, showing that the patient had developed mass-type radiation-induced fibrosis (CT scan in C), with an SUV < 5 (18F-FDG PET/CT scan in D).

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Figure 7
Unenhanced axial CT slice showing moderate pericardial effusion in a patient who had undergone radiotherapy of the left breast for the treatment of breast cancer.

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Figure 8
CT scans of a patient who had undergone radiotherapy for the treatment of lung cancer, showing retractile, ground-glass opacities in the left perihilar region (in A) and slight thickening of the esophageal walls (in B). Axial and sagittal 18F-FDG PET/CT slices (C and D, respectively), showing increased metabolic activity in the esophagus, suggestive of a radiation-induced inflammatory process (esophagitis).

Figure 1 Axial and sagittal CT slices (A and B, respectively) showing peripheral ground-glass opacities in the region of the irradiated site in a patient who had undergone four weeks of radiotherapy of the right breast for the treatment of breast cancer.

Figure 2 Coronal CT slice (A) and axial CT slices (B,C), showing signs of architectural distortion, characterized by volume reduction and retractile opacities, together with bilateral cylindrical and varicose bronchiectasis, predominantly in the upper lung fields, in a patient who had undergone chemotherapy and radiotherapy 20 years prior for the treatment of lymphoma.

Figure 3 CT scan of a patient with a history of thymoma (A), showing ground-glass opacities in the paramediastinal regions, especially on the right. Follow-up CT scan, acquired at 8 months after radiotherapy (B), showing a predominance of retractile opacities and volume reduction, suggesting that the radiation-induced lesion had evolved to the fibrotic phase.

Figure 4 A: CT scan of a patient with a recurrent pulmonary nodule. B: Follow-up CT scan, acquired at 6 months after stereotactic radiotherapy, showing that the patient had developed a linear atelectatic opacity, with a scarring pattern and adjacent ground-glass opacities, at the radiotherapy site.

Figure 5 A: CT scan of a patient with an irregularly shaped pulmonary nodule at the right apex, which was diagnosed as pulmonary adenocarcinoma. B: On a follow-up CT scan, acquired at 9 months after stereotactic radiotherapy, the nodule is no longer well-defined, having been replaced by an area of consolidation, with some air bronchograms and distortion of the local pulmonary architecture, findings characteristic of the mass pattern.

Figure 6 Lung metastasis from an adrenal carcinoma, shown in a CT scan (A), as well as in an 18F-FDG PET/CT scan (B), on which the standardized uptake value (SUV) was 6.1. C,D: Follow-up images acquired at 15 months after treatment with stereotactic radiotherapy, showing that the patient had developed mass-type radiation-induced fibrosis (CT scan in C), with an SUV < 5 (18F-FDG PET/CT scan in D).

Figure 7 Unenhanced axial CT slice showing moderate pericardial effusion in a patient who had undergone radiotherapy of the left breast for the treatment of breast cancer.

Figure 8 CT scans of a patient who had undergone radiotherapy for the treatment of lung cancer, showing retractile, ground-glass opacities in the left perihilar region (in A) and slight thickening of the esophageal walls (in B). Axial and sagittal 18F-FDG PET/CT slices (C and D, respectively), showing increased metabolic activity in the esophagus, suggestive of a radiation-induced inflammatory process (esophagitis).

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The role of the radiologist in the assessment of thoracic changes after radiotherapy

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[1] Correspondence: Dra. Sabrina de Mello Ando. Instituto de Radiologia - HC-FMUSP. Rua Doutor Ovídio Pires de Campos, 75, Cerqueira César. São Paulo, SP, Brazil, 05403-010. Email: sabrina.ando78@gmail.com.