In patients with esophageal cancer undergoing neoadjuvant chemoradiotherapy (nCRT), subsequent restaging with F-18-fluorodeoxyglucose (18F-FDG) positron emission tomography–computed tomography (PET-CT) can reveal the presence of interval metastases, such as liver metastases, in approximately 10% of cases. Nevertheless, it is not uncommon in clinical practice to observe focal FDG uptake in the liver that is not associated with liver metastases but rather with radiation-induced liver injury (RILI), which can result in the overstaging of the disease. Liver radiation damage is also a concern during distal esophageal cancer radiotherapy due to its proximity to the left liver lobe, typically included in the radiation field. Post-CRT, if FDG activity appears in the left or caudate liver lobes, a thorough investigation is needed to confirm or rule out distant metastases. The increased FDG uptake in liver lobes post-CRT often presents a diagnostic dilemma. Distinguishing between radiation-induced liver disease and metastasis is vital for appropriate patient management, necessitating a combination of imaging techniques and an understanding of the factors influencing the radiation response. Diagnosis involves identifying new foci of hepatic FDG avidity on PET/CT scans. Geographic regions of hypoattenuation on CT and well-demarcated regions with specific enhancement patterns on contrast-enhanced CT scans and MRI are characteristic of radiation-induced liver disease (RILD). Lack of mass effect on all three modalities (CT, MRI, PET) indicates RILD. Resolution of abnormalities on subsequent examinations also helps in diagnosing RILD. Moreover, it can also help to rule out occult metastases, thereby excluding those patients from further surgery who will not benefit from esophagectomy with curative intent.
在接受新辅助放化疗（nCRT）的食管癌患者中，后续通过F-18-氟脱氧葡萄糖（18F-FDG）正电子发射断层扫描-计算机断层扫描（PET-CT）进行再分期时，约10%的病例可发现间期转移灶，如肝转移。然而，在临床实践中，常观察到肝脏局灶性FDG摄取与肝转移无关，而是与放射性肝损伤（RILI）相关，这可能导致疾病分期过高。由于远端食管癌放疗区域邻近左肝叶（通常包含在照射野内），肝脏放射性损伤也是放疗过程中需要关注的问题。放化疗后，若左肝叶或尾状叶出现FDG活性，需进行全面检查以确认或排除远处转移。放化疗后肝叶FDG摄取增加常造成诊断困境。区分放射性肝病与转移灶对制定恰当的治疗方案至关重要，这需要结合多种影像学技术并充分理解影响放射反应的因素。诊断需通过PET/CT扫描识别新出现的肝脏FDG高摄取灶。CT显示的地图样低密度区，以及增强CT和MRI中边界清晰且具有特定强化模式的区域，是放射性肝病（RILD）的特征性表现。在CT、MRI、PET三种检查中均未见占位效应可提示RILD。后续检查中异常表现的消退也有助于RILD的诊断。此外，该方法还有助于排除隐匿性转移，从而避免对无法从根治性食管切除术中获益的患者进行进一步手术。
肿瘤(癌症)患者之家