title: Radiation-induced liver damage: correlation of histopathology with hepatobiliary magnetic resonance imaging, a feasibility study.
abstract: OBJECTIVE
  Radiotherapy of liver malignancies shows promising results (radioembolization, stereotactic irradiation, interstitial brachytherapy). Regardless of the route of application, a certain amount of nontumorous liver parenchyma will be collaterally damaged by radiation. The functional reserve may be significantly reduced with an impact on further treatment planning. Monitoring of radiation-induced liver damage by imaging is neither established nor validated. We performed an analysis to correlate the histopathological presence of radiation-induced liver damage with functional magnetic resonance imaging (MRI) utilizing hepatobiliary contrast media (Gd-BOPTA).
  
  
  METHODS
  Patients undergoing local high-dose-rate brachytherapy for whom a follow-up hepatobiliary MRI within 120 days after radiotherapy as well as an evaluable liver biopsy from radiation-exposed liver tissue within 7 days before MRI were retrospectively identified. Planning computed tomography (CT)/dosimetry was merged to the CT-documentation of the liver biopsy and to the MRI. Presence/absence of radiation-induced liver damage (histopathology) and Gd-BOPTA uptake (MRI) as well as the dose applied during brachytherapy at the site of tissue sampling was determined.
  
  
  RESULTS
  Fourteen biopsies from eight patients were evaluated. In all cases with histopathological evidence of radiation-induced liver damage (n = 11), no uptake of Gd-BOPTA was seen. In the remaining three, cases no radiation-induced liver damage but Gd-BOPTA uptake was seen. Presence of radiation-induced liver damage and absence of Gd-BOPTA uptake was correlated with a former high-dose exposition.
  
  
  CONCLUSIONS
  Absence of hepatobiliary MRI contrast media uptake in radiation-exposed liver parenchyma may indicate radiation-induced liver damage. Confirmatory studies are warranted.
authors.affiliation: Klinik für Radiologie und Nuklearmedizin, Universitätsklinik Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany, max.seidensticker@med.ovgu.de.
authors.forename: Max
authors.initials: M
authors.lastname: Seidensticker
authors.forename: Miroslaw
authors.initials: M
authors.lastname: Burak
authors.forename: Thomas
authors.initials: T
authors.lastname: Kalinski
authors.forename: Benjamin
authors.initials: B
authors.lastname: Garlipp
authors.forename: Konrad
authors.initials: K
authors.lastname: Koelble
authors.forename: Peter
authors.initials: P
authors.lastname: Wust
authors.forename: Kai
authors.initials: K
authors.lastname: Antweiler
authors.forename: Ricarda
authors.initials: R
authors.lastname: Seidensticker
authors.forename: Konrad
authors.initials: K
authors.lastname: Mohnike
authors.forename: Maciej
authors.initials: M
authors.lastname: Pech
authors.forename: Jens
authors.initials: J
authors.lastname: Ricke
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects*; D003287:Contrast Media; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007089:Image Enhancement; D008099:Liver / Q000473:pathology* / Q000528:radiation effects* / Q000648:ultrastructure; D008113:Liver Neoplasms / Q000532:radiotherapy*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008536:Meglumine / Q000031:analogs & derivatives; D008875:Middle Aged; D009942:Organometallic Compounds; D011832:Radiation Injuries / Q000175:diagnosis*
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C064572:gadobenic acid; D008536:Meglumine