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Intraoperative Radiation Therapy in Liver Tissue in a Pig Model: Monitoring with Dual-Modality PET/CT¹

¹ From the Depts of Diagnostic and Interventional Radiology (G.A., H.K., J.F.D.), General and Transplantation Surgery (G.M.K., H.Z., S.W., C.E.B.), Radiation Therapy (A.B.M.), Pathology (K.A.M.), and Nuclear Medicine (S.P.M., A.B.); and Institute of Medical Physics (A.B.), Univ Hosp Essen, Hufelandstrasse 55, 45127 Essen, Germany. Received Sep 24, 2002; revision requested Nov 26; final revision received Jul 21, 2003; accepted Aug 6. Address correspondence to G.A. (e-mail: gerald.antoch@uni-essen.de).

View larger version (157K): [in a new window]   Figure 1. Transverse PET (left) and fused PET/CT (right) images of an irradiated pig liver. A, A focal decrease in FDG uptake (arrows) was seen in the irradiated area 2 weeks after hilar bile duct resection and 20-Gy IORT. B, FDG uptake (arrows) in the irradiated field increased gradually after 4 weeks. C, After 8 weeks, no difference in FDG uptake between the liver hilum and the liver periphery could be seen.

View larger version (27K): [in a new window]   Figure 2. Graph shows ratios of radioactive tracer concentrations in the liver hilum and liver periphery 2, 4, and 8 weeks after bile duct resection-anastomosis surgery. Data are based on three measurements obtained in each pig. Compared with the nonirradiated pigs (no IORT), the pigs irradiated with either a 5-cm (group 2) or 7-cm (group 3) applicator demonstrated decreased glucose metabolism in the liver hilum 2 and 4 weeks after surgery. No decreased FDG uptake in the liver was observed 8 weeks postoperatively in any group; this finding is consistent with the visually homogeneous uptake pattern seen on the PET images.

View larger version (139K): [in a new window]   Figure 3a. Transverse CT images obtained (a) 2, (b) 4, and (c) 8 weeks after central hilar bile duct resection and 20-Gy IORT in a pig. Bile duct dilatation (arrows in b) was noted 2 weeks postoperatively, and the dilatation increased gradually but substantially over time.

View larger version (140K): [in a new window]   Figure 3b. Transverse CT images obtained (a) 2, (b) 4, and (c) 8 weeks after central hilar bile duct resection and 20-Gy IORT in a pig. Bile duct dilatation (arrows in b) was noted 2 weeks postoperatively, and the dilatation increased gradually but substantially over time.

View larger version (152K): [in a new window]   Figure 3c. Transverse CT images obtained (a) 2, (b) 4, and (c) 8 weeks after central hilar bile duct resection and 20-Gy IORT in a pig. Bile duct dilatation (arrows in b) was noted 2 weeks postoperatively, and the dilatation increased gradually but substantially over time.

View larger version (24K): [in a new window]   Figure 4a. Graphs show mean diameters of (a) central and (b) peripheral bile ducts in the pigs after central bile duct resection and biliodigestive anastomosis creation only (no IORT) and after resection-anastomosis surgery plus IORT with a 5- or 7-cm applicator. After IORT, the central and peripheral bile ducts became dilated. After IORT, bile duct dilatation increased with time.

View larger version (27K): [in a new window]   Figure 4b. Graphs show mean diameters of (a) central and (b) peripheral bile ducts in the pigs after central bile duct resection and biliodigestive anastomosis creation only (no IORT) and after resection-anastomosis surgery plus IORT with a 5- or 7-cm applicator. After IORT, the central and peripheral bile ducts became dilated. After IORT, bile duct dilatation increased with time.

View larger version (134K): [in a new window]   Figure 5a. Inhomogeneously perfused pig liver after hilar bile duct resection and 20-Gy IORT depicted on transverse contrast-enhanced CT images obtained at combined PET/CT examination. (a) Two weeks after surgery the perfusion deficit was graded as severe. (b) Four weeks after surgery the perfusion decreased to the extent that it was graded as mild. Note the bile duct dilatation (arrow). (c) Eight weeks after surgery and IORT, homogeneous perfusion of the liver could be seen; however, the bile duct diameter increased gradually over time.

View larger version (136K): [in a new window]   Figure 5b. Inhomogeneously perfused pig liver after hilar bile duct resection and 20-Gy IORT depicted on transverse contrast-enhanced CT images obtained at combined PET/CT examination. (a) Two weeks after surgery the perfusion deficit was graded as severe. (b) Four weeks after surgery the perfusion decreased to the extent that it was graded as mild. Note the bile duct dilatation (arrow). (c) Eight weeks after surgery and IORT, homogeneous perfusion of the liver could be seen; however, the bile duct diameter increased gradually over time.

View larger version (132K): [in a new window]   Figure 5c. Inhomogeneously perfused pig liver after hilar bile duct resection and 20-Gy IORT depicted on transverse contrast-enhanced CT images obtained at combined PET/CT examination. (a) Two weeks after surgery the perfusion deficit was graded as severe. (b) Four weeks after surgery the perfusion decreased to the extent that it was graded as mild. Note the bile duct dilatation (arrow). (c) Eight weeks after surgery and IORT, homogeneous perfusion of the liver could be seen; however, the bile duct diameter increased gradually over time.

View larger version (143K): [in a new window]   Figure 6a. A, Histologic tissue sample of the liver hilum of a pig shows fibrotic changes in the liver parenchyma with a reduced number of viable cells due to 20-Gy irradiation. (Hematoxylin-eosin stain; magnification, x100.) B, Histologic tissue sample of normal liver parenchyma taken from the liver periphery of the same pig. (Hematoxylin-eosin stain; magnification, x40.)

View larger version (131K): [in a new window]   Figure 6b. A, Histologic tissue sample of the liver hilum of a pig shows fibrotic changes in the liver parenchyma with a reduced number of viable cells due to 20-Gy irradiation. (Hematoxylin-eosin stain; magnification, x100.) B, Histologic tissue sample of normal liver parenchyma taken from the liver periphery of the same pig. (Hematoxylin-eosin stain; magnification, x40.)

View larger version (151K): [in a new window]   Figure 7. Histologic tissue sample shows regenerative and inflammatory reactions and an increased number of granulocytes and lymphocytes 8 weeks after central bile duct resection and IORT. Inflammatory and regenerative processes are thought to be the main reason for the increased glucose uptake in the irradiated field at 8 weeks. (Hematoxylin-eosin stain; magnification, x100.)