PMC6800412_01
67-year-old asymptomatic woman with hepatic metastatic renal cell carcinoma who presented with organizing pneumonia after radioembolization treatment. (a) Pre-procedure contrast-enhanced MRI demonstrated conglomerate renal metastases in segments 7 and 8 adjacent to the diaphragm. (b) Catheter angiography demonstrates hypervascular metastases supplied by three arterial conduits. (c) Postradioembolization bremsstrahlung SPECT/CT demonstrates activity within the targeted angiosomes covering both tumors and a margin.
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F1
There were two conglomerate tumors in hepatic segments 7 and 8 measuring 7.2 cm in maximal diameter [Figure 1a]. Mapping angiography demonstrated hypervascular tumors supplied by the segment 7 and 8 angiosomes without parasitization of the phrenic artery [Figure 1b]. 2 mCi of TcMAA was administered via the planned treatment vessels with subsequent SPECT/CT scintigraphy demonstrating a lung shunt of 1%. Ablative radioembolization was performed 2 weeks later using Yttrium 90 containing glass microspheres (TheraSphere, BTG International Group; London, United Kingdom) with a Medical Internal Radiation Dose of 377 gray (Gy), 388 Gy, and 311 Gy delivered to the segment 7, dorsal segment 8, and ventral segment 8 arteries, respectively [Figure 1c].
67-year-old asymptomatic woman with hepatic metastatic renal cell carcinoma who presented with organizing pneumonia after radioembolization treatment. (a-c) Contrast-enhanced MRI performed three months after TARE demonstrates tumor necrosis without evidence of residual disease. There is also an enhancement of pulmonary parenchyma abutting tumor margin*.
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F2
The tumor demonstrated an mRECIST complete response per MRI three months after treatment [Figure 2a-c].
67-year-old asymptomatic woman with hepatic metastatic renal cell carcinoma who presented with organizing pneumonia after radioembolization treatment. (a) Non-contrast CT with lung windows 3 months after TARE demonstrates geographic mixed ground glass and consolidation in the right lower lobe. (b) Noncontrast CT with lung windows 6 months after TARE demonstrates bibasilar reversed halo (atoll) signs most consistent with OP. Concurrent PET/CT image at the same level demonstrates increased metabolic activity predominantly in the peripheral areas of consolidation. (c) Non-contrast CT with lung windows 8 months after TARE demonstrates near resolution of mixed consolidation and ground glass opacities in the lung bases.
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F3
Computed tomography (CT) of the chest was subsequently obtained 3 months after treatment demonstrating new geographic mixed ground glass and consolidation in the right lower lobe abutting the diaphragm in close proximity to the treated liver lesions [Figure 3a]. Approximately 6 months after radioembolization, surveillance positron emission tomography-computed tomography (PET-CT) demonstrated new bibasilar mixed peripheral airspace consolidation with central ground-glass opacities compatible with a reversed halo sign (atoll sign) highly suggestive of organizing pneumonia [Figure 3b]. A chest CT 8 months after radioembolization demonstrated near- complete resolution of OP [Figure 3c].