PMC2655298_01
FDG-PET/CT image sets demonstrating progressive decrease in the functional and anatomic volume of the tumor with concurrent left lobe hypertrophy. a: Pre-treatment, b: 4-weeks after first SIRT treatment, c: At the completion of the full course of the treatment.
1477-7819-7-6-1.jpg
PMC2655298_01_1477-7819-7-6-1.jpg
F1
The current imaging assessment with fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) indicated a large necrotic tumor occupying the greater part of the right lobe (Figure 1a). A 4-week post-treatment FDG-PET/CT scan demonstrated a complete metabolic response, and a 25% decrease in anatomic volume (Figure 1b, 2). Three months after the second SIRT, tumor anatomic volume decreased to 10% of the pretreatment size (Figures 1c, 2). Left liver lobe volume showed 2.7 times increase from the pretreatment value (Figures 1c, 3).
Graph analysis of anatomic (VA) and functional (VF) tumor volume changes during the course of the treatment. Functional volume following the first course of the treatment becomes too low to be depicted on this graph.
1477-7819-7-6-2.jpg
PMC2655298_01_1477-7819-7-6-2.jpg
F2
A 4-week post-treatment FDG-PET/CT scan demonstrated a complete metabolic response, and a 25% decrease in anatomic volume (Figure 1b, 2). The patient's physical performance status showed remarkable improvement over the next 3 months, and serial PET/CT imaging studies indicated further decrease in anatomic volume (Figure 2). Metabolic status of the tumor remained depressed (Figure 2). Three months after the second SIRT, tumor anatomic volume decreased to 10% of the pretreatment size (Figures 1c, 2).
Graph analysis of left and right hepatic lobe volumes during the course of the treatment. Note the progressive increase in left lobe volume with concurrent decrease in the right lobe volume.
1477-7819-7-6-3.jpg
PMC2655298_01_1477-7819-7-6-3.jpg
F3
The left lobe volume showed progressive increase (Figure 3). Left liver lobe volume showed 2.7 times increase from the pretreatment value (Figures 1c, 3).
Intra-operative pictures demonstrating significantly down-sized tumor with scarring and, major left lobe hypertrophy.
1477-7819-7-6-4.jpg
PMC2655298_01_1477-7819-7-6-4.jpg
F4
The left lobe was satisfactorily hypertrophied (Figure 4).
Surgical pathology findings. Tumor necrosis and degeneration with microspheres in the treatment field (10x).
1477-7819-7-6-5.jpg
PMC2655298_01_1477-7819-7-6-5.jpg
F5
The surrounding liver tissue showed portal triaditis with mononuclear inflammatory cellular response predomination and portal and periportal fibrosis (Figure 5).