PMC4995847_01
A 60-year-old man with gastroesophageal junction adenocarcinoma with the radiographic evolution of segment three hepatic uptake in a patient with advanced gastroesophageal adenocarcinoma. (a) Axial images of pretreatment positron emission tomography-computed tomography confirms the absence of fluorodeoxyglucose uptake in the liver (b) positron emission tomography-computed tomography 30, 90, and 180 days after completion of chemoradiation revealed fluorodeoxyglucose uptake in the left lobe of liver (arrow) (d, f, h) positron emission tomography-computed tomography at 3 and 6 months after CRT revealed no fluorodeoxyglucose uptake in the left lobe of the liver. Respective coronal images are shown (a, c, e, g). Area within red, white, green, and blue isodose line encompasses 37.5 Gy, 33.3 Gy, 30 Gy, and 26.3 Gy, respectively.
JCIS-6-30-g002.jpg
PMC4995847_01_JCIS-6-30-g002.jpg
F1
A PET/CT showed decreased FDG avidity in the GEJ mass [Figure 1a and b]. A PET/CT scan was obtained 34 days after completion of radiation [Figure 1c and d]. On retrospective imaging review, the FDG avid area of the liver was within the 37.5 Gy isodose line [Figure 1d]. Due to clinical stability, a plan for repeat imaging was favored over more invasive tissue sampling, and a repeat PET/CT scan 3 months [Figure 1e and f] and 6 months [Figure 1g and h] later showed resolution of the FDG avid area in the left hepatic lobe and ongoing systemic response.
PMC4995847_02
A 55-year-old man with adenocarcinoma of the distal esophagus. (a and b) Axial images of pretreatment positron emission tomography-computed tomography confirms the absence of fluorodeoxyglucose uptake in the liver, (c and d) positron emission tomography-computed tomography 45 days after completion of chemoradiation revealed fluorodeoxyglucose uptake in the left lobe of liver (arrow), (e and f) positron emission tomography-computed tomography 3 months posttreatment revealed no fluorodeoxyglucose uptake in the left lobe of the liver. Area within red, white, green, and blue isodose line encompasses 50.4 Gy, 45.4 Gy, 40.3 Gy, and 35.3 Gy, respectively.
JCIS-6-30-g003.jpg
PMC4995847_02_JCIS-6-30-g003.jpg
F2
A pretreatment staging PET/CT scan demonstrated a large 51 mm mass in the lower esophagus extending to the GEJ and to the gastric fundus measuring SUV 8.4 with no suspicious nodal uptake [Figure 2a and b]. A repeat PET-CT was performed 42 days from completion of radiotherapy and demonstrated FDG uptake (SUV 4.5) in the left lobe of the liver corresponding an area of low attenuation in the periphery of the left lobe of the liver measuring 28 mm x 35 mm on CT [Figure 2c and d]. Similar to Case 1, the hepatic function was normal, and retrospective review confirmed the FDG avid area was within the 50.4 Gy isodose line [Figure 2d]. A follow-up PET scan 3 months later showed the resolution of FDG uptake [Figure 2e and f].