Abstract
INTRODUCTION: Radiotherapy is a treatment option in the management of patients with metastatic liver disease. The aim in this case was to evaluate radiation-induced dysfunctional liver lesions using 99mTc-GSA-SPECT, Gd-EOB-DTPA-enhanced MRI, and radiation dose distribution in a patient after radiation therapy. PRESENTATION OF CASE: After sigmoid colon resection, three liver metastases were treated with radiotherapy at the same time. Liver function after radiotherapy was determined to be A according to the Child-Turcott-Pugh classification. 99mTc-GSA-SPECT showed a wider reduction in uptake than Gd-EOB-DTPA MRI at all three sites. HH15 showed decreased liver function. DISCUSSION: In the 99mTc-GSA-SPECT and Gd-EOB-DTPA MRI hepatocyte phases, residual signals of normal hepatocytes were observed despite irradiation at three sites. Additional treatment could be considered for the two recurrent lesions because there was no deterioration of liver function in post-irradiation imaging findings and blood sampling. CONCLUSION: 99mTc-GSA-SPECT and EOB-MRI showed characteristic findings for evaluation of liver function after radiotherapy for multiple liver metastases, suggesting the need for both imaging evaluations. It is now possible to choose whether to perform local additional treatment (additional radiation, RFA) or other chemotherapy for liver metastases after recurrence.