Radiological response of Liver metastases to 90Y Theraspheres shown by 18FDG PET CT

Contibuted by: Dr Parameshwaran R V, Manipal Hospital, Bangalore
 

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A 60yr old gentleman presented with complaints of nausea, vomiting and weight loss (10 kg) since 4-6months. Was evaluated elsewhere with the following investigations:

1. Upper GI endoscopy- antral gastritis
2. CECT abdomen- multiple bilobar liver metastases.

No history of pain abdomen, hematemesis, malena or bleeding per rectum. On per rectum examination we found a low rectal lesion. A biopsy done showed a poorly differentiated adenocarcinoma with neuroendocrine differentiation. Serum CEA and chromogen A levels were raised.

EUA and wide local excision of the lower rectal lesion was done on 28/08/08.

Triphase CT showed innumerable large metastases in the liver largest in right lobe (9cm), some of which show small areas of necrosis. Pt was not sent for pre 90Y Therasphere PET imaging.

90Y Therasphere infusion was given to both lobes of liver on 10/09/08. 5.4GBq to the right lobe and 2.3GBq to the left lobe

A PET-CT done after 6 months showed significant reduction in the liver lesion. The largest in the right lobe measured 5cm in size with low grade FDG uptake of SUVmax=4.6 was noted which represented possible residual active disease.

CT (of PET-CT) showed significant reduction in the size and number of the liver lesions indicating significant response to treatment