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. 2018 Oct 4;13(10):e0204734.
doi: 10.1371/journal.pone.0204734. eCollection 2018.

Assessment and agreement of the CT appearance pattern and its severity grading of radiation-induced lung injury after stereotactic body radiotherapy for lung cancer

Takaya Yamamoto  1 , Noriyuki Kadoya  1 , Yohei Morishita  2 , Yoshinao Sato  2 , Haruo Matsushita  1 , Rei Umezawa  1 , Yojiro Ishikawa  1 , Noriyoshi Takahashi  1 , Yu Katagiri  1 , Ken Takeda  1 , Keiichi Jingu  1
Affiliations

Assessment and agreement of the CT appearance pattern and its severity grading of radiation-induced lung injury after stereotactic body radiotherapy for lung cancer

Takaya Yamamoto et al. PLoS One. .

Abstract

Purpose: Radiographic severity of radiation-induced lung injury (RILI) has not been well-studied. The goal of this study was to assess the CT appearance pattern and severity of RILI without consideration of the clinical presentation.

Material and methods: A total of 49 patients, 41 with primary lung cancer and 8 with metastatic lung cancer, were treated by 4-fraction stereotactic body radiotherapy (SBRT). RILI after SBRT was separately assessed by two observers. The early and late CT appearance patterns and CT-based severity grading were explored.

Results: The median follow-up period was 39.0 months. In the early CT findings of observers 1 and 2, there was diffuse consolidation in 15 and 8, diffuse ground glass opacity (GGO) in 0 and 0, patchy consolidation and GGO in 17 and 20, patchy GGO in 3 and 3, and no changes in 10 and 14, respectively (kappa = 0.61). In late CT findings of observer 1 and 2, there were modified conventional pattern in 28 and 24, mass-like pattern in 8 and 11, scar-like pattern in 12 and 12, and no changes in 1 and 2, respectively (kappa = 0.63). In the results of the CT-based grading by observers 1 and 2, there were grade 0 in 1 and 2, grade 1 in 10 and 14, grade 2 in 31 and 29, grade 3 in 7 and 4, and none of grade 4 or more, respectively (kappa = 0.66). According to multivariate analyses (MVA), the significant predicting factors of grade 2 or more CT-based RILI were age (p = 0.01), oxygen dependence (p = 0.03) and interstitial shadow (p = 0.03).

Conclusions: The agreement of the CT appearance and CT-based grading between two observers was good. These indicators may be able to provide us with more objective information and a better understanding of RILI.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Concordance CT appearance, case 1.
(a) The shadow extends to the right middle and lower lobes beyond the high-dose region; this was diagnosed as diffuse consolidation at 6 months after SBRT. (b) The shadow shows consolidation, volume loss and bronchiectasis; this was diagnosed as the modified conventional pattern at 21 months after SBRT. (c) The shadow remained at 45 months after SBRT.
Fig 2
Fig 2. Concordance CT appearance, case 2.
(a) Before SBRT, the lung tumor was located in the right upper lobe. (b) The consolidation expands beyond the high-dose region; this shadow was diagnosed as diffuse consolidation at 5 months after SBRT. (c) The shadow shrank, and only a linear opacity remained. This shadow was diagnosed as a scar-like pattern at 20 months after SBRT.
Fig 3
Fig 3. Concordance CT appearance, case 3.
(a) Before SBRT, the lung tumor was located in the right upper lobe. (b) Patchy areas of hazy and consolidation are seen; this shadow was diagnosed as patchy consolidation and GGO at 5 months after SBRT. (c) The shadow forms a focal consolidation; this was diagnosed as a mass-like pattern at 17 months after SBRT. (d) The shadow shrank, but a mass-like shadow remained at 35 months after SBRT.
Fig 4
Fig 4. Concordance CT appearance, case 4.
(a) Before SBRT, the lung tumor was located in the left lower lobe. (b) Patchy areas of hazy are seen; this shadow was diagnosed as patchy GGO at 3 months after SBRT.
See this image and copyright information in PMC

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