CTICasesRadiation Pneumonitis post-SABR
Imaging findings
Serial chest CT scans in a patient treated with stereotactic ablative radiotherapy (SABR) for two lung lesions demonstrate newly developing and subsequently consolidating ground-glass and solid opacities in both treatment regions. Over time, the opacities show mild volume loss and organization. Comparison with the radiation treatment plan's isodose curves confirms that all newly developed opacities are strictly confined within the boundaries of the high-dose regions (exceeding 35 to 52 Gray).
Key takeaways
Radiation pneumonitis and subsequent fibrosis following stereotactic body radiotherapy (SBRT/SABR) can cause a temporary increase in opacity size within the first year, raising suspicion for tumor recurrence. Correlating the anatomical distribution of the opacities with the treatment plan's isodose curves (e.g., confirming the changes are within the 20 Gray contour) is extremely helpful in confirming benign post-radiation changes rather than tumor progression.
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