Diagnostic value/performance of radiological liver imaging during chemoterapy for gastrointestinal malignancy: a critical review

Abstract

This article reviews the main toxic effect, complications and relative imaging findings of the liver that may appear during the oncologic follow up among patients affected by gastrointestinal malignancy. Awareness of the causative chemotherapeutic agent and regimens, pathophysiology and relative characteristic imaging findings of hepatic injuries is critical in order to obtain an accurate diagnosis especially when these parenchymal lesions are focal. An accurate synergic radiological diagnosis with Computed Tomography (CT) and Magnetic Resonance (MR) techniques may induce a potential termination of ineffective/toxic chemotherapy during early phases of treatment, changing the therapeutic plan in order to avoid first unnecessary liver biopsy and then invasive treatment as hepatic resection if not required.

Figure 1.

55-year old woman affected by left colon adenocarcinoma who undergoes to left hemicolectomy. We may observe in this preoperative CT diffuse low attenuation of the liver

Figure 2.

After the surgical resection of the primary tumor, the histological staging is pT3N1M1 for the presence, in the first post-operative CT, of a nodular hypodense lesion surrounded by rim enhancement with the appereance of a colorectal liver metastases

Figure 3.

MR dynamic imaging confirms CT diagnosis of a colorectal metastase. This lesion is hypointense in T1w images before and after administration of contrast agent compared to the surrounding liver

Figure 4.

After a six-cycles-Folfox neoadjuvant regimen, these CT post-operative imaging shows common findings after surgical resection. The hepatic malignant lesion is confermed with the addiction of “blue liver” as chemotherapeutic liver adverse reaction