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Review
. 2021 Sep 15;8(4):HEP32.
doi: 10.2217/hep-2020-0026. eCollection 2021 Dec.

Imaging of chemotherapy-induced liver toxicity: an illustrated overview

Giovanni Brondani Torri  1 , Matheus Dorigatti Soldatelli  2 , Gustavo Felipe Luersen  3   4   5 , Caroline Lorenzoni Almeida Ghezzi  6   7
Affiliations
Review

Imaging of chemotherapy-induced liver toxicity: an illustrated overview

Giovanni Brondani Torri et al. Hepat Oncol. .

Abstract

Chemotherapy is a potential cause of focal and diffuse hepatobiliary lesions. Many of these lesions may be demonstrated on imaging, especially computed tomography and MRI. Some of these lesions, especially those of steatosis and sinusoidal obstruction syndrome, are associated with a worse prognosis and risk of hepatic failure in the context of surgical management. Notably, some chemotherapy-induced hepatic alterations, such as sinusoidal obstruction syndrome, pseudocirrhosis and focal hepatopathies, may be mistakenly interpreted as signs of cancer progression, misguiding the therapeutic planning for patients receiving chemotherapy.

Keywords: adverse effects; chemotherapy; hepatology; imaging; liver; magnetic resonance; oncology.

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Conflict of interest statement

Financial & competing interests disclosure The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. No writing assistance was utilized in the production of this manuscript.

Figures

Figure 1.
Figure 1.. Yellow liver.
Intraoperative photograph of a steatotic liver.
Figure 2.
Figure 2.. Axial T1-weighted gradient echo.
MRI demonstrate loss of signal in the opposing-phase MRI predominantly in the left hepatic lobe after taxol and anastrozole use. (A) In phase. (B) Opposing phase.
Figure 3.
Figure 3.. Blue liver.
Intraoperative photograph of a liver with sinusoidal obstruction syndrome.
Figure 4.
Figure 4.. Axial T1-weighted MRI obtained using hepatospecific contrast media in the hepatobiliary phase.
(A) Before chemotherapy. (B) After chemotherapy with the FOLFOX regimen in a patient with colon cancer; demonstrates a diffuse heterogeneous reticular pattern. Regarded to be the characteristic feature of sinusoidal obstructive syndrome.
Figure 5.
Figure 5.. Coronal T1-weighted MRI obtained using hepatospecific contrast media in the hepatobiliary phase.
They demonstrate onset of a diffuse heterogeneous reticular pattern after chemotherapy with the FOLFOX regimen for 8 months.
Figure 6.
Figure 6.. Coronal T2-weighted MRI.
It demonstrates a diffuse nodular pattern with capsular retraction and hepatic parenchymal distortion.
Figure 7.
Figure 7.. T1-weighted MRI postcontrast with hepatospecific contrast agent in the hepatobiliary phase.
They demonstrate subtle focal enhancing lesions in a patient who received oxaliplatin.
Figure 8.
Figure 8.. Axial MRIs of nodules.
(A) Axial MRI shows a hypervascular nodule (arrow) that is predominantly hyperintense in the hepatobiliary phase (arrow in [B]). The imaging findings are consistent with FNH. (C) In another contrasting example the arrows indicate several nodules with peripheral arterial hyperenhancement (arrows) and central hypointensity in the hepatobiliary phase (arrow in [D]), suggesting metastases. The pattern of reticular enhancement associated with sinusoidal obstruction syndrome is also visible.
See this image and copyright information in PMC

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