Skip to main content

Advertisement

SpringerLink
Log in

CT and MR imaging of chemotherapy-induced hepatopathy

  • Review
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Chemotherapy-induced hepatopathy includes a wide variety of parenchymal and vascular hepatic changes on imaging, including diffuse or focal hepatopathies (i.e. hepatitis, steatosis, fibrosis, pseudocirrhosis, or sinusoidal obstruction). These changes can profoundly alter the hepatic parenchyma on imaging and result in both false negative and false-positive diagnoses of hepatic metastases and lead to errors in patient management strategies. It is therefore important for radiologists to have a comprehensive knowledge of the imaging patterns that may develop following chemotherapy. The purpose of this review is to explore the broad spectrum of hepatic parenchymal and vascular chemotherapy-induced changes on CT and MR imaging.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13

Similar content being viewed by others

References

  1. Grigorian A, O’Brien CB (2014) Hepatotoxicity Secondary to Chemotherapy. J Clin Transl Hepatol 2:95–102.

    PubMed  PubMed Central  Google Scholar 

  2. Sharma A, Houshyar R, Bhosale P, Choi JI, Gulati R, Lall C (2014) Chemotherapy induced liver abnormalities: an imaging perspective. Clin Mol Hepatol 20:317–326.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Ramadori G, Cameron S (2010) Effects of systemic chemotherapy on the liver. Ann Hepatol 9:133–143.

    Article  CAS  PubMed  Google Scholar 

  4. Cohen AD, Kemeny NE (2003) An update on hepatic arterial infusion chemotherapy for colorectal cancer. Oncologist 8:553–566.

    Article  PubMed  Google Scholar 

  5. Lewandowski RJ, Geschwind JF, Liapi E, Salem R (2011) Transcatheter intraarterial therapies: rationale and overview. Radiology 2011;259:641–657.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Uslusoy HS, Nak SG, Gülten M, Biyikli Z (2009) Non-alcoholic steatohepatitis with normal aminotransferase values. World J Gastroenterol;15: 1863–1868.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Oba A, Mise Y, Ito H, et al (2018) Clinical implications of disappearing colorectal liver metastases have changed in the era of hepatocyte-specific MRI and contrast-enhanced intraoperative ultrasonography. HPB (Oxford) 20:708–714.

    Article  Google Scholar 

  8. Iannaccone R, Federle MP, Brancatelli G, et al (2006) Peliosis hepatis: spectrum of imaging findings. Am J Roentgenol 187:W43–52.

    Article  Google Scholar 

  9. Furlan A, Brancatelli G, Dioguardi Burgio M, et al (2018) Focal Nodular Hyperplasia After Treatment With Oxaliplatin: A Multiinstitutional Series of Cases Diagnosed at MRI. Am J Roentgenol 210:775–779

    Article  Google Scholar 

  10. Han NY, Park BJ, Sung DJ, et al (2014) Chemotherapy-induced focal hepatopathy in patients with gastrointestinal malignancy: gadoxetic acid–enhanced and diffusion-weighted MR imaging with clinical-pathologic correlation. Radiology 271:416–425.

    Article  PubMed  Google Scholar 

  11. Viganò L, Capussotti L, De Rosa G, et al (2013) Liver resection for colorectal metastases after chemotherapy: impact of chemotherapy-related liver injuries, pathological tumor response, and micrometastases on long-term survival. Ann Surg;258(5):731–740; discussion 741-2.

  12. Krishna M (2017) Patterns of necrosis in liver disease. Clinical Liver Disease 10:53–56

    Article  PubMed  PubMed Central  Google Scholar 

  13. Jeong WK, Choi SY, Kim J (2013) Pseudocirrhosis as a complication after chemotherapy for hepatic metastasis from breast cancer. Clin Mol Hepato 19:190–194.

    Article  Google Scholar 

  14. Vilgrain V, Lagadec M, Ronot M (2016) Pitfalls in Liver Imaging. Radiology 278:34–51.

    Article  PubMed  Google Scholar 

  15. Young ST, Paulson EK, Washington K, Gulliver DJ, Vredenburgh JJ, Baker ME (1994) CT of the liver in patients with metastatic breast carcinoma treated by chemotherapy: findings simulating cirrhosis. Am J Roentgenol 163:1385–1388

    Article  CAS  Google Scholar 

  16. Qayyum A, Lee GK, Yeh BM, Allen JN, Venook AP, Coakley FV (2007) Frequency of hepatic contour abnormalities and signs of portal hypertension at CT in patients receiving chemotherapy for breast cancer metastatic to the liver. Clin Imaging 31:6–10.

    Article  PubMed  Google Scholar 

  17. Adike A, Karlin N, Menias C, Carey EJ (2016) Pseudocirrhosis: A Case Series and Literature Review. Case Rep Gastroenterol 10:381–391.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Peppercorn PD, Reznek RH, Wilson P, Slevin ML, Gupta RK (1998) Demonstration of hepatic steatosis by computerized tomography in patients receiving 5-fluorouracil-based therapy for advanced colorectal cancer. Br J Cancer 77:2008–2011

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Fernandez FG, Ritter J, Goodwin JW, Linehan DC, Hawkins WG, Strasberg SM (2005) Effect of steatohepatitis associated with irinotecan or oxaliplatin pretreatment on resectability of hepatic colorectal metastases. J Am Coll Surg 200:845–853.

    Article  PubMed  Google Scholar 

  20. Rubbia-Brandt L, Lauwers GY, Wang H, et al (2010) Sinusoidal obstruction syndrome and nodular regenerative hyperplasia are frequent oxaliplatin-associated liver lesions and partially prevented by bevacizumab in patients with hepatic colorectal metastasis. Histopathology 56:430–439.

    Article  PubMed  Google Scholar 

  21. Vauthey JN, Pawlik TM, Ribero D, et al (2006) Chemotherapy regimen predicts steatohepatitis and an increase in 90-day mortality after surgery for hepatic colorectal metastases. J Clin Oncol 24:2065–2072

    Article  CAS  PubMed  Google Scholar 

  22. Robinson SM, Wilson CH, Burt AD, Manas DM, White SA (2012) Chemotherapy-associated liver injury in patients with colorectal liver metastases: a systematic review and meta-analysis. Ann Surg Oncol 19:4287–4299.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Bethke A, Kühne K, Platzek I, Stroszczynski C (2011) Neoadjuvant treatment of colorectal liver metastases is associated with altered contrast enhancement on computed tomography. Cancer Imaging 11:91–99

    Article  PubMed  PubMed Central  Google Scholar 

  24. Berger-Kulemann V, Schima W, Baroud S, et al (2012) Gadoxetic acid-enhanced 3.0 T MR imaging versus multidetector-row CT in the detection of colorectal metastases in fatty liver using intraoperative ultrasound and histopathology as a standard of reference. Eur J Surg Oncol 38:670–676

    Article  CAS  PubMed  Google Scholar 

  25. Tang A, Desai A, Hamilton G, et al (2015) Accuracy of MR imaging-estimated proton density fat fraction for classification of dichotomized histologic steatosis grades in nonalcoholic fatty liver disease. Radiology 274:416–425.

    Article  PubMed  Google Scholar 

  26. Idilman IS, Aniktar H, Idilman R, et al (2013) Hepatic steatosis: quantification by proton density fat fraction with MR imaging versus liver biopsy. Radiology 267:767–775

    Article  PubMed  Google Scholar 

  27. Reissfelder C, Brand K, Sobiegalla J, et al (2014) Chemotherapy-associated liver injury and its influence on outcome after resection of colorectal liver metastases. Surgery 155:245–254.

    Article  PubMed  Google Scholar 

  28. Zhao J, van Mierlo KMC, Gómez-Ramírez J, et al (2017) Systematic review of the influence of chemotherapy-associated liver injury on outcome after partial hepatectomy for colorectal liver metastases. Br J Surg 104:990–1002.

    Article  CAS  PubMed  Google Scholar 

  29. Vauthey JN, Mizuno T, Overman MJ, Soubrane O (2017) Can we navigate chemotherapy-induced hepatic injuries from pathology to bedside? J Hepatol 67:10–11

    Article  PubMed  Google Scholar 

  30. Wong VW, Adams LA, de Lédinghen V, Wong GL, Sookoian S (2018) Noninvasive biomarkers in NAFLD and NASH - current progress and future promise. Nat Rev Gastroenterol Hepatol 15:461–478.

    Article  CAS  PubMed  Google Scholar 

  31. Venkatesh SK, Yin M, Ehman RL (2013) Magnetic resonance elastography of liver: clinical applications. J Comput Assist Tomogr 37:887–896.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Han NY, Park BJ, Kim MJ, Sung DJ, Cho SB (2015) Hepatic Parenchymal Heterogeneity on Contrast-enhanced CT Scans Following Oxaliplatin-based Chemotherapy: Natural History and Association with Clinical Evidence of Sinusoidal Obstruction Syndrome. Radiology 276:766–774.

    Article  PubMed  Google Scholar 

  33. Fan CQ, Crawford JM (2014) Sinusoidal obstruction syndrome (hepatic veno-occlusive disease). J Clin Exp Hepatol 4:332–346.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Marzano C, Cazals-Hatem D, Rautou PE, Valla DC (2015) The significance of nonobstructive sinusoidal dilatation of the liver: Impaired portal perfusion or inflammatory reaction syndrome. Hepatology 62:956–963.

    Article  CAS  PubMed  Google Scholar 

  35. Rubbia-Brandt L, Audard V, Sartoretti P, et al (2004) Severe hepatic sinusoidal obstruction associated with oxaliplatin-based chemotherapy in patients with metastatic colorectal cancer. Ann Oncol 15:460–466

    Article  CAS  Google Scholar 

  36. Nakano H, Oussoultzoglou E, Rosso E, et al (2008) Sinusoidal injury increases morbidity after major hepatectomy in patients with colorectal liver metastases receiving preoperative chemotherapy. Ann Surg 247:118–124

    Article  PubMed  Google Scholar 

  37. Narita M, Oussoultzoglou E, Bachellier P, Jaeck D, Uemoto S (2015) Post-hepatectomy liver failure in patients with colorectal liver metastases. Surg Today 45: 1218–1226.

    Article  CAS  PubMed  Google Scholar 

  38. Hubert C, Sempoux C, Humblet Y, et al (2013) Sinusoidal obstruction syndrome (SOS) related to chemotherapy for colorectal liver metastases: factors predictive of severe SOS lesions and protective effect of bevacizumab. HPB (Oxford) 15:858–864.

    Article  Google Scholar 

  39. Soubrane O, Brouquet A, Zalinski S, et al (2010) Predicting high grade lesions of sinusoidal obstruction syndrome related to oxaliplatin-based chemotherapy for colorectal liver metastases: correlation with post-hepatectomy outcome. Ann Surg 251:454–460

    Article  PubMed  Google Scholar 

  40. Pereyra D, Rumpf B, Ammann M, et al (2019) The Combination of APRI and ALBI Facilitates Preoperative Risk Stratification for Patients Undergoing Liver Surgery After Neoadjuvant Chemotherapy Ann Surg Oncol 26:791–799

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Overman MJ, Ferrarotto R, Raghav K, et al (2018) The Addition of Bevacizumab to Oxaliplatin-Based Chemotherapy: Impact Upon Hepatic Sinusoidal Injury and Thrombocytopenia. J Natl Cancer Inst 110:888–894.

    Article  CAS  PubMed  Google Scholar 

  42. Hubert C, Lucidi V, Weerts J, et al (2018) Impact of biological agents on the prevalence of chemotherapy associated liver injury (CALI): Multicentric study of patients operated for colorectal liver metastases. Eur J Surg Oncol 44:1532–1538

    Article  PubMed  Google Scholar 

  43. Robinson SM, Mann J, Vasilaki A, Mathers J, Burt AD, Oakley F, White SA, Mann DA (2013) Pathogenesis of FOLFOX induced sinusoidal obstruction syndrome in a murine chemotherapy model. J Hepatol 59:318–326.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Brancatelli G, Furlan A, Calandra A, Dioguardi Burgio M (2018) Hepatic sinusoidal dilatation. Abdom Radiol (NY) 43:2011–2022.

    Article  Google Scholar 

  45. Furlan A, Minervini MI, Borhani AA, Dioguardi Burgio M, Tublin ME, Brancatelli G (2016) Hepatic Sinusoidal Dilatation: A Review of Causes With Imaging-Pathologic Correlation. Semin Ultrasound CT MR 37:525–532.

    Article  PubMed  Google Scholar 

  46. Shin NY, Kim MJ, Lim JS, et al (2012) Accuracy of gadoxetic acid-enhanced magnetic resonance imaging for the diagnosis of sinusoidal obstruction syndrome in patients with chemotherapy-treated colorectal liver metastases. Eur Radiol 22:864–871.

    Article  PubMed  Google Scholar 

  47. Cayet S, Pasco J, Dujardin F, et al (2017) Diagnostic performance of contrast-enhanced CT-scan in sinusoidal obstruction syndrome induced by chemotherapy of colorectal liver metastases: Radio-pathological correlation. Eur J Radiol 94:180–190.

    Article  PubMed  Google Scholar 

  48. Yoneda N, Matsui O, Ikeno H, et al (2015) Correlation between Gd-EOB-DTPA-enhanced MR imaging findings and OATP1B3 expression in chemotherapy-associated sinusoidal obstruction syndrome. Abdom Imaging 40:3099–3103.

    Article  PubMed  Google Scholar 

  49. Xiong WJ, Hu LJ, Jian YC, et al (2012) Focal peliosis hepatis in a colon cancer patient resembling metastatic liver tumor. World J Gastroenterol 18:5999–6002.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Donato H, Andrade L, Bastati N, Cipriano A, Ba-Ssalamah A, Caseiro-Alves F (2018) Liver Multiacinar Regenerative Nodules: Imaging Findings and Clinical Implications. Acta Med Port 31:470–477.

    Article  PubMed  Google Scholar 

  51. Wicherts DA, de Haas RJ, Sebagh M, et al (2011) Regenerative nodular hyperplasia of the liver related to chemotherapy: impact on outcome of liver surgery for colorectal metastases. Ann Surg Oncol 18:659–669.

    Article  PubMed  Google Scholar 

  52. Morris-Stiff G, White AD, Gomez D, et al (2014) Nodular regenerative hyperplasia (NRH) complicating oxaliplatin chemotherapy in patients undergoing resection of colorectal liver metastases. Eur J Surg Oncol 40:1016–1020.

    Article  CAS  PubMed  Google Scholar 

  53. Viganò L, Rubbia-Brandt L, De Rosa G, et al (2015) Nodular Regenerative Hyperplasia in Patients Undergoing Liver Resection for Colorectal Metastases After Chemotherapy: Risk Factors, Preoperative Assessment and Clinical Impact. Ann Surg Oncol 22:4149–4157.

    Article  PubMed  Google Scholar 

  54. Vigano L, De Rosa G, Toso C, et al (2017) Reversibility of chemotherapy-related liver injury. J Hepatol 2017; 67:84–91.

    Article  CAS  PubMed  Google Scholar 

  55. Calderaro J, Azoulay D, Zafrani ES (2014) Hepatocellular carcinoma and nodular regenerative hyperplasia after chemotherapy for metastatic colorectal carcinoma. Hepatology 60:1440–1441.

    Article  PubMed  Google Scholar 

  56. Ames JT, Federle MP, Chopra K (2009) Distinguishing clinical and imaging features of nodular regenerative hyperplasia and large regenerative nodules of the liver. Clin Radiol 64:1190–1195.

    Article  CAS  PubMed  Google Scholar 

  57. Brisse H, Servois V, Bouche B, et al Hepatic regenerating nodules: a mimic of recurrent cancer in children. Pediatr Radiol. 2000;30(6):386–93

    Article  CAS  PubMed  Google Scholar 

  58. Donadon M, Di Tommaso L, Roncalli M, Torzilli G (2013) Multiple focal nodular hyperplasias induced by oxaliplatin-based chemotherapy. World J Hepatol 5:340–344

    Article  PubMed  PubMed Central  Google Scholar 

  59. Yoneda N, Matsui O, Kitao A, et al (2016) Benign Hepatocellular Nodules: Hepatobiliary Phase of Gadoxetic Acid-enhanced MR Imaging Based on Molecular Background. Radiographics 36:2010–2027

    Article  PubMed  Google Scholar 

  60. Morana G, Grazioli L, Kirchin MA, et al (2011) Solid hypervascular liver lesions: accurate identification of true benign lesions on enhanced dynamic and hepatobiliary phase magnetic resonance imaging after gadobenate dimeglumine administration. Invest Radiol 46:225–239

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Dipartimento Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro”, University Hospital “Paolo Giaccone”, University of Palermo, Via del Vespro, 129, 90124, Palermo, Italy

    Federica Vernuccio

  2. I.R.C.C.S. Centro Neurolesi Bonino Pulejo, Contrada Casazza, SS113, 98124, Messina, Italy

    Federica Vernuccio

  3. Hôpitaux Universitaires Beaujon, Radiology, Université Paris VII, Clichy, France

    Federica Vernuccio, Marco Dioguardi Burgio & Valérie Vilgrain

  4. Laboratory of Imaging Biomarkers, Center of Research on Inflammation, UMR 1149, INSERM, University Paris-Diderot, Paris, France

    Marco Dioguardi Burgio & Valérie Vilgrain

  5. Azienda Sanitaria Provinciale Agrigento - UO Complessa Radiologia Distretto Ag 2 Sciacca-Ribera. Presidio Ospedaliero di Sciacca (AG), Sciacca, ‎Agrigento, Italy

    Filippo Barbiera

  6. Oncologic Department, “La Maddalena”, Palermo, Italy

    Silvestro Cusmà

  7. Dipartimento di Discipline Chirurgiche, Oncologiche e Stomatologiche (Di.Chir.On.S.), University Hospital “Paolo Giaccone”, Palermo, Italy

    Giuseppe Badalamenti

  8. Dipartimento di Biomedicina, Neuroscienze e Diagnostica avanzata (BIND), University of Palermo, Palermo, Italy

    Massimo Midiri & Giuseppe Brancatelli

Authors
  1. Federica Vernuccio
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marco Dioguardi Burgio
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Filippo Barbiera
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Silvestro Cusmà
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Giuseppe Badalamenti
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Massimo Midiri
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Valérie Vilgrain
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Giuseppe Brancatelli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Federica Vernuccio.

Ethics declarations

Disclosures

FV, M.D.B., F.B., S.C., G. Badalamenti, M.M., V.V.: Nothing to disclose. G. Brancatelli: has received lecture fees from Bayer.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 17 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vernuccio, F., Dioguardi Burgio, M., Barbiera, F. et al. CT and MR imaging of chemotherapy-induced hepatopathy. Abdom Radiol 44, 3312–3324 (2019). https://doi.org/10.1007/s00261-019-02193-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-019-02193-y

Keywords

Search

Navigation