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Chemotherapy induced liver abnormalities: an imaging perspective.

Sharma A, Houshyar R, Bhosale P, Choi JI, Gulati R, Lall C - Clin Mol Hepatol (2014)

Bottom Line: There are several hepatic conditions that can result and keen clinical as well as radiographic recognition are paramount.These conditions can display clinical signs of acute hepatitis, liver cirrhosis, and even liver failure.It is important to anticipate and recognize these adverse reactions and thus appropriate clinical action can be taken.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, University of California, Irvine, Orange, CA, USA.

ABSTRACT
Treating patients undergoing chemotherapy who display findings of liver toxicity, requires a solid understanding of these medications. It is important for any clinician to have an index of suspicion for liver toxicity and be able to recognize it, even on imaging. Cancer chemotherapy has evolved, and newer medications that target cell biology have a different pattern of liver toxicity and may differ from the more traditional cytotoxic agents. There are several hepatic conditions that can result and keen clinical as well as radiographic recognition are paramount. Conditions such as sinusoidal obstructive syndrome, steatosis, and pseudocirrhosis are more commonly associated with chemotherapy. These conditions can display clinical signs of acute hepatitis, liver cirrhosis, and even liver failure. It is important to anticipate and recognize these adverse reactions and thus appropriate clinical action can be taken. Often times, patients with these liver manifestations can be managed with supportive therapies, and liver toxicity may resolve after discontinuation of chemotherapy.

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Related in: MedlinePlus

Hepatic sinusoidal obstructive syndrome. Fifty six-year-old female with metastatic colon cancer. Chemotherapy with FOLFOX (Folinic Acid, 5 Flurouracil & Oxaliplatin) regimen was performed. This may lead to sinusoidal congestion, damage to the hepatic sinusoids with features of portal hypertension, splenomegaly and resultant thrombocytopenia. Coronal contrast enhanced CT (A) and axial contrast enhanced CT (B) demonstrate an enlarged spleen (arrow).
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Figure 1: Hepatic sinusoidal obstructive syndrome. Fifty six-year-old female with metastatic colon cancer. Chemotherapy with FOLFOX (Folinic Acid, 5 Flurouracil & Oxaliplatin) regimen was performed. This may lead to sinusoidal congestion, damage to the hepatic sinusoids with features of portal hypertension, splenomegaly and resultant thrombocytopenia. Coronal contrast enhanced CT (A) and axial contrast enhanced CT (B) demonstrate an enlarged spleen (arrow).

Mentions: Computed tomography (CT) and ultrasonographic findings of hepatic SOS includes hepatosplenomegaly, ascites, gallbladder wall thickening, periesophageal varices and recanalization of umbilical veins (Fig. 1). On Doppler ultrasound, decreased flow in the portal vein can be noted.21,22 On postcontrast CT and MRI, patchy liver enhancement and narrowing of main hepatic veins were reported as frequent findings (Fig. 2).23 On gadoxetic acid enhanced MRI, reticular pattern is noted on hepatobiliary phase images in patients with hepatic SOS after chemotherapy and this finding is highly specific for correct diagnosis of hepatic SOS.24


Chemotherapy induced liver abnormalities: an imaging perspective.

Sharma A, Houshyar R, Bhosale P, Choi JI, Gulati R, Lall C - Clin Mol Hepatol (2014)

Hepatic sinusoidal obstructive syndrome. Fifty six-year-old female with metastatic colon cancer. Chemotherapy with FOLFOX (Folinic Acid, 5 Flurouracil & Oxaliplatin) regimen was performed. This may lead to sinusoidal congestion, damage to the hepatic sinusoids with features of portal hypertension, splenomegaly and resultant thrombocytopenia. Coronal contrast enhanced CT (A) and axial contrast enhanced CT (B) demonstrate an enlarged spleen (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4197183&req=5

Figure 1: Hepatic sinusoidal obstructive syndrome. Fifty six-year-old female with metastatic colon cancer. Chemotherapy with FOLFOX (Folinic Acid, 5 Flurouracil & Oxaliplatin) regimen was performed. This may lead to sinusoidal congestion, damage to the hepatic sinusoids with features of portal hypertension, splenomegaly and resultant thrombocytopenia. Coronal contrast enhanced CT (A) and axial contrast enhanced CT (B) demonstrate an enlarged spleen (arrow).
Mentions: Computed tomography (CT) and ultrasonographic findings of hepatic SOS includes hepatosplenomegaly, ascites, gallbladder wall thickening, periesophageal varices and recanalization of umbilical veins (Fig. 1). On Doppler ultrasound, decreased flow in the portal vein can be noted.21,22 On postcontrast CT and MRI, patchy liver enhancement and narrowing of main hepatic veins were reported as frequent findings (Fig. 2).23 On gadoxetic acid enhanced MRI, reticular pattern is noted on hepatobiliary phase images in patients with hepatic SOS after chemotherapy and this finding is highly specific for correct diagnosis of hepatic SOS.24

Bottom Line: There are several hepatic conditions that can result and keen clinical as well as radiographic recognition are paramount.These conditions can display clinical signs of acute hepatitis, liver cirrhosis, and even liver failure.It is important to anticipate and recognize these adverse reactions and thus appropriate clinical action can be taken.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, University of California, Irvine, Orange, CA, USA.

ABSTRACT
Treating patients undergoing chemotherapy who display findings of liver toxicity, requires a solid understanding of these medications. It is important for any clinician to have an index of suspicion for liver toxicity and be able to recognize it, even on imaging. Cancer chemotherapy has evolved, and newer medications that target cell biology have a different pattern of liver toxicity and may differ from the more traditional cytotoxic agents. There are several hepatic conditions that can result and keen clinical as well as radiographic recognition are paramount. Conditions such as sinusoidal obstructive syndrome, steatosis, and pseudocirrhosis are more commonly associated with chemotherapy. These conditions can display clinical signs of acute hepatitis, liver cirrhosis, and even liver failure. It is important to anticipate and recognize these adverse reactions and thus appropriate clinical action can be taken. Often times, patients with these liver manifestations can be managed with supportive therapies, and liver toxicity may resolve after discontinuation of chemotherapy.

Show MeSH
Related in: MedlinePlus