Imaging manifestations of focal parenchymal liver injury induced by chemotherapy in a case of gastric cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

XING Cuicui ^1,2 , WU Jian ¹ , ZHANG Meng ¹ ,  LIU Xijiao ^1,2,3 , CHEN Weixia ² , SONG Bin ^1,2,3

1. Department of Radiology, Sanya People’s Hospital/West China Sanya Hospital, Sichuan University, Sanya, Hainan 572000, P. R. China;
2. Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
3. Key Laboratory of Functional and Molecular Imaging, Sichuan Province, Chengdu 610041, P. R. China;

Corresponding author：

LIU Xijiao, Email: bless_jiao@163.com

Keywords：

chemotherapy-induced liver injury; focal liver injury; imaging; differential diagnosis; metastatic tumor

DOI：

10.7507/1007-9424.202412144

Video：

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Tumor chemotherapy is a treatment method that employs chemotherapeutic drugs to eradicate cancer cells. These drugs are cytotoxic, meaning they can affect both tumor cells and normal cells. In recent years, there has been a gradual increase in chemotherapy-induced liver injury. Chemotherapy-induced parenchymal liver injury often manifests as diffuse lesions, although focal lesions can occasionally be observed. There is a diversity in the pathogenesis and pathological changes of chemotherapy-induced focal liver disease. Radiologically, there is often challenging in differentiating chemotherapy-induced focal liver disease from hepatic metastases. Therefore, early and accurate diagnosis of this condition poses a certain challenge in clinical practice. This article presents the radiological findings of a case of chemotherapy-induced focal liver disease induced by chemotherapy for gastric cancer, and summarizes the radiological features and differential diagnostic points of chemotherapy-induced focal liver disease, aiming to enhance the understanding of this type of lesion among radiologists and clinicians and reduce related missed diagnoses and misdiagnoses.

1.	Xiao K, Zhang S, Peng Q, et al. PD-L1 protects tumor-associated dendritic cells from ferroptosis during immunogenic chemotherapy. Cell Rep, 2024, 43(11): 114868. doi: 10.1016/j.celrep.2024.114868.
2.	胡江峰, 陆伦根. 药物性肝损伤的规范化诊治策略. 中华医学信息导报, 2021, 36(19): 17.
3.	莫楚君, 马金誉, 缪辉来. 化疗相关药物性肝损伤的研究进展. 中国医学创新, 2023, 20(18): 166-169.
4.	Han NY, Park BJ, Sung DJ, et al. Chemotherapy-induced focal hepatopathy in patients with gastrointestinal malignancy: gadoxetic acid–enhanced and diffusion-weighted MR imaging with clinical-pathologic correlation. Radiology, 2014, 271(2): 416-425.
5.	Rubbia-Brandt L, Audard V, Sartoretti P, et al. Severe hepatic sinusoidal obstruction associated with oxaliplatin-based chemotherapy in patients with metastatic colorectal cancer. Ann Oncol, 2004, 15(3): 460-466.
6.	Torrisi JM, Schwartz LH, Gollub MJ, et al. CT findings of chemotherapy-induced toxicity: what radiologists need to know about the clinical and radiologic manifestations of chemotherapy toxicity. Radiology, 2011, 258(1): 41-56.
7.	Vauthey JN, Pawlik TM, Ribero D, et al. Chemotherapy regimen predicts steatohepatitis and an increase in 90-day mortality after surgery for hepatic colorectal metastases. J Clin Oncol, 2006, 24(13): 2065-2072.
8.	Jang JK, Jang HJ, Kim JS, et al. Focal fat deposition in the liver: diagnostic challenges on imaging. Abdom Radiol (NY), 2017, 42(6): 1667-1678.
9.	Calistri L, Rastrelli V, Nardi C, et al. Imaging of the chemotherapy-induced hepatic damage: yellow liver, blue liver, and pseudocirrhosis. World J Gastroenterol, 2021, 27(46): 7866-7893.
10.	Donati F, Cioni D, Guarino S, et al. Chemotherapy-induced liver injury in patients with colorectal liver metastases: findings from MR imaging. Diagnostics (Basel), 2022, 12(4): 867. doi: 10.3390/diagnostics12040867.
11.	唐桂香, 刘建滨, 谢安, 等. 肝紫癜影像学表现1例. 中华放射学杂志, 2022, 56(1): 101-102.
12.	叶旭燕, 胡明哲, 吴温秋, 等. 局限性紫癜性肝病计算机断层扫描与磁共振成像特征分析. 中华消化杂志, 2024, 44(6): 379-384.
13.	Trenschel GM, Schubert A, Dries V, et al. Nodular regenerative hyperplasia of the liver: case report of a 13-year-old girl and review of the literature. Pediatr Radiol, 2000, 30(1): 64-68.
14.	Rubbia-Brandt L, Lauwers GY, Wang H, et al. 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, 2010, 56(4): 430-439.
15.	张明. 肝窦阻塞综合征的研究进展. 临床肝胆病杂志, 2024, 40(1): 24-28.
16.	赵紫园, 赵又瑾, 陈卫霞, 等. 病例分析: 肝窦阻塞综合征的影像学征象. 中国普外基础与临床杂志, 2024, 31(5): 571-574.
17.	Arakawa Y, Shimada M, Utsunomya T, et al. Oxaliplatin-related sinusoidal obstruction syndrome mimicking metastatic liver tumors. Hepatol Res, 2013, 43(6): 685-689.
18.	Ding Y, Rao SX, Wang WT, et al. Gd-EOB-DTPA-enhanced MR findings in chemotherapy-induced sinusoidal obstruction syndrome in colorectal liver metastases. J Int Med Res, 2020, 48(6): 300060520926031. doi:10.1177/0300060520926031.
19.	陈乾, 林慧敏, 严福华. 磁共振成像评估肝功能储备的研究进展. 诊断学理论与实践, 2023, 22(2): 190-196.
20.	Wang Y, Mao S, Huang R, et al. MRI findings of newly present benign focal hepatic observations following chemotherapy: distinct features in early- and late-term follow-up. Eur Radiol, 2024. doi:10.1007/s00330-024-11185-6.
21.	Vernuccio F, Dioguardi Burgio M, Barbiera F, et al. CT and MR imaging of chemotherapy-induced hepatopathy. Abdom Radiol (NY), 2019, 44(10): 3312-3324.
22.	陈国勇, 李真林. DWI和肝胆特异性对比剂Gd-EOB-DTPA在肝局灶性病变诊断和鉴别诊断中的应用现状. 四川大学学报 (医学版), 2022, 53(5): 737-743.
23.	王琪璠, 赵雪峰, 刘舰, 等. 磁共振体素内不相干运动扩散加权成像在肝脏局灶性病变性质诊断中的应用价值. 广西医学, 2022, 44(3): 266-269.
24.	张晨, 郑卓肇, 赵本琦. 体素内不相干运动扩散加权成像鉴别诊断肝脏实性局灶性病变. 中国介入影像与治疗学, 2018, 15(7): 419-423.
25.	Poston GJ, Adam R, Alberts S, et al. OncoSurge: a strategy for improving resectability with curative intent in metastatic colorectal cancer. J Clin Oncol, 2005, 23(28): 7125-7134.

1. Xiao K, Zhang S, Peng Q, et al. PD-L1 protects tumor-associated dendritic cells from ferroptosis during immunogenic chemotherapy. Cell Rep, 2024, 43(11): 114868. doi: 10.1016/j.celrep.2024.114868.
2. 胡江峰, 陆伦根. 药物性肝损伤的规范化诊治策略. 中华医学信息导报, 2021, 36(19): 17.
3. 莫楚君, 马金誉, 缪辉来. 化疗相关药物性肝损伤的研究进展. 中国医学创新, 2023, 20(18): 166-169.
4. Han NY, Park BJ, Sung DJ, et al. Chemotherapy-induced focal hepatopathy in patients with gastrointestinal malignancy: gadoxetic acid–enhanced and diffusion-weighted MR imaging with clinical-pathologic correlation. Radiology, 2014, 271(2): 416-425.
5. Rubbia-Brandt L, Audard V, Sartoretti P, et al. Severe hepatic sinusoidal obstruction associated with oxaliplatin-based chemotherapy in patients with metastatic colorectal cancer. Ann Oncol, 2004, 15(3): 460-466.
6. Torrisi JM, Schwartz LH, Gollub MJ, et al. CT findings of chemotherapy-induced toxicity: what radiologists need to know about the clinical and radiologic manifestations of chemotherapy toxicity. Radiology, 2011, 258(1): 41-56.
7. Vauthey JN, Pawlik TM, Ribero D, et al. Chemotherapy regimen predicts steatohepatitis and an increase in 90-day mortality after surgery for hepatic colorectal metastases. J Clin Oncol, 2006, 24(13): 2065-2072.
8. Jang JK, Jang HJ, Kim JS, et al. Focal fat deposition in the liver: diagnostic challenges on imaging. Abdom Radiol (NY), 2017, 42(6): 1667-1678.
9. Calistri L, Rastrelli V, Nardi C, et al. Imaging of the chemotherapy-induced hepatic damage: yellow liver, blue liver, and pseudocirrhosis. World J Gastroenterol, 2021, 27(46): 7866-7893.
10. Donati F, Cioni D, Guarino S, et al. Chemotherapy-induced liver injury in patients with colorectal liver metastases: findings from MR imaging. Diagnostics (Basel), 2022, 12(4): 867. doi: 10.3390/diagnostics12040867.
11. 唐桂香, 刘建滨, 谢安, 等. 肝紫癜影像学表现1例. 中华放射学杂志, 2022, 56(1): 101-102.
12. 叶旭燕, 胡明哲, 吴温秋, 等. 局限性紫癜性肝病计算机断层扫描与磁共振成像特征分析. 中华消化杂志, 2024, 44(6): 379-384.
13. Trenschel GM, Schubert A, Dries V, et al. Nodular regenerative hyperplasia of the liver: case report of a 13-year-old girl and review of the literature. Pediatr Radiol, 2000, 30(1): 64-68.
14. Rubbia-Brandt L, Lauwers GY, Wang H, et al. 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, 2010, 56(4): 430-439.
15. 张明. 肝窦阻塞综合征的研究进展. 临床肝胆病杂志, 2024, 40(1): 24-28.
16. 赵紫园, 赵又瑾, 陈卫霞, 等. 病例分析: 肝窦阻塞综合征的影像学征象. 中国普外基础与临床杂志, 2024, 31(5): 571-574.
17. Arakawa Y, Shimada M, Utsunomya T, et al. Oxaliplatin-related sinusoidal obstruction syndrome mimicking metastatic liver tumors. Hepatol Res, 2013, 43(6): 685-689.
18. Ding Y, Rao SX, Wang WT, et al. Gd-EOB-DTPA-enhanced MR findings in chemotherapy-induced sinusoidal obstruction syndrome in colorectal liver metastases. J Int Med Res, 2020, 48(6): 300060520926031. doi:10.1177/0300060520926031.
19. 陈乾, 林慧敏, 严福华. 磁共振成像评估肝功能储备的研究进展. 诊断学理论与实践, 2023, 22(2): 190-196.
20. Wang Y, Mao S, Huang R, et al. MRI findings of newly present benign focal hepatic observations following chemotherapy: distinct features in early- and late-term follow-up. Eur Radiol, 2024. doi:10.1007/s00330-024-11185-6.
21. Vernuccio F, Dioguardi Burgio M, Barbiera F, et al. CT and MR imaging of chemotherapy-induced hepatopathy. Abdom Radiol (NY), 2019, 44(10): 3312-3324.
22. 陈国勇, 李真林. DWI和肝胆特异性对比剂Gd-EOB-DTPA在肝局灶性病变诊断和鉴别诊断中的应用现状. 四川大学学报 (医学版), 2022, 53(5): 737-743.
23. 王琪璠, 赵雪峰, 刘舰, 等. 磁共振体素内不相干运动扩散加权成像在肝脏局灶性病变性质诊断中的应用价值. 广西医学, 2022, 44(3): 266-269.
24. 张晨, 郑卓肇, 赵本琦. 体素内不相干运动扩散加权成像鉴别诊断肝脏实性局灶性病变. 中国介入影像与治疗学, 2018, 15(7): 419-423.
25. Poston GJ, Adam R, Alberts S, et al. OncoSurge: a strategy for improving resectability with curative intent in metastatic colorectal cancer. J Clin Oncol, 2005, 23(28): 7125-7134.

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