Amiodarone toxicity showing high liver density on CT scan with normal liver function and plasma amiodarone levels in a long-term amiodarone user

Kim, Bo-Bae; Kim, Dong-Min; Choi, Dong-Hyun; Chung, Joong-Wha; Koh, Young‐Youp; Chang, Kyong-Sig; Hong, Soon-Pyo

doi:10.1016/j.ijcard.2014.01.020

Cited by 15 publications

(13 citation statements)

References 7 publications

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“…For patients with increased liver attenuation undergoing amiodarone treatment, material decomposition and TNC might give radiologists and clinicians more confidence to identify amiodarone as the cause of increased liver attenuation 7,28,29 , potentially allowing for more precise monitoring of liver attenuation and earlier adaption of drug treatment. Identification and quantification of amiodarone in the liver might also be useful as additional guidance for amiodarone treatment, as tissue levels have been suggested to be useful to anticipate toxic liver damage and treatment efficacy 7,18,29 . Differences in liver attenuation between TNC and VNC could be used as a measure to quantify amiodarone accumulation in the liver 21,47 .…”

Section: Resultsmentioning

confidence: 99%

Iodine accumulation of the liver in patients treated with amiodarone can be unmasked using material decomposition from multiphase spectral-detector CT

Laukamp

Lennartz

Hashmi

et al. 2020

Sci Rep

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Amiodarone accumulates in the liver, where it increases x-ray attenuation due to its iodine content. We evaluated liver attenuation in patients treated and not treated with amiodarone using true-noncontrast (TNC) and virtual-non-contrast (VNC) images acquired with spectral-detector-CT (SDCT). 142 patients, of which 21 have been treated with amiodarone, receiving SDCT-examinations (unenhancedchest CT [TNC], CT-angiography of chest and abdomen [CTA-Chest, CTA-Abdomen]) were included. TNC, CTA-Chest, CTA-Abdomen, and corresponding VNC-images (VNC-Chest, VNC-Abdomen) were reconstructed. Liver-attenuation-index (LAI) was calculated as difference between liver-and spleenattenuation. Liver-attenuation and LAI derived from TNC-images of patients receiving amiodarone were higher. Contrary to TNC, liver-attenuation and LAI were not higher in amiodarone patients in VNC-Chest and in VNC-Abdomen. To verify these initial results, a phantom scan was performed and an additional patient cohort included, both confirming that VNC is viable of accurately subtracting iodine of hepatic amiodarone-deposits. This might help to monitor liver-attenuation more accurately and thereby detect liver steatosis as a sign of liver damage earlier as well as to verify amiodarone accumulation in the liver.Amiodarone is an antiarrhythmic drug that has shown its effectiveness for several decades to treat various forms of tachyarrhythmia 1,2 . However, oral absorption and bioavailability are poor and greatly variable. Onset of therapeutic effects using oral application range between 2-21 days and after long-term treatment plasma half-life is around 100 days. Because of its lipophilic properties, iodine-containing amiodarone accumulates, among others, in hepatocytes. Here, it inhibits the enzyme phospholipase which subsequentially stops the removal of lysosomal phospholipids. Consequently, amiodarone forms a nondigestible complex with the phospholipids, resulting in phospholipidosis and extended amiodarone accumulation. Amiodarone concentrations in the liver can be up to 500-times higher than in the blood serum and release from hepatocytes is slow after treatment discontinuation 1-6 . Earlier studies found that this condition can lead to steatohepatitis and liver cirrhosis 1,7,8 .Iodinated contrast media is broadly applied in CT imaging. Due to its high physical density and k-edge effects of iodine, it increases attenuation and image contrast that improves depiction of anatomical structures (e.g. organ parenchyma and vessels) 9,10 . For intravascular injections in CT imaging almost exclusively non-ionic low-or iso-osmotic iodinated contrast media is applied. Molecular structures between agents are similar, a commonly applied agent is for example Ioversol (C 18 H 24 I 3 N 3 O 9 , molecular mass of 807.1 g/mol). It contains three iodine atoms that constitute almost 50% of its molecular mass 9-12 . Amiodarone shows several similarities to iodinated contrast media regarding the molecular structure. It is a di-iodinated benzofuran derivate, as a drug it is u...

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Section: Resultsmentioning

confidence: 99%

Iodine accumulation of the liver in patients treated with amiodarone can be unmasked using material decomposition from multiphase spectral-detector CT

Laukamp

Lennartz

Hashmi

et al. 2020

Sci Rep

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“…Similar in histopathologic appearance to alcoholic fatty liver disease, amiodarone-induced hepatotoxicity may be distinguished by the presence of phospholipid-laden lysosomal lamellar bodies (representing phospholipidosis) on an electron microscope [15]. If a CT scan is taken without contrast, the liver will often appear bright due to the accumulated iodinated medication [16].…”

Section: Discussionmentioning

confidence: 99%

Prolonged Jaundice Secondary to Amiodarone Use: A Case Report and Literature Review

Bratton

Alomari

Momani

et al. 2019

Cureus

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Adverse reactions to the antiarrhythmic medication amiodarone are severe, potentially life-threatening, and not rare. One in three patients on long-term therapy experience elevated liver enzymes, and clinically apparent liver toxicity occurs in 1% of patients treated. We report the case of a 76-year-old patient with amiodarone-induced intrahepatic cholestasis and prolonged hyperbilirubinemia despite the discontinuation of the offending agent. Current research hypothesizes that amiodarone leads to hepatic injury both by direct hepatotoxicity and by increasing the likelihood of hepatocytes to create abnormal, toxic metabolites. Increased awareness of such an adverse effect can guide clinicians toward the possible underlying etiologies of prolonged jaundice.

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“…Previous reports showed that the plasma amiodarone level may be poorly correlated with its toxicity [ 10 ]. However, high liver density seen on CT scans, which is secondary to increased iodine content of amiodarone and reflects the tissue level of amiodarone, may be useful to detect the toxicity [ 11 ]. In this regard, it is important to evaluate elevations of liver enzymes, liver CT imaging (high attenuation of the liver parenchyma), and histology, and discontinuation should be considered when amiodarone-induced hepatotoxicity is suspected.…”

Section: Discussionmentioning

confidence: 99%

Amiodarone-induced reversible and irreversible hepatotoxicity: two case reports

et al. 2018

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BackgroundAmiodarone is a highly effective treatment for supraventricular and ventricular tachyarrhythmia; however, it could be associated with several serious adverse effects, including liver injury.Case presentationWe report the clinical and histological features of two contrasting Japanese patients with amiodarone-induced reversible and irreversible hepatotoxicity. One patient with amiodarone-induced irreversible hepatotoxicity showed liver cirrhosis during treatment with amiodarone and died of hepatic failure; the other patient, who had reversible hepatotoxicity, showed a reversible course of liver function and imaging after discontinuation of amiodarone.ConclusionsWe emphasize the importance of close monitoring of liver enzymes and evaluation of liver computed tomographic imaging as well as liver biopsy during treatment with amiodarone, and discontinuation should be considered when amiodarone-induced hepatotoxicity is suspected.

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Amiodarone toxicity showing high liver density on CT scan with normal liver function and plasma amiodarone levels in a long-term amiodarone user

Cited by 15 publications

References 7 publications

Iodine accumulation of the liver in patients treated with amiodarone can be unmasked using material decomposition from multiphase spectral-detector CT

Iodine accumulation of the liver in patients treated with amiodarone can be unmasked using material decomposition from multiphase spectral-detector CT

Prolonged Jaundice Secondary to Amiodarone Use: A Case Report and Literature Review

Amiodarone-induced reversible and irreversible hepatotoxicity: two case reports

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