Chemotherapy induced liver abnormalities: an imaging perspective

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.

Effect of ursodeoxycholic acid and vitamin E in the prevention of liver injury from methotrexate in pediatric leukemia

“…Regarding CBC, the difference between mean 1 and 2 of total WBC and ANC in group 1 was statistically significant (3016±807/mm 3 vs. 3478±891/mm 3 and 1562±650/mm 3 vs. 2067±977/mm 3 , respectively) (p=0.015 and 0.034, respectively). In other words, the mean WBC count and ANC during the 6-month period after vitamin E withdrawal were significantly higher than those during the period when vitamin E was being used.…”

“…While this function predisposes liver to damage, some medications are identified that induce liver damage more commonly than others (1,2). The liver damage induced by chemotherapy agents can manifest in a number of forms varying from an asymptomatic patient with mild elevation in transaminases on laboratory study to a severely ill patient presenting with a condition such as acute viral hepatitis (3). Methotrexate (MTX) is an anti-metabolite agent that inhibits folate metabolism and can be used for different indications.…”

“…The reduction of folate supplies causes inappropriate (DNA) replication inside hepatocytes, leading to the accumulation of toxins in the liver and raising aminotransferase levels. Therefore, hepatotoxicity remains a major concern among pediatric patients with acute lymphoblastic leukemia (ALL) in their maintenance phase of treatment, which includes the weekly ingestion of lowdose oral MTX (1,3,4).…”

Hepatic changes after treatment with oxaliplatin

“…Various classes of chemotherapeutic agents have been associated with hepatic lesions such as steatosis, steatohepatitis, sinusoidal obstruction syndrome, acute hepatitis, and liver necrosis ( 2 ) . Oxaliplatin-based treatments are most often associated with sinusoidal obstruction syndrome and regenerative nodular hyperplasia ( 2 , 3 ) .…”

“…Oxaliplatin-based treatments are most often associated with sinusoidal obstruction syndrome and regenerative nodular hyperplasia ( 2 , 3 ) .…”