Diagnostic performance of Contrast-enhanced CT in Pyrrolizidine Alkaloids-induced Hepatic Sinusoidal Obstructive Syndrome

Abstract

Hepatic sinusoidal obstruction syndrome (HSOS) can be caused by pyrrolizidine alkaloids(PAs)-containing herbals. Since PAs exposure is obscure and clinical presentation of HSOS is unspecific, it is challenge to establish the diagnosis of PAs-induced HSOS. Gynura segetum is one of the most wide-use herbals containing PAs. The aim of our study is to describe the features of contrast-enhanced computed tomography (CT) in gynura segetum-induced HSOS, and then determine diagnostic performance of radiological signs. We retrospectively analyzed medical records and CT images of HSOS patients (71 cases) and the controls (222 cases) enrolled from January 1, 2008, to Oct 31, 2015. The common findings of contrast CT in PAs-induced HSOS included: ascites (100%), hepatomegaly (78.87%), gallbladder wall thickening (86.96%), pleural effusion (70.42%), hepatic vein narrowing (87.32%), patchy liver enhancement (92.96%), and heterogeneous hypoattenuation (100%); of these signs, patchy enhancement and heterogeneous hypoattenuation were valuable features. Then, the result of diagnostic performance demonstrated that contrast CT possessed better performance in diagnosing PAs-induced HSOS compared with various parameters of Seattle criteria. In conclusion, the patients with PAs-induced HSOS display distinct radiologic features at CT-scan, which reveals that contrast-enhanced CT provides an effective noninvasive method for diagnosing PAs-induced HSOS.

Role of Virtual Touch Tissue Imaging Quantification in the Assessment of Hepatic Sinusoidal Obstruction Syndrome in a Rat Model

“…Apart from US and US elastography, several imaging modalities have been recommended for detecting HSOS, including superparamagnetic iron oxide-enhanced, gradient-recalled echo magnetic resonance imaging, gadoxetic acid-enhanced magnetic resonance imaging, [20][21][22][23] and contrast-enhanced computed tomography. 22,24,25 However, we consider VTIQ a promising technique for the noninvasive characterization of HSOS because of its compact and portable form factor; no contrast agent is needed; and it does not have the ionizing radiation of computed tomography. It is an ideal technology that uses a US system to measure the SWV for providing a quantitative evaluation of liver stiffness.…”

Expert consensus on the clinical management of pyrrolizidine alkaloid‐induced hepatic sinusoidal obstruction syndrome

“…Significant dilation and congestion of hepatic sinusoids, varying degrees of hepatic cell swelling and necrosis, red blood cell infiltration into the space of Disse, thickening of the walls of small intrahepatic veins with narrowing and occlusion of the lumen, and lack of fibrosis or mild fibrous proliferation in interlobular portal areas are usually seen (Fig. ) Consensus statements The liver is the primary target of PA damage (A1).…”

“…2). 8,24,25 (2)Consensus statementsThe liver is the primary target of PA damage (A1). (3) The pathology of acute PA-HSOS includes swelling, damage, and shedding of hepatic sinusoid endothelial cells in hepatic acinus zone III and significant dilation and congestion of hepatic sinusoids (A1).…”

Oxaliplatin-induced hepatic sinusoidal obstruction syndrome in a patient with gastric cancer: A case report

“…The clinical presentations of HSOS include jaundice, right upper-quadrant pain and tender hepatomegaly, ascites and unexplained weight gain. The diagnosis of a HSOS result from HSCT or pyrrolizidine alkaloid (PA)-containing herbals is based on a history of taking PAs-containing herbs and a classical triad of weight gain, painful hepatomegaly and jaundice (13,14). However, clinical manifestations of the patients with oxaliplatin-induced HSOS appear to be mild or absent (10).…”

“…It occurs as a result of cytoreductive therapy prior to hematopoietic stem cell transplantation (HSCT), following oxaliplatin-containing chemotherapy for colorectal carcinoma metastatic to the liver, in patients taking pyrrolizidine alkaloid-containing herbal remedies (5,13,14). It is histologically characterized by sinusoidal dilatation, hepatocyte necrosis and obliterated hepatic venules due to damage to the sinusoidal endothelial cells (4).…”