Imaging of the chemotherapy-induced hepatic damage: Yellow liver, blue liver, and pseudocirrhosis

Abstract

The liver is the major drug-metabolizing and drug-detoxifying organ. Many drugs can cause liver damage through various mechanisms; however, the liver response to injury includes a relatively narrow spectrum of alterations that, regardless of the cause, are represented by phlogosis, oxidative stress and necrosis. The combination of these alterations mainly results in three radiological findings: vascular alterations, structural changes and metabolic function reduction. Chemotherapy has changed in recent decades in terms of the drugs, protocols and duration, allowing patients a longer life expectancy. As a consequence, we are currently observing an increase in chemotherapy-associated liver injury patterns once considered unusual. Recognizing this form of damage in an early stage is crucial for reconsidering the therapy regimen and thus avoiding severe complications. In this frontier article, we analyze the role of imaging in detecting some of these pathological patterns, such as pseudocirrhosis, “yellow liver” due to chemotherapy-associated steatosis-steatohepatitis, and “blue liver”, including sinusoidal obstruction syndrome, veno-occlusive disease and peliosis.

MRI of Peliosis Hepatis: A Case Series Presentation With a 2022 Systematic Literature Update

“…Our analysis might confirm this association in patients with PH on chemotherapy and sinusoidal obstruction syndrome 40 . Both the two conditions would fall within the sinusoidal forms of hepatic outflow obstruction, as a consequence of endothelial damage to the sinusoids, and the pattern of enhancement of the peliotic lacunae could depend on the site and extension of the sinusoidal wall rupture 59,60 . Thus, we hypothesize that if the damage is essentially located around an arterial vessel, the lesion might show a homogeneously high persisting enhancement or a progressive centrifugal enhancement with an arterial target sign.…”

“…59,60 Thus, we hypothesize that if the damage is essentially located around an arterial vessel, the lesion might show a homogeneously high persisting enhancement or a progressive centrifugal enhancement with an arterial target sign. Conversely, if the damage is predominantly located around a dilated central vein, the PH nodule might show an arterial peripheral rim enhancement with progressive centripetal or heterogeneous nonspecific patterns.…”

Pseudocirrhosis: A Case Series with Clinical and Radiographic Correlation and Review of the Literature

“…Other studies have suggested that a direct hepatotoxic effect of chemotherapy treatment may play a role, and some have implicated specific agents such as paclitaxel, trastuzumab, tamoxifen, regorafenib, and palbociclib [ 2 , 37 , 45 , 62 ]. Interruption or pause of chemotherapy may result in resolution of imaging features of pseudocirrhosis [ 63 ]. Kang et al describe a case of pseudocirrhosis in which cessation of chemotherapy resulted in improvement of portal hypertensive complications, lab abnormalities, and near resolution of cirrhotic liver appearance on imaging [ 43 ].…”

Simple systemic index associated with oxaliplatin‐induced liver damage can be a novel biomarker to predict prognosis after resection of colorectal liver metastasis

“…As previously reported by Calistri et al, BL referred to parenchymal venous congestion resulting from blockage of blood outflow, macroscopically characterized by an intraoperative subcapsular livid appearance and a similar “marble” bluish‐red discoloration on the cut surface. 9 Therefore, three or more surgeons determined the presence or absence of oxaliplatin‐associated BL by confirming the color of the liver during the operation. 10 , 11 The findings of BL in this study are shown in Figure S1 .…”