New Ultrasound Techniques Challenge the Diagnosis of Sinusoidal Obstruction Syndrome

Abstract

Sinusoidal obstruction syndrome, also known as veno-occlusive disease (SOS/VOD), is a potentially life-threatening complication that can develop after hematopoietic cell transplantation. Clinically, SOS/VOD is characterized by hepatomegaly, right upper quadrant pain, jaundice and ascites, most often occurring within the first 3 wk after hematopoietic cell transplantation. Early therapeutic intervention is pivotal for survival in SOS/VOD. Thus, a rapid and reliable diagnosis has to be made. Diagnosis of SOS/VOD is based on clinical criteria, such as the Seattle, Baltimore or recently issued European Society for Blood and Marrow Transplantation criteria, to which hemodynamic and/or ultrasound evidence of SOS were added for the first time. However, to rule out major differential diagnoses and to verify the diagnosis, a reliable imaging method is needed. Ultrasound techniques have been proposed in SOS/VOD. Nevertheless, the sensitivity and specificity of transabdominal ultrasound and Doppler techniques need to be improved. Innovative ultrasound methods such as a combination of Doppler ultrasound with shear wave elastography and contrast-enhanced ultrasound techniques should be evaluated for diagnosis and follow-up of SOS/VOD. The goals of this review are to discuss currently available ultrasound techniques and to identify areas for future studies in SOS/VOD.

Systematic review of defibrotide studies in the treatment of veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS)

“…Finally, early use of magnetic resonance imaging for evaluating iron overload and/or ultrasound imaging to confirm such clinical criteria as ascites or hepatomegaly for VOD/SOS diagnosis and intervention may be of benefit to high-risk patients [5]. Elastographic methods also are under investigation to detect early markers of VOD/SOS, which may lead to earlier diagnosis and treatment [50]. In this pooled analysis of studies of defibrotide given approximately at the approved dose of 25 mg/kg/day for the treatment of VOD/SOS, estimated Day + 100 survival was 56% in the 2073 patients with or without MOD.…”

EFSUMB Gastrointestinal Ultrasound (GIUS) Task Force Group: Celiac sprue and other rare gastrointestinal diseases ultrasound features

“…GVHD frequently involves both the upper and lower gastrointestinal tract [135][136][137][138]. Acute GVHD usually develops 3-5 weeks after transplantation, while chronic GVHD can develop following acute GVHD or it can arise several months after allogenic stem cell transplantation [139,140]. Gastrointestinal involvement usually presents with high volume secretory diarrhea and abdominal pain, but may also manifest as nausea, vomiting and anorexia.…”

Imaging in Hepatic Veno-Occlusive Disease/Sinusoidal Obstruction Syndrome

“…Invasive measures to diagnose VOD/SOS are usually not warranted [50][51][52]. In particular, the decision to perform a liver biopsy should be considered carefully, as the procedure carries a small risk of serious and potentially life-threatening complications.…”