Sinusoidal obstruction syndrome: A systematic review of etiologies, clinical symptoms, and magnetic resonance imaging features

Abstract

BACKGROUNDSinusoidal obstruction syndrome (SOS) is a kind of rare liver disease which is characterized by damage to small hepatic vessels, affecting particularly the sinusoidal endothelium. Due to the special etiology and high mortality, early diagnosis of SOS is significant for clinical survival and prognosis.AIMTo generalize the common etiologies and clinical symptoms of SOS and summarize the characteristic magnetic resonance imaging (MRI) features so as to provide more valuable information for early diagnosis of SOS.METHODWe searched PubMed, Web of science, Wanfang Data, China Knowledge Resource Integrated, VIP, and Cochrane Library databases without a limiting period and the types of articles. The search process mainly revolved around the etiologies, common clinical symptoms, and MRI imaging features of SOS. Ultimately, 29 full articles were included in this review and 222 articles were excluded.RESULTSEleven case reports included 13 patients. The etiologies of these patients including chemotherapy (5/13), medicinal herbs containing pyrrolidine alkaloids (PAs, e.g. Tusanqi) (4/13), hematopoietic stem cell transplantation (HSCT) (2/13), drug toxicity (6-thioguanine) (1/13), and “poppers”, a recreational drug used during anal intercourse (1/13). Eighteen case series including 497 patients, and SOS in 465 (93.6%) patients was caused by PAs. Ascites, abdominal pain and swelling, jaundice were the most common clinical symptoms. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma-glutamyl transpeptidase (GGT), total bilirubin (TBil), direct bilirubin (DBil), and prothrombin time (PT) had varying degrees of elevation. Heterogeneous signals on T1 weighted imaging/T2 weighted imaging (T1WI/T2WI), heterogeneous enhancement of liver parenchyma, ascites, hepatomegaly, narrowing and blurring of intrahepatic inferior vena cava and three main hepatic veins, edema around the portal vein, and gallbladder wall edema were the most common MRI imaging features of SOS.CONCLUSIONIn the West, SOS was mostly secondary to HSCT. Some SOS developed in the process of chemotherapy for hepatic metastatic tumor. A few SOS were caused by toxicity of certain drugs. In the East, Tusanqi was a major cause of SOS. Ascites, abdominal pain and swelling, jaundice were the common clinical symptoms. Elevations of ALT, AST, GGT, ALP, TBil, and DBil could be used as predictors of liver function damage. Numerous characteristic MRI imaging features could provide more valuable information for early diagnosis of SOS.

Effects of Yinzhihuang Granules on Serum Liver Enzymes in Jaundice Patients: A Real-World Study Based on HIS Data

“…The decrease of TBil and IBil indicated that Yinzhihuang granules can improve the degree of jaundice. The increase of GGT and ALP was more common in cholestatic jaundice [ 17 ]. The decrease of their values proved that cholestasis has been alleviated in patients with jaundice.…”

Role of the Surgical Pathologist in Diagnosis of Drug-induced Liver Injury: Recognizing Specific Patterns of Drug Injury

“…Non-DILI causes of SOS/VOD are few and far between. [5][6][7][8][9] In contrast to the chronic injury caused by low doses of environmental toxins such as pyrrolizidine alkaloids, SOS/VOD often has an acute presentation when caused by chemotherapeutic agents. 10 PubMed searches for "sinusoidal obstruction syndrome" and "veno-occlusive disease" yield over 1500 articles.…”

“…39 In China, SOS/VOD is most commonly associated with Tusanqi (Gynura segetum), a traditional medicine used to relieve pain, improve blood circulation and prevent blood stasis. 9,40 Outbreaks due to contamination of grains by plants containing pyrrolizidine alkaloids have been reported in Afghanistan and India. [41][42][43] A case due to acute arsenic poisoning is reported.…”

“…An otherwise rare lesion in liver biopsies, SOS/VOD is increasingly seen in contemporary practice, associated most often with the use of cytotoxic chemotherapeutic drugs, and as a complication of bone marrow transplantation. Non-DILI causes of SOS/VOD are few and far between 5–9. In contrast to the chronic injury caused by low doses of environmental toxins such as pyrrolizidine alkaloids, SOS/VOD often has an acute presentation when caused by chemotherapeutic agents 10…”

“…SOS/VOD was reported in a newborn infant whose mother consumed herbal tea during pregnancy38 and in an infant who was given herbal tea containing gordolobo yerba , a folk remedy used by Mexican-Americans 39. In China, SOS/VOD is most commonly associated with Tusanqi ( Gynura segetum ), a traditional medicine used to relieve pain, improve blood circulation and prevent blood stasis 9,40. Outbreaks due to contamination of grains by plants containing pyrrolizidine alkaloids have been reported in Afghanistan and India 41–43.…”