The effects of cancer chemotherapy on liver imaging

Abstract

Chemotherapy changes the appearance of liver tumours and may also affect the liver parenchyma. Tumours respond with changes in size, outline, and internal architecture. The accuracy of liver CT for detecting metastases is reduced after chemotherapy. Histologic studies have shown that some metastases which become invisible on follow-up CT are completely sterile at later resection, but most 'disappearing' lesions still contain active tumour. Hepatic steatosis becomes much more common after chemotherapy. Diffuse fatty change may conceal metastases on US and CT, whilst focal steatosis may mimic tumour. Chemical-shift MRI will distinguish fat from tumour. Fatty change is usually reversible, unless the liver receives a 'second hit' of damage from other causes. Sinusoidal obstructive syndrome (SOS), nodular regenerative hyperplasia, veno-occlusive disease and peliosis are manifestations of microvascular injury which can result from chemotherapy. SOS, the most common of these, is undetectable on US and CT, but can be shown on SPIO-enhanced MRI. Although SOS causes no symptoms in most patients, it may cause increased bleeding from the friable liver at surgery, and greater risk of peri-operative adverse events. Rarer complications of chemotherapy include pseudo-cirrhosis and sclerosing cholangitis.

Improvement of Early 18F-FDG PET Interpretation in Diffuse Large B-Cell Lymphoma: Importance of the Reference Background

“…Background intensities were stable between PET0 and PET2, indicating a relatively low influence of treatment regimens on MBP and liver uptake of 18 F-FDG (Table 1). This finding is interesting, considering the observation that chemotherapy-induced steatosis and sinusoid obstruction affect liver imaging by CT, ultrasound, and MRI but apparently not, at least not to any significant extent, by 18 F-FDG PET (14). In addition, there was little variability in the SUVs of both the liver and MBP between patients.…”

Invisible fat on CT: making it visible by MRI

“…Although the diagnosis of these abnormalities might be easier in typical locations such as near the gallbladder fossa, medial segment of the left hepatic lobe, or close to the falciform ligament (12,13), in atypical locations and in case of unconventional morphology, the diagnosis can be difficult. Focal steatotic changes are more and more commonly seen in oncologic patients due to complex and prolonged chemotherapy (14). Therefore, in case a new liver lesion detected in the follow-up of these patients,…”

Female Pelvis: Genital Organs

“…It is usually found in patients with treated metastatic breast cancer or lymphoma, most often after prolonged chemotherapy treatment. Histology typically shows dense fi brosis associated with residual tumor, and the absence of bridging fi brosis distinguishes this condition from true cirrhosis (Robinson 2009 ). The imaging features of pseudocirrhosis are similar to those of true cirrhosis (Fig.…”