Chemotherapy-induced focal hepatopathy in patients with gastrointestinal malignancy: Gadoxetic acid-enhanced and diffusion-weighted MR imaging with clinical-pathologic correlation

Na Yeon Han, Beomjin Park, Deuk Jae Sung, Min Ju Kim, Sung Bum Cho, Chang-Hee Lee, Yun Jin Jang, So Yeon Kim, Dong-Sik Kim, Soon-Ho Um, Nam Hee Won, Kyung Sook Yang

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Abstract

Purpose: To retrospectively evaluate findings of chemotherapyinduced focal hepatopathy (CIFH) on gadoxetic acid- enhanced magnetic resonance (MR) and diffusion-weighted (DW) images and to determine imaging features that are most helpful in differentiating CIFH from metastasis. Materials and Methods: This retrospective study was approved by the institutional review board, and informed consent was waived. MR images, including DW images and gadoxetic acid-enhanced images, from 12 patients (four men, eight women; age range, 25-64 years) with 15 CIFHs were reviewed independently and in consensus by two radiologists and were compared with those obtained in 20 control patients (12 men, eight women; age range, 32-84 years) with 30 hepatic metastasis who were matched for tumor size, primary organ, and chemotherapy regimen. Interobserver agreement was assessed with κ statistics, and univariate analysis was performed for comparisons. For quantitative analyses, apparent diffusion coefficients (ADCs) and lesion-to-liver contrast ratios (CRs) were measured. Histopathologic examinations were performed for CIFHs. Results: Histopathologic examination revealed that the development of CIFHs was attributable to accentuated manifestations of sinusoidal obstruction syndrome. Interobserver agreement was excellent (κ > 0.85). An ill-defined margin on hepatobiliary phase (HBP) images was the most discriminating independent variable in the differentiation of CIFH from metastasis (odds ratio, 16; P = .009). ADC and CR values in CIFH group were significantly higher than those in metastasis group (P < .001 and P = .041). Conclusion: CIFH should be considered a mimicker of metastasis in patients with gastrointestinal malignancy during chemotherapy. CIFH can be differentiated from metastasis on the basis of gadoxetic acid-enhanced MR and DW imaging findings; an ill-defined margin on HBP images was especially characteristic.

Original languageEnglish
Pages (from-to)416-425
Number of pages10
JournalRadiology
Volume271
Issue number2
DOIs
Publication statusPublished - 2014 Jan 1

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Diffusion Magnetic Resonance Imaging
Neoplasm Metastasis
Drug Therapy
Neoplasms
Magnetic Resonance Spectroscopy
Hepatic Veno-Occlusive Disease
Organ Size
Research Ethics Committees
Liver
Informed Consent
gadolinium ethoxybenzyl DTPA
Retrospective Studies
Odds Ratio

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

@article{068fcab410b541e2bd66f70466dca074,
title = "Chemotherapy-induced focal hepatopathy in patients with gastrointestinal malignancy: Gadoxetic acid-enhanced and diffusion-weighted MR imaging with clinical-pathologic correlation",
abstract = "Purpose: To retrospectively evaluate findings of chemotherapyinduced focal hepatopathy (CIFH) on gadoxetic acid- enhanced magnetic resonance (MR) and diffusion-weighted (DW) images and to determine imaging features that are most helpful in differentiating CIFH from metastasis. Materials and Methods: This retrospective study was approved by the institutional review board, and informed consent was waived. MR images, including DW images and gadoxetic acid-enhanced images, from 12 patients (four men, eight women; age range, 25-64 years) with 15 CIFHs were reviewed independently and in consensus by two radiologists and were compared with those obtained in 20 control patients (12 men, eight women; age range, 32-84 years) with 30 hepatic metastasis who were matched for tumor size, primary organ, and chemotherapy regimen. Interobserver agreement was assessed with κ statistics, and univariate analysis was performed for comparisons. For quantitative analyses, apparent diffusion coefficients (ADCs) and lesion-to-liver contrast ratios (CRs) were measured. Histopathologic examinations were performed for CIFHs. Results: Histopathologic examination revealed that the development of CIFHs was attributable to accentuated manifestations of sinusoidal obstruction syndrome. Interobserver agreement was excellent (κ > 0.85). An ill-defined margin on hepatobiliary phase (HBP) images was the most discriminating independent variable in the differentiation of CIFH from metastasis (odds ratio, 16; P = .009). ADC and CR values in CIFH group were significantly higher than those in metastasis group (P < .001 and P = .041). Conclusion: CIFH should be considered a mimicker of metastasis in patients with gastrointestinal malignancy during chemotherapy. CIFH can be differentiated from metastasis on the basis of gadoxetic acid-enhanced MR and DW imaging findings; an ill-defined margin on HBP images was especially characteristic.",
author = "Han, {Na Yeon} and Beomjin Park and Sung, {Deuk Jae} and Kim, {Min Ju} and Cho, {Sung Bum} and Chang-Hee Lee and Jang, {Yun Jin} and Kim, {So Yeon} and Dong-Sik Kim and Soon-Ho Um and Won, {Nam Hee} and Yang, {Kyung Sook}",
year = "2014",
month = "1",
day = "1",
doi = "10.1148/radiol.13131810",
language = "English",
volume = "271",
pages = "416--425",
journal = "Radiology",
issn = "0033-8419",
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TY - JOUR

T1 - Chemotherapy-induced focal hepatopathy in patients with gastrointestinal malignancy

T2 - Gadoxetic acid-enhanced and diffusion-weighted MR imaging with clinical-pathologic correlation

AU - Han, Na Yeon

AU - Park, Beomjin

AU - Sung, Deuk Jae

AU - Kim, Min Ju

AU - Cho, Sung Bum

AU - Lee, Chang-Hee

AU - Jang, Yun Jin

AU - Kim, So Yeon

AU - Kim, Dong-Sik

AU - Um, Soon-Ho

AU - Won, Nam Hee

AU - Yang, Kyung Sook

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Purpose: To retrospectively evaluate findings of chemotherapyinduced focal hepatopathy (CIFH) on gadoxetic acid- enhanced magnetic resonance (MR) and diffusion-weighted (DW) images and to determine imaging features that are most helpful in differentiating CIFH from metastasis. Materials and Methods: This retrospective study was approved by the institutional review board, and informed consent was waived. MR images, including DW images and gadoxetic acid-enhanced images, from 12 patients (four men, eight women; age range, 25-64 years) with 15 CIFHs were reviewed independently and in consensus by two radiologists and were compared with those obtained in 20 control patients (12 men, eight women; age range, 32-84 years) with 30 hepatic metastasis who were matched for tumor size, primary organ, and chemotherapy regimen. Interobserver agreement was assessed with κ statistics, and univariate analysis was performed for comparisons. For quantitative analyses, apparent diffusion coefficients (ADCs) and lesion-to-liver contrast ratios (CRs) were measured. Histopathologic examinations were performed for CIFHs. Results: Histopathologic examination revealed that the development of CIFHs was attributable to accentuated manifestations of sinusoidal obstruction syndrome. Interobserver agreement was excellent (κ > 0.85). An ill-defined margin on hepatobiliary phase (HBP) images was the most discriminating independent variable in the differentiation of CIFH from metastasis (odds ratio, 16; P = .009). ADC and CR values in CIFH group were significantly higher than those in metastasis group (P < .001 and P = .041). Conclusion: CIFH should be considered a mimicker of metastasis in patients with gastrointestinal malignancy during chemotherapy. CIFH can be differentiated from metastasis on the basis of gadoxetic acid-enhanced MR and DW imaging findings; an ill-defined margin on HBP images was especially characteristic.

AB - Purpose: To retrospectively evaluate findings of chemotherapyinduced focal hepatopathy (CIFH) on gadoxetic acid- enhanced magnetic resonance (MR) and diffusion-weighted (DW) images and to determine imaging features that are most helpful in differentiating CIFH from metastasis. Materials and Methods: This retrospective study was approved by the institutional review board, and informed consent was waived. MR images, including DW images and gadoxetic acid-enhanced images, from 12 patients (four men, eight women; age range, 25-64 years) with 15 CIFHs were reviewed independently and in consensus by two radiologists and were compared with those obtained in 20 control patients (12 men, eight women; age range, 32-84 years) with 30 hepatic metastasis who were matched for tumor size, primary organ, and chemotherapy regimen. Interobserver agreement was assessed with κ statistics, and univariate analysis was performed for comparisons. For quantitative analyses, apparent diffusion coefficients (ADCs) and lesion-to-liver contrast ratios (CRs) were measured. Histopathologic examinations were performed for CIFHs. Results: Histopathologic examination revealed that the development of CIFHs was attributable to accentuated manifestations of sinusoidal obstruction syndrome. Interobserver agreement was excellent (κ > 0.85). An ill-defined margin on hepatobiliary phase (HBP) images was the most discriminating independent variable in the differentiation of CIFH from metastasis (odds ratio, 16; P = .009). ADC and CR values in CIFH group were significantly higher than those in metastasis group (P < .001 and P = .041). Conclusion: CIFH should be considered a mimicker of metastasis in patients with gastrointestinal malignancy during chemotherapy. CIFH can be differentiated from metastasis on the basis of gadoxetic acid-enhanced MR and DW imaging findings; an ill-defined margin on HBP images was especially characteristic.

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U2 - 10.1148/radiol.13131810

DO - 10.1148/radiol.13131810

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