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

Na Yeon Han, Beom Jin 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 May

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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    Han, N. Y., Park, B. J., Sung, D. J., Kim, M. J., Cho, S. B., Lee, C. H., Jang, Y. J., Kim, S. Y., Kim, D. S., Um, S. H., Won, N. H., & Yang, K. S. (2014). Chemotherapy-induced focal hepatopathy in patients with gastrointestinal malignancy: Gadoxetic acid-enhanced and diffusion-weighted MR imaging with clinical-pathologic correlation. Radiology, 271(2), 416-425. https://doi.org/10.1148/radiol.13131810