title: A multicenter assessment of liver toxicity by MRI and biopsy in IBD patients on 6-thioguanine.
abstract: OBJECTIVE
  Although 6-thioguanine (6-TG) has been suggested as an effective treatment option for patients with inflammatory bowel disease (IBD), the recent description of its hepatotoxicity has led to the recommendation not to consider this drug. We initiated a multicenter safety study in IBD-patients treated with 6-TG to investigate hepatic changes by liver biopsy and magnetic resonance imaging (MRI).
  
  
  METHODS
  Forty-five patients from three European centers treated with 6-TG (40-80 mg/d) at least for 8 weeks were enrolled. In all patients liver biopsy and MRI were performed. Slides and MR images were independently read by two pathologists and radiologists, respectively, and interpreted according to predefined criteria by consent.
  
  
  RESULTS
  In 8 patients nodular regenerative hyperplasia (NRH) was diagnosed by liver biopsy, in 8 additional patients NRH could not be excluded due to equivocal pathological findings. MRI demonstrated a sensitivity of 77% and a specificity of 72% in the detection of pathohistological findings consistent with and/or possibly related to NRH.
  
  
  CONCLUSIONS
  Our study suggests that 6-TG therapy in IBD patients is associated with NRH of the liver. Based on a special MRI protocol, non-invasive diagnosis of NRH with promising sensitivity and specificity was demonstrated.
authors.affiliation: Department of Internal Medicine II, University Hospital Munich-Grosshadern, Munich, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Seiderer
authors.forename: Christoph J
authors.initials: CJ
authors.lastname: Zech
authors.forename: Walter
authors.initials: W
authors.lastname: Reinisch
authors.forename: Milan
authors.initials: M
authors.lastname: Lukas
authors.forename: Joachim
authors.initials: J
authors.lastname: Diebold
authors.forename: Friedrich
authors.initials: F
authors.lastname: Wrba
authors.forename: Alexander
authors.initials: A
authors.lastname: Teml
authors.forename: Petra
authors.initials: P
authors.lastname: Chalupna
authors.forename: Jan
authors.initials: J
authors.lastname: Stritesky
authors.forename: Stefan O
authors.initials: SO
authors.lastname: Schoenberg
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schima
authors.forename: Burkhard
authors.initials: B
authors.lastname: Göke
authors.forename: Thomas
authors.initials: T
authors.lastname: Ochsenkühn
mesh_terms: D000328:Adult; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects* / Q000627:therapeutic use; D001706:Biopsy; D056487:Chemical and Drug Induced Liver Injury, Chronic / Q000209:etiology / Q000473:pathology*; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006965:Hyperplasia / Q000139:chemically induced / Q000473:pathology; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy*; D008099:Liver / Q000187:drug effects / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012449:Safety; D013866:Thioguanine / Q000009:adverse effects* / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000964:Antimetabolites, Antineoplastic; D013866:Thioguanine