Sinusoidal obstructive syndrome diagnosed with superparamagnetic iron oxide-enhanced magnetic resonance imaging in patients with chemotherapy-treated colorectal liver metastases.
OBJECTIVE
To assess the predictive value of superparamagnetic iron oxide (SPIO) -enhanced T2-weighted gradient echo (GRE) imaging to determine the presence and severity of sinusoidal obstructive syndrome (SOS).


METHODS
Sixty hepatic resection patients with colorectal metastases treated with chemotherapy underwent unenhanced magnetic resonance imaging (MRI) followed by T2-weighted GRE sequences obtained after SPIO. The images were reviewed in consensus by two experienced observers who determined the presence and severity of linear and reticular hyperintensities, indicating SOS-type liver injury, using a 4-point ordinal scale. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) with 95% CIs for the detection of SOS were calculated.


RESULTS
Twenty-four of 60 patients had moderate to severe SOS on MRI. MRI achieved a sensitivity of 87% (95% CI, 66% to 97%), specificity of 89% (95% CI, 75% to 97%), PPV of 83% (95% CI, 63% to 95%), and NPV of 92% (95% CI, 77% to 98%). SOS was never found at surgery or histology in patients whose background liver parenchyma was normal on SPIO-enhanced MRI.


CONCLUSIONS
SOS is present in a significant proportion of patients with treated colorectal metastases and is effectively detected on SPIO-enhanced T2-weighted GRE images.
Ward
Janice
J
Clinical Radiology, Medical Physics Department St James University Hospital, Leeds, United Kingdom. Janice.ward@leedsth.nhs.uk
Guthrie
James A
JA
Sheridan
Maria B
MB
Boyes
Sheila
S
Smith
Jonathan T
JT
Wilson
Daniel
D
Wyatt
Judy I
JI
Treanor
Darren
D
Robinson
Philip J
PJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects*; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000473:pathology; D003287:Contrast Media; D005260:Female; D005290:Ferric Compounds; D006504:Hepatic Veno-Occlusive Disease / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000556:secondary; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged
D000970:Antineoplastic Agents; D003287:Contrast Media; D005290:Ferric Compounds; C000499:ferric oxide