title: Sinusoidal obstructive syndrome diagnosed with superparamagnetic iron oxide-enhanced magnetic resonance imaging in patients with chemotherapy-treated colorectal liver metastases.
abstract: 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.
authors.affiliation: Clinical Radiology, Medical Physics Department St James University Hospital, Leeds, United Kingdom. Janice.ward@leedsth.nhs.uk
authors.forename: Janice
authors.initials: J
authors.lastname: Ward
authors.forename: James A
authors.initials: JA
authors.lastname: Guthrie
authors.forename: Maria B
authors.initials: MB
authors.lastname: Sheridan
authors.forename: Sheila
authors.initials: S
authors.lastname: Boyes
authors.forename: Jonathan T
authors.initials: JT
authors.lastname: Smith
authors.forename: Daniel
authors.initials: D
authors.lastname: Wilson
authors.forename: Judy I
authors.initials: JI
authors.lastname: Wyatt
authors.forename: Darren
authors.initials: D
authors.lastname: Treanor
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Robinson
mesh_terms: 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
chemical_list: D000970:Antineoplastic Agents; D003287:Contrast Media; D005290:Ferric Compounds; C000499:ferric oxide