Chemotherapy-induced focal hepatopathy in patients with gastrointestinal malignancy: gadoxetic acid--enhanced and diffusion-weighted MR imaging with clinical-pathologic correlation.
OBJECTIVE
To retrospectively evaluate findings of chemotherapy-induced 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.


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).


CONCLUSIONS
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.
From the Departments of Radiology (H.N.Y., B.J.P., D.J.S., M.J.K., S.B.C.), Surgery (D.S.K.), Internal Medicine (S.H.U.), and Pathology (N.H.W.), College of Medicine, and Department of Biostatistics (K.S.Y.), Korea University, Anam Hospital, 126-1 5-Ka, Anam-Dong, Sungbuk-ku, Seoul 136-705, Republic of Korea; Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea (C.H.L.); Department of Radiology, Kyungpook National University Hospital, Daegu, Republic of Korea (Y.J.J.); and Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 138-736, Republic of Korea (S.Y.K.).
Na Yeon
NY
Han
Beom Jin
BJ
Park
Deuk Jae
DJ
Sung
Min Ju
MJ
Kim
Sung Bum
SB
Cho
Chang Hee
CH
Lee
Yun-Jin
YJ
Jang
So Yeon
SY
Kim
Dong Sik
DS
Kim
Soon Ho
SH
Um
Nam Hee
NH
Won
Kyung Sook
KS
Yang
D000970:Antineoplastic Agents / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D016022:Case-Control Studies; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis* / Q000473:pathology; D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D005472:Fluorouracil / Q000009:adverse effects; D019786:Gadolinium DTPA; D005770:Gastrointestinal Neoplasms / Q000188:drug therapy* / Q000473:pathology*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D002955:Leucovorin / Q000009:adverse effects; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000556:secondary; D008297:Male; D008875:Middle Aged; D009944:Organoplatinum Compounds / Q000009:adverse effects; D012189:Retrospective Studies
D000970:Antineoplastic Agents; D003287:Contrast Media; D009944:Organoplatinum Compounds; C073590:gadolinium ethoxybenzyl DTPA; D019786:Gadolinium DTPA; D002955:Leucovorin; D005472:Fluorouracil