Correlation between Gd-EOB-DTPA-enhanced MR imaging findings and OATP1B3 expression in chemotherapy-associated sinusoidal obstruction syndrome

Abstract

We report a female case of sinusoidal obstruction syndrome (SOS) diagnosed pathologically after chemotherapy (Pmab+m-FOLFOX6) for ascending colon cancer with multiple liver metastases, focusing on the findings of gadoxetic acid-enhanced MRI (EOB-MRI) and the organic anion transporting polypeptide 1B3 (OATP1B3) expression of in the liver. The patient was a 75-year-old female. She had received chemotherapy (Pmab+m-FOLFOX6) as six cycles for preoperative chemotherapy. After the preoperative chemotherapy, tumor sizes of hepatic metastases were reduced and hepatobiliary phase of EOB-MRI clearly depicted diffuse reticular hypointensity in the background liver. On the other hand, dynamic CT and/or other sequences of EOB-MRI did not show definite abnormality in the background liver. After the operation, this patient was pathologically confirmed as SOS demonstrating centrilobular congestion, sinusoidal dilatation, and perisinusoidal fibrosis. In normal liver parenchyma, OATP1B3 (uptake transporter of the EOB-MRI) expression is observed predominantly in centrilobular hepatocytes (zone 3). On the other hand, OATP1B3 expression was remarkably reduced because of the damages in the centrilobular (zone 3) hepatocytes in this SOS case. This indicated that EOB-MRI might be extremely sensitive in diagnosing SOS in its early stage.

Imaging of Colorectal Liver Metastases: New Developments and Pending Issues

“…The early detection of chemotherapy-induced sinusoidal obstruction syndrome (SOS) is an interesting topic. Previously known as veno-occlusive disease, SOS is a distinctive and potentially fatal condition of hepatic injury which occurs predominantly after drug or toxin exposure; SOS can be considered to be an adverse side effect in patients with CRLM treated with oxaliplatin [32,33]. Currently, Gd-EOB-DTPA MRI is the best imaging technique for assessing this negative side effect [32].…”

“…Previously known as veno-occlusive disease, SOS is a distinctive and potentially fatal condition of hepatic injury which occurs predominantly after drug or toxin exposure; SOS can be considered to be an adverse side effect in patients with CRLM treated with oxaliplatin [32,33]. Currently, Gd-EOB-DTPA MRI is the best imaging technique for assessing this negative side effect [32]. In fact, the depiction of diffuse reticular hypointensity in the background liver, visible during the hepatobiliary phase, represents the key finding of the disease.…”

“…In fact, the depiction of diffuse reticular hypointensity in the background liver, visible during the hepatobiliary phase, represents the key finding of the disease. It can be explained by the reduction in the organic anion transporting polypeptide 1B3 (OATP1B3) in the centrilobular hepatocyte, with effects resulting from the damage of the centrilobular hepatocytes [32]. This finding has been increasingly observed in chemotherapy-associated liver injuries.…”

“…This finding has been increasingly observed in chemotherapy-associated liver injuries. Therefore, Gd-EOB-DTPA may be a very useful tool in detecting and depicting SOS at a relatively early stage before the vascular manifestations detected by imaging and, therefore, before its clinical manifestation [32]. This finding has serious clinical implications.…”

Welcome to the JSAR radiologic–pathologic correlation section

“…Morton A. Meyers, the previous Editor-in-Chief of Abdominal Imaging, and Dr. C. Daniel Johnson, the current Editor-in-Chief of Abdominal Imaging/Radiology, understood the merit of publication of this JSAR's Radiologic-Pathologic Correlation, although most medical journals had given up to publish case reports because of their relatively low citation. Five papers of the JSAR Radiologic-Pathologic Correlation Section first appeared in a group in Abdominal Imaging in 2015 [7][8][9][10][11] and three appeared independently [12][13][14]. This is the second appearance of 6 papers in a group.…”