Multiparametric MRI with MR elastography findings in patients with sinusoidal obstruction syndrome after oxaliplatin-based chemotherapy

Abstract

Objective To evaluate the magnetic resonance elastography (MRE)-derived liver stiffness measurement (LSM), T1 and T2 relaxation times, and hepatobiliary phase images in patients, who developed sinusoidal obstruction syndrome (SOS) after oxaliplatin-based chemotherapy. Methods Thirty-four patients (M/F:22/12) who underwent liver MRI-MRE and received oxaliplatin for colorectal, gastric, and pancreas cancer were included in the study. SOS was diagnosed by Gd-EOB-DTPA-enhanced MRI in 18 patients. MRE-LSM and T1–T2 maps were evaluated. Patients with SOS were grouped according to the amount of reticular hypointensity on the hepatobiliary phase images. Results The mean MRE-LSM in the patients with SOS was 3.14 ± 0.45 kPa, and the control group was 2.6 ± 0.5 kPa (p = 0.01). The mean-corrected T1 (cT1) relaxation time was 1181 ± 151 ms in the SOS group and 1032 ± 129 ms in the control group (p = 0.005). The mean T2 relaxation time was 50.29 ± 3.6 ms in the SOS group and 44 ± 3.9 ms in the control group (p = 0.01). Parenchymal stiffness values were 2.8 ± 0.22 kPa, 3 ± 0.33 kPa, and 3.65 ± 0.28 kPa in patients with mild, moderate, and advanced SOS findings, respectively (p = 0.002). Although cT1 and T2 relaxation times increased with increasing SOS severity, no statistical significance was found. Conclusions We observed increased MRE-LSM in patients with SOS after chemotherapy compared to control group. T1 and T2 relaxation times were also useful in diagnosing SOS but were found inadequate in determining SOS severity. MRE is effective in diagnosing SOS and determining SOS severity in patients who cannot receive contrast agents, and it may be useful in the follow-up evaluation of these patients.

Diagnosis and severity criteria for sinusoidal obstruction syndrome/veno-occlusive disease in adult patients: a refined classification from the European society for blood and marrow transplantation (EBMT)

“…They found that a significant increase at day +14 allowed early detection of SOS (AUROC = 0.84, p = 0.004) with a high sensibility (75%) and specificity (99%). LSM can also be evaluated through magnetic resonance imaging (MRI) and increased LSM using magnetic resonance elastography was also reported in patients that developed SOS/VOD after chemotherapy treatment with oxaliplatin, further confirming the role of LSM for SOS/VOD diagnosis [29].…”

Imaging in translational cancer research

“…In contrast, T1 mapping has been found to predict Gleason scores 96 . In liver cancer, multiparametric MRI (T1, T2 relaxation times) has been found to be useful in detecting sinusoidal obstruction syndrome after oxaliplatin-based chemotherapy 105 . T2 relaxation times have been shown to be more sensitive and accurate in identifying malignant liver lesions than ADC values 106 , whereas T1 mapping has enabled differentiation among tumorous liver regions according to extracellular matrix composition in a rabbit hepatic cancer model 107 , as well as accurate detection of liver metastases in a mouse model at 7 Tesla 108 .…”

Wavelet MRE: Imaging propagating broadband acoustic waves with wavelet‐based motion‐encoding gradients

“…As a noninvasive tool for measuring tissue mechanical properties, MRE has an expanding role in clinical applications, from assessing liver fibrosis [3][4][5] to applications in heart, 6,7 brain, [8][9][10][11][12][13][14][15][16] and other organs. 1,[17][18][19][20][21][22][23][24] The mechanical properties of biological tissue can be frequency-dependent, and there is currently an increasing interest in evaluating such frequency dependency with multifrequency MRE. [25][26][27][28][29][30][31][32] In most of the previous studies, MRE images were acquired at each frequency monochromatically.…”

“…Images are acquired representing different phases of the propagating wavefield. As a noninvasive tool for measuring tissue mechanical properties, MRE has an expanding role in clinical applications, from assessing liver fibrosis 3–5 to applications in heart, 6,7 brain, 8–16 and other organs 1,17–24 …”