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Sinusoidal Obstructive Syndrome Diagnosed With Superparamagnetic Iron Oxide–Enhanced Magnetic Resonance Imaging in Patients With Chemotherapy-Treated Colorectal Liver Metastases

Janice Ward, James A. Guthrie, Maria B. Sheridan, Sheila Boyes, Jonathan T. Smith, Daniel Wilson, Judy I. Wyatt, Darren Treanor, Philip J. Robinson

From the Clinical Radiology, Medical Physics Department, and Department of Histopathology, St James University Hospital, Leeds, United Kingdom

Corresponding author: Janice Ward, Clinical Radiology, MSc, St James's University Hospital, Beckett St, Leeds LS9 7TF, United Kingdom; e-mail: Janice.ward{at}leedsth.nhs.uk

Purpose 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).

Patients and 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.

Conclusion SOS is present in a significant proportion of patients with treated colorectal metastases and is effectively detected on SPIO-enhanced T2-weighted GRE images.

Presented in part at the 93rd Scientific Assembly and Annual Meeting of the Radiological Society of North America, November 25-30, 2007, Chicago, IL.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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