University Hospital center of Tours, General Radiology Department, Trousseau Hospital, Tours, France.
University Hospital center of Tours, Clinical Data Center, Bretonneau Hospital, Tours, France.
Eur J Radiol. 2017 Sep;94:180-190. doi: 10.1016/j.ejrad.2017.06.025. Epub 2017 Jul 3.
Sinusoidal obstruction syndrome (SOS) is a likely side effect of colorectal liver metastases (CRLM) chemotherapy. This study aimed to assess computed tomography scan (CT-scan) performance for SOS diagnosis for patients receiving neoadjuvant chemotherapy (NC) prior to CRLM surgery, comparing obtained results with pathological gold standard.
Preoperative CT-scans of 67 patients who had received a NC prior to liver resection for CRLM from 2011 to 2016 were retrospectively analysed. Positive diagnosis and severity of SOS were established after consensual review of the slides by three pathologists. Preoperative CT-scans were separately interpreted by two radiologists and evocative signs of SOS were sought, defined according to a literature review and operators experience. In order to identify SOS predictors, univariate analysis and multivariate logistic regression were used to study CT-scan signs and pathological results correlation.
Twenty-nine patient (43%) had an SOS, 22 (33%) were low-grade and 7 (10%) were high-grade. All patient had received a median of 6 cures (3-27) containing Oxaliplatin for 53 (79%) of them. In univariate analysis, hepatic heterogeneity (p<0.001), puddle-like or micronodular appearance (p<0.001), peripheral distribution of heterogeneity (p=0.085), clover-like sign (p=0.02), splenomegaly (p=0.0026), spleen volume increase ≥30% (p=0.04) or splenic length increase ≥15% (p=0.04), as well as the subjective impression of the observer (P<0.001) were significantly associated with SOS diagnosis. In multivariate analysis, clover-like sign (OR 1.87, 95% CI 1.18-2.95, p=0.0081), increase in spleen volume ≥30% (OR 1.29, 95% CI 1.01-1.64, p=0.04), and the peripheral distribution of heterogeneity (OR 1.53, 95% CI 1.21-1.94, p<0.001) were independent SOS predictors. The area under the ROC curve was 0.804. The inter-observer agreement for SOS diagnosis was moderate (Kappa=0.546).
CT-scan can detect suggestive signs of SOS in patients receiving chemotherapy for CRLM. By integrating clinical and biological information into CT-scan data, it may be fruitful to create a positive diagnostic and severity score for chemotherapy-induced SOS.
窦状隙阻塞综合征（SOS）是结直肠肝转移（CRLM）化疗的一种可能的副作用。本研究旨在评估 CT 扫描（CT 扫描）在接受 CRLM 手术前新辅助化疗（NC）的患者中的 SOS 诊断性能，将获得的结果与病理金标准进行比较。
回顾性分析 2011 年至 2016 年间接受 NC 后行肝切除术治疗 CRLM 的 67 例患者的术前 CT 扫描。通过三位病理学家对切片进行一致审查，确定 SOS 的阳性诊断和严重程度。由两名放射科医生分别对术前 CT 扫描进行解读，并根据文献复习和操作者经验寻找 SOS 的提示性征象。为了确定 SOS 的预测因素，使用单变量分析和多变量逻辑回归来研究 CT 扫描征象与病理结果的相关性。
29 例患者（43%）出现 SOS，22 例（33%）为低级别，7 例（10%）为高级别。所有患者均接受了中位数为 6 个疗程（3-27 个）的化疗，其中 53 例（79%）接受了奥沙利铂治疗。在单变量分析中，肝不均匀性（p<0.001）、水坑样或微结节样外观（p<0.001）、不均匀性外周分布（p=0.085）、三叶草样征（p=0.02）、脾肿大（p=0.0026）、脾体积增加≥30%（p=0.04）或脾长度增加≥15%（p=0.04）以及观察者的主观印象（P<0.001）与 SOS 诊断显著相关。在多变量分析中，三叶草样征（OR 1.87，95%CI 1.18-2.95，p=0.0081）、脾体积增加≥30%（OR 1.29，95%CI 1.01-1.64，p=0.04）和不均匀性的外周分布（OR 1.53，95%CI 1.21-1.94，p<0.001）是 SOS 的独立预测因素。ROC 曲线下面积为 0.804。SOS 诊断的观察者间一致性为中度（Kappa=0.546）。
CT 扫描可检测接受 CRLM 化疗患者的 SOS 提示性征象。通过将临床和生物学信息整合到 CT 扫描数据中，可能会产生有益的化疗诱导 SOS 的阳性诊断和严重程度评分。
