Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
Sci Rep. 2019 Feb 4;9(1):1231. doi: 10.1038/s41598-018-37775-1.
Hepatic sinusoidal obstruction syndrome (HSOS) can be caused by pyrrolizidine alkaloids(PAs)-containing herbals. In this study, the aim of our study was to investigate the imaging features of PAs-induced HSOS on gadoxetic acid-enhanced magnetic resonance imaging (MRI), susceptibility-weighted imaging(SWI) and T2* weighted imaging (T2* WI). We analyzed medical records and MR images of 28 PAs-induced HSOS patients enrolled from Feb, 2013, to Apr, 2017. Abnormal liver function was observed in most of the PAs-induced HSOS patients. Heterogeneity of liver parenchyma in hepatobillary phase (HBP) of gadoxetic acid-enhanced MR scan was observed in 100% of the PAs-induced HSOS patients. Distributional patterns of heterogeneous hypointensity were multifocal distribution (mild) in 4 patients (14.29%), multifocal distribution (severe) in 15 cases (53.57%), and diffuse distribution in 9 patients (32.14%). Hypointense in SWI and T2WI was observed in the patients of PAs-induced HSOS, and the distribution of hypointense in SWI and T2WI was similar to that of portal-venous phase of MR scan. The severity of heterogeneous hypointensity scored by volume fraction in hepatobillary phase of gadoxetic acid-enhanced MRI was positively correlated with PT and INR, the severity of hypointensity in HBP was a risk factor of death events. In conclusion: Heterogenous hypointensity of liver parenchyma was an imaging sign of hepatobillary phase in gadoxetic acid-enhanced MRI; thus, it will provide evidences for the diagnosis of PA-induced HSOS.
肝窦阻塞综合征（HSOS）可由含吡咯里西啶生物碱（PAs）的草药引起。本研究旨在探讨钆塞酸增强磁共振成像（MRI）、磁敏感加权成像（SWI）和 T2加权成像（T2WI）中 PAs 诱导的 HSOS 的影像学特征。我们分析了 2013 年 2 月至 2017 年 4 月期间收治的 28 例 PAs 诱导的 HSOS 患者的病历和 MRI 图像。大多数 PAs 诱导的 HSOS 患者肝功能异常。在所有 PAs 诱导的 HSOS 患者中，在肝胆期（HBP）的钆塞酸增强 MR 扫描中观察到肝实质不均匀。不均匀低信号的分布模式为 4 例（14.29%）为多灶性分布（轻度），15 例（53.57%）为多灶性分布（重度），9 例（32.14%）为弥漫性分布。PAs 诱导的 HSOS 患者在 SWI 和 T2WI 上均可见低信号，SWI 和 T2WI 上低信号的分布与 MR 扫描门静脉期相似。肝胆期钆塞酸增强 MRI 容积分数评分的不均匀低信号严重程度与 PT 和 INR 呈正相关，HBP 中的低信号严重程度是死亡事件的危险因素。总之，肝实质不均匀低信号是肝胆期钆塞酸增强 MRI 的影像学特征，可为 PA 诱导的 HSOS 的诊断提供依据。
