Annals of gastroenterological surgery · 2025
Combination of Ethoxybenzyl-Diethylenetriamine Pentaacetic Acid-Enhanced Magnetic Resonance Imaging and a Serum Biomarker Is Useful in the Diagnosis of Hepatic Sinusoidal Disorder After Chemotherapy Treatment.
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Shimagaki Tomonari, Sugimachi Keishi, Tomino Takahiro, Kurihara Takeshi, Onishi Emi, Shimomura Yutaro, Shinozaki Kenji, Morita Masaru
Аннотация
AIM: Sinusoidal obstruction syndrome (SOS), also known as "blue liver (BL)," is a common hepatic injury following oxaliplatin-based chemotherapy in patients with colorectal liver metastases (CRLM). Early non-invasive identification of SOS is essential for safe hepatic resection and improved outcomes; however, this remains clinically challenging.
METHODS: We retrospectively analyzed 155 patients who underwent preoperative ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI) and hepatic resection for CRLM between 2014 and 2022. Radiologists evaluated SOS on EOB-MRI using a five-point reticular signal grading scale. Aspartate aminotransferase to platelet ratio index (APRI) scores were calculated preoperatively. BL was confirmed intraoperatively based on characteristic liver discoloration. Correlations between EOB-MRI scores, APRI, and clinical outcomes were analyzed using receiver operating characteristic curves, survival analysis, and multivariate statistics.
RESULTS: Of 70 patients treated with preoperative oxaliplatin, 25 (35.7%) exhibited intraoperative BL. Overall survival was significantly worse in the blue liver group (p = 0.0338), although disease-free survival did not differ significantly. Patients in the BL group had significantly higher APRI and EOB-MRI scores (p = 0.0028 and p < 0.0001, respectively). The combined EOB-MRI assessment and APRI had the highest diagnostic ability for BL detection, yielding an area under the curve of 0.806, with 78.0% sensitivity and 67.7% specificity. Patients with high scores in both modalities exhibited significantly poorer overall survival.
CONCLUSION: A combination of EOB-MRI and APRI is a valuable non-invasive tool for preoperative detection of SOS in patients with CRLM. This approach improves diagnostic accuracy, facilitates surgical planning, and may predict long-term prognosis following hepatic resection.
METHODS: We retrospectively analyzed 155 patients who underwent preoperative ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI) and hepatic resection for CRLM between 2014 and 2022. Radiologists evaluated SOS on EOB-MRI using a five-point reticular signal grading scale. Aspartate aminotransferase to platelet ratio index (APRI) scores were calculated preoperatively. BL was confirmed intraoperatively based on characteristic liver discoloration. Correlations between EOB-MRI scores, APRI, and clinical outcomes were analyzed using receiver operating characteristic curves, survival analysis, and multivariate statistics.
RESULTS: Of 70 patients treated with preoperative oxaliplatin, 25 (35.7%) exhibited intraoperative BL. Overall survival was significantly worse in the blue liver group (p = 0.0338), although disease-free survival did not differ significantly. Patients in the BL group had significantly higher APRI and EOB-MRI scores (p = 0.0028 and p < 0.0001, respectively). The combined EOB-MRI assessment and APRI had the highest diagnostic ability for BL detection, yielding an area under the curve of 0.806, with 78.0% sensitivity and 67.7% specificity. Patients with high scores in both modalities exhibited significantly poorer overall survival.
CONCLUSION: A combination of EOB-MRI and APRI is a valuable non-invasive tool for preoperative detection of SOS in patients with CRLM. This approach improves diagnostic accuracy, facilitates surgical planning, and may predict long-term prognosis following hepatic resection.