Abstract
PurposeImaging features of sinusoidal obstruction syndrome (SOS), an increasingly common drawback of chemotherapy, were evaluated via 18F-fluorodeoxyglucose (FDG) positron emission tomography computed tomography (PET/CT).Experimental DesignThis retrospective study was approved by our Institutional Review Board, with a waiver of informed consent. FDG PET/CT studies of 35 patients (male, 24; female, 11; median age, 53.2 years) obtained between January, 2005 and December, 2012 were analyzed before and after systemic chemotherapy. Diagnosis of SOS was based on histologic (n=13) or gadoxetic acid-enhanced MRI (n=22) findings. On PET/CT images, ROIs drawn on non-tumorous liver generated mean standardized uptake value (SUVliver). Total lesion glycolysis of liver (TLGliver) was calculated as: SUVliver × CT-derived hepatic volume. Paired t-test was applied to compare changes before and after SOS.ResultsMean (±standard error [SE]) values of hepatic volume (baseline, 1307.7±46.2 cm3; SOS, 1395.4±41.3 cm3; p=0.004), SUVliver (baseline, 2.08±0.06; SOS, 2.27±0.07; p=0.02), and TLGliver (baseline, 2697.5±114.5; SOS, 3170.2±134.2; p=0.001) significantly increased with development of SOS. In contrast, mean SUVaorta was unchanged (baseline, 1.53±0.04; SOS, 1.50±0.04; p=0.52).ConclusionsHepatic FDG uptake on PET/CT intensified after onset of SOS and thus may be an inappropriate reference in this setting, potentially skewing chemotherapeutic responses gauged by lesion-to-liver SUV ratio.
Highlights
Recent advances in chemotherapeutic regimens, surgical techniques, and imaging studies have markedly improved treatment outcomes in various types of cancer [1,2,3,4]
Hepatic FDG uptake on positron emission tomography computed tomography (PET/CT) intensified after onset of sinusoidal obstruction syndrome (SOS) and may be an inappropriate reference in this setting, potentially skewing chemotherapeutic responses gauged by lesion-to-liver SUV ratio
The basic demographic and clinical characteristics of patients with SOS are provided in Figure 1 and Table 1
Summary
Recent advances in chemotherapeutic regimens, surgical techniques, and imaging studies have markedly improved treatment outcomes in various types of cancer [1,2,3,4]. Regimens incorporating oxaliplatin and cisplatin have significantly improved treatment response rates, enabling surgical resection of initially unresectable liver metastases in carefully selected patients [5,6,7,8,9]. These newer agents are not without side effects and often induce hepatic sinusoidal obstruction syndrome (SOS) [10]. As their usage increases, a commensurate upsurge in SOS may well be anticipated. Patients with hepatic SOS are more prone to bleeding and are at greater risk of intra- and post-operative complications [13,14,15]
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