Basic Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 21, 2020; 26(7): 706-716
Published online Feb 21, 2020. doi: 10.3748/wjg.v26.i7.706
Liver stiffness and perfusion changes for hepatic sinusoidal obstruction syndrome in rabbit model
Jaeseung Shin, Haesung Yoon, Yoon Jin Cha, Kyunghwa Han, Mi-Jung Lee, Myung-Joon Kim, Hyun Joo Shin
Jaeseung Shin, Haesung Yoon, Mi-Jung Lee, Myung-Joon Kim, Hyun Joo Shin, Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 03722, South Korea
Yoon Jin Cha, Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, South Korea
Kyunghwa Han, Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Seoul 03722, South Korea
Author contributions: Shin HJ designed the research; Shin HJ, Shin J, Yoon H and Cha YJ performed the research; Shin HJ and Han K analyzed the data; Shin HJ and Shin J wrote the paper; Shin HJ, Lee M-J, Kim M-J, Yoon H, and Shin J revised and edited manuscript.
Supported by a Faculty Research Grant of Yonsei University College of Medicine for 2017, No. 6-2017-0090.
Institutional animal care and use committee statement: This study was approved by the Institution’s Animal Care and Use Committee of Yonsei University Health System (IACUC approval no. 2017-0174).
Conflict-of-interest statement: Dr. Shin reports grants from Yonsei University College of Medicine, during the conduct of the study.
Data sharing statement: No additional data are available.
ARRIVE guidelines statement: The authors have read the ARRIVE guidelines, and the manuscript was prepared and revised according to the ARRIVE guidelines.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Hyun Joo Shin, MD, PhD, Clinical Assistant Professor, Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea. lamer-22@yuhs.ac
Received: October 29, 2019
Peer-review started: October 29, 2019
First decision: December 23, 2019
Revised: January 8, 2020
Accepted: January 19, 2020
Article in press: January 19, 2020
Published online: February 21, 2020
Processing time: 114 Days and 15.5 Hours
Abstract
BACKGROUND

Hepatic sinusoidal obstruction syndrome (SOS) is caused by damage to hepatic sinusoidal endothelial cells that results in fibrous obliteration of intrahepatic venules and necrosis of hepatocytes. Currently the diagnosis is primarily based on nonspecific clinical features and invasive liver biopsy. Therefore, noninvasive imaging methods are required for the early diagnosis and severity assessment of hepatic SOS.

AIM

To determine the effectiveness of supersonic shear wave imaging (SSI) and dual energy computed tomography (DECT) for diagnosing hepatic SOS using a rabbit model.

METHODS

Among nine New Zealand white rabbits (3-4 kg, male), three in control group ingested normal saline for 20 d and six in the SOS group ingested 6-thioguanine (5 mg/kg/d) for 20 d. Liver stiffness was measured using SSI on days 0, 3, 10, and 20. On the same days, liver perfusion was evaluated from virtual monochromatic images of 55 keV and iodine map using DECT. Morphologic changes in the liver were assessed using CT. Final pathology scores were compared between the two groups. Liver stiffness and perfusion parameters were compared according to the groups, days, and pathology scores.

RESULTS

Final pathology scores were significantly higher in the SOS than the control group (median 22 vs 2, P = 0.024). No gross morphologic changes were seen in livers. Liver stiffness, Hounsfield Unit values, and iodine concentrations were higher in the SOS compared to the control group on days 10 and 20 (all, P ≤ 0.007). Compared to day 0, liver stiffness and perfusion parameters were higher on day 20 in the SOS group (all, P ≤ 0.001). Correlation coefficients for liver stiffness (r = 0.635), Hounsfield Unit values (r = 0.587), and iodine concentration (r = 0.611) with final pathology scores were positive without significance (all, P > 0.05).

CONCLUSION

Liver stiffness and perfusion parameters were significantly increased in the livers of a rabbit SOS model. SSI and DECT might aid in early diagnosis of hepatic SOS.

Keywords: Hepatic sinusoidal obstruction syndrome; Elasticity imaging techniques; Iodine; Computed tomography; Liver; Animals

Core tip: Noninvasive imaging methods are required for the early diagnosis and severity assessment of hepatic sinusoidal obstruction syndrome (SOS). This study showed that liver stiffness on supersonic shear wave imaging was significantly elevated as hepatic SOS progressed in rabbit model. In addition, as hepatic SOS progressed, perfusion parameters measured on dual energy computed tomography were significantly elevated. We suggested that quantitative imaging with supersonic shear wave imaging and dual energy computed tomography could aid in the early diagnosis of hepatic SOS.