Imaging of the chemotherapy-induced hepatic damage: Yellow liver, blue liver, and pseudocirrhosis

Abstract

The liver is the major drug-metabolizing and drug-detoxifying organ. Many drugs can cause liver damage through various mechanisms; however, the liver response to injury includes a relatively narrow spectrum of alterations that, regardless of the cause, are represented by phlogosis, oxidative stress and necrosis. The combination of these alterations mainly results in three radiological findings: vascular alterations, structural changes and metabolic function reduction. Chemotherapy has changed in recent decades in terms of the drugs, protocols and duration, allowing patients a longer life expectancy. As a consequence, we are currently observing an increase in chemotherapy-associated liver injury patterns once considered unusual. Recognizing this form of damage in an early stage is crucial for reconsidering the therapy regimen and thus avoiding severe complications. In this frontier article, we analyze the role of imaging in detecting some of these pathological patterns, such as pseudocirrhosis, “yellow liver” due to chemotherapy-associated steatosis-steatohepatitis, and “blue liver”, including sinusoidal obstruction syndrome, veno-occlusive disease and peliosis.

Keywords: Hepatic damage; Yellow liver; Chemotherapy-associated steatohepatitis; Blue liver; Sinusoidal obstruction syndrome; Veno-occlusive disease; Peliosis; Pseudocirrhosis

Core Tip: Chemotherapy-induced hepatic damage represents an increasingly frequent condition observed in oncology patients: recent pharmacological innovations and specific and longer therapies have led to longer life expectancy and, inevitably, to an increase in systemic side effects and organ damage, primarily in the liver because of its detoxifying function. Even for experienced radiologists, the assessment of radiological patterns associated with liver injury derived from chemotherapy can sometimes be challenging. Our aim is to summarize useful ways to recognize, understand and monitor the evolution of these forms of hepatic damage to support clinicians in decision making.