Sinusoidal obstruction syndrome: A systematic review of etiologies, clinical symptoms, and magnetic resonance imaging features

Table 1 Quality assessment of 11 case reports

Case No.	Authors	Demographic data	Clinical symptom data	laboratory examination data	Diagnostic workup	Imaging findings
1	Hu et al[17]	**	**	**	*	**
2	Kang et al[18]	**	**	**	**	**
3	Yan[20]	**	**	**	*	**
4	Yoneda et al[21]	**	*	*	**	*
5	Kawa et al[31]	**	*	**	**	**
6	Mortelé et al[8]	**	**	*	**	**
7	van den Bosch et al[13]	**	**	**	**	**
8	Marasco et al[9]	**	*	*	*	**
9	Liu et al[32]	**	*	**	**	*
10	Choi et al[28]	**	*	**	**	**
11	Arakawa et al[29]	**	*	**	**	**

*: Quality assessment score.

Table 2 Quality assessment of 18 case series

Case No.	Authors	Patients enrollment	Demographic data	Clinical symptom data	Laboratory examination data	Diagnostic workup	Imaging findings
1	Chen et al[33]	*	**	*	*	**	**
2	Xu[34]	*	**	*	*	**	**
3	Ye et al[35]	*	**	*	**	**	**
4	Zheng et al[36]	*	**	*	*	*	**
5	Ren et al[37]	*	**	**	**	**	**
6	Geng et al[38]	*	**	*	*	*	**
7	Chen et al[39]	*	**	*	*	**	**
8	Zhang et al[40]	*	**	*	*	**	**
9	Li et al[41]	*	**	*	**	**	**
10	Hu et al[42]	*	**	*	*	*	**
11	Li et al[43]	*	**	*	*	*	**
12	Li et al[44]	*	**	*	**	*	**
13	Yu et al[24]	*	**	*	*	*	**
14	Rong[45]	*	**	**	*	*	**
15	Pei et al[46]	*	**	*	*	**	**
16	Zhou et al[47]	*	**	*	*	**	**
17	Guo[48]	*	**	*	*	*	**
18	Yang[49]	*	**	**	**	*	**

*: Quality assessment score.

Table 3 Characteristic information of patients in 11 case reports

No.	Authors	Country	Publication year	Patient No.	Sex (male/fe-male)	Age (average)	Primary disease	Etiology	Time of duration	Diagnostic method
1	Hu et al[17]	China	2014	2	(2/0)	71/63	/	Tusanqi	UK	Clinical manifesta-tions + laboratory examination + imaging
2	Kang et al[18]	China	2015	1	Female	62	/	Tusanqi	UK	Biopsy
3	Yan[20]	China	2015	1	Male	65	Liver cirrhosis	Tusanqi (300g)	UK	Clinical manifesta-tions + laboratory examination + imaging
4	Yoneda et al[21]	Japan	2015	1	Female	75	Hepatic metastasis of colonic carcinoma	Preoperative chemotherapy (Pmab + m-FOLFOX6)	6 cycles (preoperative) + 4.5 month (postopera-tive)	Biopsy
5	Kawa et al[31]	Japan	2016	1	Female	40	Rectal cancer underwent high anterior resection and partial liver resection due to liver metastasis	Oxaliplatin-based chemo-therapy (mFOLFOX6)	6 mo	Biopsy
6	Mortelé et al[8]	USA	2001	1	Male	32	/	“Poppers”, a recreational drug used during anal intercourse	UK	Biopsy
7	van den Bosch et al[13]	Netherlands	1999	2	(1/1)	17/34	Lymph-ocytic leukemia/acute myeloid leukemia	Bone marrow transplanta-tion	UK	Percuta-neous puncture + histological examination/autopsy
8	Marasco et al[9]	UK	2016	1	Male	50	Ulcerative colitis	6-thioguanine	UK	Clinical manifesta-tions + imaging
9	Liu et al[32]	China	2017	1	Male	52	Gastric adenocarcinoma	S-1 and oxaliplatine (SOX) regimen	Five cycles	Biopsy
10	Choi et al[28]	Korea	2016	1	Female	22	Laparo-scopic right hemicolectomy for ascending colon cancer	Oxaliplatin-based adjuvant chemo-therapy	Four cycles	Biopsy
11	Arakawa et al[29]	Japan	2013	1	Female	40	Low anterior resection for advanced rectal cancer	Oxaliplatin-based chemo-therapy	Eight cycles	Biopsy

UK: Unknown.

Table 4 Characteristic information of patients in 18 case series

No.	Authors	Country	Publication year	Patient enroll-ment	Patient No.	Year range	Sex (male/fe-male)	Age (range, average)	Primary disease	Etiology	Time of duration	Dia-gnostic method
1	Chen et al[33]	China	2016	Retro-spective	8	2006-2013	5/3	21-67, 42	/	Tusanqi	3-18 mo	Biopsy (5) Clinical manifesta-tions + imaging (3)
2	Xu[34]	China	2015	Retro-spective	11	2004-2012	9/2	37-65, 49	/	Tusanqi (350-800 g)	15-50 d	Biopsy (2) Clinical manifesta-tions + imaging (9)
3	Ye et al[35]	China	2015	Retro-spective	20	2010-2012	1/19	36-76, 51	Trauma or stroke	Tusanqi	10 d-6 mo	Biopsy (12) Clinical manifesta-tions + laboratory examina-tion + imaging (8)
4	Zheng et al[36]	China	2015	Retro-spective	4	2012-2014	4/0	45-66	Alcoholic liver cirrhosis, trauma, body pain	Tusanqi (600-1500 g)	1-4 mo	Clinical manifesta-tions + imaging
5	Ren et al[37]	China	2017	Retro-spective	239	2010-2017	151/88	15-86 (59.6 ± 10.9)	Trauma, hypertension, extravasated blood, URI	Tusanqi	UK	Biopsy (48), Clinical manifesta-tions + imaging
6	Geng et al[38]	China	2009	Retro-spective	4	2007-2008	1/3	42-72, 57	/	Tusanqi	12-60 d	Clinical manifesta-tions
7	Chen et al[39]	China	2012	Retro-spective	45	1998-2011	23/22	33-73, 57	Trauma	Tusanqi	2-16 wk	Biopsy (21) Clinical manifesta-tions + laboratory examina-tion + imaging (8)
8	Zhang et al[40]	China	2012	Retro-spective	15	2005-2011	12/3	42-65	/	Tusanqi	1-6 mo	Biopsy (6) DSA (1) Clinical manifesta-tions + laboratory examina-tion + MRI
9	Li et al[41]	China	2011	Retro-spective	4	2009-2011	2/2	27-63, 35	/	Tusanqi (3), chemo-therapy (1)	Tusanqi (1-3 mo)	Biopsy (2) Clinical manifesta-tions + imaging
10	Hu et al[42]	China	2011	Retro-spective	5	2006-2011	4/1	40-60	Trauma history (3), health fitness (1)	Tusanqi	≥1 mo	Biopsy (2) Clinical manifesta-tions + imaging
11	Li et al[43]	China	2015	Retro-spective	4	2009-2014	3/1	35-61	Myocar-dial infarction (1)	Tusanqi	/	UK
12	Li et al[44]	China	2014	Retro-spective	8	2011-2014	5/3	21-71, 44.9	/	Tusanqi (2) Chemo-therapy or immune suppres-sive therapy (9)	/	Biopsy
13	Yu et al[24]	China	2013	Retro-spective	6	2002-2012	1/5	10-62 (36.5 ± 20.2)	Trauma (5) Irregular menstrua-tion (1)	Tusanqi (200-700 g)	8-30 d	Biopsy
14	Rong[45]	China	2015	Retro-spective	51	2009-2015	36/15	20-79	Drinking (14) Hyperten-sion (1) Diabetes (1) TB (1) RA (1)	Tusanqi (27) HSCT (4),	3 d-4 yr	Biopsy (6) Clinical manifesta-tions + imaging
15	Pei et al[46]	China	2010	Retro-spective	6	2006-2008	2/4	17-46	/	Tusanqi (5)	30 d	Biopsy (3) Clinical manifesta-tions + imaging
16	Zhou et al[47]	Hong Kong, China	2014	Retro-spective	16	2009-2011	12/4	22-72, 55.6	/	Intake of Gynura segetum	UK	Liver transplanta-tion (1) Clinical manifesta-tions
17	Guo[48]	China	2015	Retro-spective	12	2013-2014	9/3	45-62, 53	/	Tusanqi	UK	Clinical manifesta-tions + imaging
18	Yang[49]	China	2018	Retro-spective	39	2010-2016	9/30	36-74, 59.18 ± 9.36	/	Pyrrolizi-dine alkaloid (PA)–containing herbals	UK	Clinical manifesta-tions + imaging

UK: Unknown.

Table 5 Clinical characteristics of 13 patients in 11 case reports, n (%)

Variable	No. of patients with available data	Value
Sex (male/female)	13	7/6
Age, yr	13	47.9
Underlying disease
None	13	4 (30.8)
Postoperative liver metastasis of advanced colorectal cancer	13	3 (23.1)
Leukemia	13	2 (15.4)
Liver cirrhosis	13	1 (7.7)
Hepatic metastasis of colonic carcinoma	13	1 (7.7)
Gastric adenocarcinoma	13	1 (7.7)
Clinical symptom
Ascites	13	7 (53.8)
Abdominal swelling	13	4 (30.8)
Pleural effusion	13	4 (30.8)
Hepatomegaly	13	3 (23.1)
Jaundice	13	3 (23.1)
Stomach ache	13	3 (23.1)
Weak	13	3 (23.1)
Lower limbs edema	13	2 (15.4)
Lower limbs lassitude	13	2 (15.4)
Loss of appetite	13	2 (15.4)
Yellow urine	13	2 (15.4)
Oliguria	13	1 (7.7)
Esophageal varices	13	1 (7.7)
PVH	13	1 (7.7)
Etiology
Chemotherapy	13	5 (38.5)
Tusanqi	13	4 (30.8)
Hematopoietic stem cell transplantation	13	2 (15.4)
“Poppers,” a recreational drug used during anal intercourse	13	1 (7.7)
Drug toxicity (6-thioguanine)	13	1 (7.7)
Laboratory index
ALP, U/L	11	206.4
ALT, U/L	9	836.2
AST, U/L	8	1284.25
GGT, U/L	7	155.42
LDH, U/L	3	5608.33
TBil, μmol/L	9	63.11
DBil, μmol/L	5	35
Alb, g/L	5	37.52
TBA, g/L	2	27.65
T-CHE, U/L	2	3242
TP, g/L	1	47.7
CA-125, U/mL	1	299.1

PVH: Portal hypertension; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; ALP: Alkaline phosphatase; GGT: Gamma-glutamyl transpeptidase; TBil: Total bilirubin; DBil: Direct bilirubin; prothrombin time; ALB: Albumin; TBA: Total bile acid.

Table 6 Magnetic resonance imaging features of all 256 examinations, n (%)

MRI feature	Number of cases
Heterogeneous signals on T1WI/T2WI	221 (86.3)
Heterogeneous enhancement	189 (73.8)
Ascites	189 (73.8)
Hepatomegaly	167 (65.2)
Narrowing and blurring of intrahepatic IVC	167 (56.6)
Gallbladder wall edema	121 (47.3)
Narrowing of three main hepatic veins	105 (41.1)
Edema around the portal vein, "cuffing"	90 (35.2)
Narrowing and blurring of intrahepatic veins	52 (20.3)
Collateral circulation opens	37 (14.6)
Splenomegaly	32 (12.5)
Narrowing and blurring of portal vein	28 (10.9)
Dilated and twisted small vessels	17 (6.6)
Hypo-intensity on HBP	17 (6.6)
Dilated hepatic arteries	12 (4.7)
"Halo signs" around the hepatic vein and intrahepatic IVC	11 (4.3)
Restricted diffusion	5 (2.0)
Gastrointestinal edema	4 (1.6)
Multiple hyperplasia nodules	2 (0.8)
Caudate lobe enlargement	2 (0.8)
Focal nodules or masses	1 (0.4)
Dilated spleen vein	1 (0.4)

MRI: Magnetic resonance imaging; IVC: Inferior vena cava.