Chemotherapy induced liver abnormalities: an imaging perspective

Clin Mol Hepatol. 2014 Sep;20(3):317-26. doi: 10.3350/cmh.2014.20.3.317.

Abstract

Treating patients undergoing chemotherapy who display findings of liver toxicity, requires a solid understanding of these medications. It is important for any clinician to have an index of suspicion for liver toxicity and be able to recognize it, even on imaging. Cancer chemotherapy has evolved, and newer medications that target cell biology have a different pattern of liver toxicity and may differ from the more traditional cytotoxic agents. There are several hepatic conditions that can result and keen clinical as well as radiographic recognition are paramount. Conditions such as sinusoidal obstructive syndrome, steatosis, and pseudocirrhosis are more commonly associated with chemotherapy. These conditions can display clinical signs of acute hepatitis, liver cirrhosis, and even liver failure. It is important to anticipate and recognize these adverse reactions and thus appropriate clinical action can be taken. Often times, patients with these liver manifestations can be managed with supportive therapies, and liver toxicity may resolve after discontinuation of chemotherapy.

Keywords: Chemotherapy; Hepatic Necrosis; Hepatic toxicity; Hepatitis; Pseudocirrhosis; Steatosis.

MeSH terms

  • Adult
  • Aged
  • Antibiotics, Antineoplastic / adverse effects
  • Antibiotics, Antineoplastic / therapeutic use
  • Antimetabolites, Antineoplastic / adverse effects
  • Antimetabolites, Antineoplastic / therapeutic use
  • Antineoplastic Agents / adverse effects*
  • Antineoplastic Agents / therapeutic use
  • Antineoplastic Agents, Alkylating / adverse effects
  • Antineoplastic Agents, Alkylating / therapeutic use
  • Chemical and Drug Induced Liver Injury / diagnostic imaging
  • Chemical and Drug Induced Liver Injury / etiology
  • Enzyme Inhibitors / adverse effects
  • Enzyme Inhibitors / therapeutic use
  • Fatty Liver / diagnostic imaging
  • Fatty Liver / etiology
  • Female
  • Humans
  • Immunotherapy
  • Liver Cirrhosis / diagnostic imaging
  • Liver Cirrhosis / etiology
  • Liver Diseases / diagnostic imaging*
  • Liver Diseases / etiology
  • Male
  • Middle Aged
  • Neoplasms / therapy
  • Tomography, X-Ray Computed

Substances

  • Antibiotics, Antineoplastic
  • Antimetabolites, Antineoplastic
  • Antineoplastic Agents
  • Antineoplastic Agents, Alkylating
  • Enzyme Inhibitors