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Cancer Therapy-related Hepatic Injury in Children: Imaging Review from the Pediatric LI-RADS Working Group
Cara E Morin1, Amy B Kolbe1, Adina Alazraki1
1From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.).
Abstract:
The liver is the primary organ for the metabolism of many chemotherapeutic agents. Treatment-induced liver injury is common in children undergoing cancer therapy. Hepatic injury occurs due to various mechanisms, including biochemical cytotoxicity, hepatic vascular injury, radiation-induced cytotoxicity, and direct hepatic injury through minimally invasive and invasive surgical treatments. Treatment-induced liver injury can be seen contemporaneous with therapy and months to years after therapy is complete. Patients can develop a combination of hepatic injuries manifesting during and after treatment. Acute toxic effects of cancer therapy in children include hepatitis, steatosis, steatohepatitis, cholestasis, hemosiderosis, and vascular injury. Longer-term effects of cancer therapy include hepatic fibrosis, chronic liver failure, and development of focal liver lesions. Quantitative imaging techniques can provide useful metrics for disease diagnosis and monitoring, especially in treatment-related diffuse liver injury such as hepatic steatosis and steatohepatitis, hepatic iron deposition, and hepatic fibrosis. Focal liver lesions, including those developing as a result of treatment-related vascular injury such as focal nodular hyperplasia-like lesions and hepatic perfusion anomalies, as well as hepatic infections occurring as a consequence of immune suppression, can be anxiety provoking and confused with recurrent malignancy or hepatic metastases, although there often are imaging features that help elucidate the correct diagnosis. Radiologic evaluation, in conjunction with clinical and biochemical screening, is integral to diagnosing and monitoring hepatic complications of cancer therapy in pediatric patients during therapy and after therapy completion for long-term surveillance. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material See the invited commentary by Ferraciolli and Gee in this issue.
