1.Chemotherapy induced liver abnormalities: an imaging perspective.
Ankush SHARMA ; Roozbeh HOUSHYAR ; Priya BHOSALE ; Joon Il CHOI ; Rajesh GULATI ; Chandana LALL
Clinical and Molecular Hepatology 2014;20(3):317-326
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.
Adult
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Aged
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Antibiotics, Antineoplastic/adverse effects/therapeutic use
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Antimetabolites, Antineoplastic/adverse effects/therapeutic use
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Antineoplastic Agents/*adverse effects/therapeutic use
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Antineoplastic Agents, Alkylating/adverse effects/therapeutic use
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Drug-Induced Liver Injury/etiology/radiography
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Enzyme Inhibitors/adverse effects/therapeutic use
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Fatty Liver/etiology/radiography
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Female
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Humans
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Immunotherapy
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Liver Cirrhosis/etiology/radiography
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Liver Diseases/etiology/*radiography
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Male
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Middle Aged
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Neoplasms/therapy
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Tomography, X-Ray Computed
2.Altered Doppler flow patterns in cirrhosis patients: an overview.
Pooya IRANPOUR ; Chandana LALL ; Roozbeh HOUSHYAR ; Mohammad HELMY ; Albert YANG ; Joon Il CHOI ; Garrett WARD ; Scott C GOODWIN
Ultrasonography 2016;35(1):3-12
Doppler ultrasonography of the hepatic vasculature is an integral part of evaluating precirrhotic and cirrhotic patients. While the reversal of the portal venous flow is a well-recognized phenomenon, other flow patterns, although not as easily understood, may play an important role in assessing the disease status. This article discusses the different characteristic flow patterns observed from the portal vein, hepatic artery, and hepatic vein in patients with liver cirrhosis or related complications and procedures. Knowledge of these different flow patterns provides additional information that may reinforce the diagnosis of cirrhosis, help in staging, and offer prognostic information for determining the direction of therapy. Doppler ultrasonography is invaluable when liver transplantation is being considered and aids in the diagnosis of cirrhosis and portal hypertension.
Diagnosis
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Fibrosis*
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Hepatic Artery
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Hepatic Veins
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Humans
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Hypertension, Portal
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Liver Cirrhosis
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Liver Transplantation
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Portal Vein
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Ultrasonography, Doppler
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Ultrasonography, Doppler, Color
3.Composite liver tumors: A radiologic-pathologic correlation.
Megha NAYYAR ; David K IMAGAWA ; Temel TIRKES ; Aram N DEMIRJIAN ; Roozbeh HOUSHYAR ; Kumar SANDRASEGARAN ; Chaitali S NANGIA ; Tara SEERY ; P BHARGAVA ; Joon II CHOI ; Chandana LALL
Clinical and Molecular Hepatology 2014;20(4):406-410
Bi-phenotypic neoplasm refers to tumors derived from a common cancer stem cell with unique capability to differentiate histologically into two distinct tumor types. Bi-phenotypic hepatocellular carcinoma-cholangiocarcinoma (HCC-CC), although a rare tumor, is important for clinicians to recognize, since treatment options targeting both elements of the tumor are crucial. Imaging findings of bi-phenotypic HCC-CC are not specific and include features of both HCC and CC. A combination of imaging and immuno-histochemical analysis is usually needed to make the diagnosis.
CA-19-9 Antigen/metabolism
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Carcinoma, Hepatocellular/mortality/pathology/radiography
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Cholangiocarcinoma/mortality/pathology/radiography
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Humans
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Liver Neoplasms/mortality/pathology/*radiography
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Magnetic Resonance Imaging
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Phenotype
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Risk Factors
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Survival Analysis
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Tomography, X-Ray Computed
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alpha-Fetoproteins/analysis
4.Magnetic resonance imaging following treatment of advanced hepatocellular carcinoma with sorafenib.
Joon Il CHOI ; David K IMAGAWA ; Priya BHOSALE ; Puneet BHARGAVA ; Temel TIRKES ; Tara E SEERY ; Chandana LALL
Clinical and Molecular Hepatology 2014;20(2):218-222
Hepatocellular carcinomas are highly vascular tumors, showing progressive hypervascularity by the process of neoangiogenesis. Tumor angiogenesis is critical for tumor growth as well as metastatic spread therefore, imaging and quantification of tumor neo-angiogenesis is essential for monitoring response to targeted therapies and predicting disease progression. Sorafenib is a molecular targeting agent used for treating hypervascular tumors. This drug is now the standard of care in treatment of patients with advanced hepatocellular carcinoma. Due to its anti-angiogenic and anti-proliferative actions, imaging findings following treatment with Sorafenib are quite distinct when compared to conventional chemotherapeutic agents. Liver MRI is a widely adopted imaging modality for assessing treatment response in hepatocellular carcinoma and imaging features may reflect pathophysiological changes within the tumor. In this mini-review, we will discuss MRI findings after Sorafenib treatment in hepatocellular carcinoma and review the feasibility of MRI as an early biomarker in differentiating responders from non-responders after treatment with molecular targeting agents.
Aged
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Antineoplastic Agents/*therapeutic use
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Carcinoma, Hepatocellular/drug therapy/physiopathology/*radiography
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Female
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Humans
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Liver Neoplasms/drug therapy/physiopathology/*radiography
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*Magnetic Resonance Imaging
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Male
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Middle Aged
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Niacinamide/*analogs & derivatives/therapeutic use
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Phenylurea Compounds/*therapeutic use
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Tomography, X-Ray Computed