Share：
Share this content in WeChat
X
[Chinese][PDF]1112242
• EXPERIENCE EXCHANGES •
Clinical and imaging identification between hepatic amyloidosis and hepatic sinusoidal obstructive syndrome
WANG Wei  LI Xueqin  ZHANG Haiying  WANG Xinxin  LI Hongjun 

Cite this article as: Wang W, Li XQ, Zhang HY, et al. Clinical and imaging identification between hepatic amyloidosis and hepatic sinusoidal obstructive syndrome[J]. Chin J Magn Reson Imaging, 2021, 12(2): 74-78. DOI:10.12015/issn.1674-8034.2021.02.017.


[Abstract] Objective The pathological site of hepatic amyloidosis and hepatic sinusoidal obstruction syndrome is the space of disse. The imaging findings can be similar, but the clinical manifestations lack specificity. It is easy to be misdiagnosed due to lack of clinical understanding. To summarize the clinical and imaging characteristics of hepatic amyloidosis and hepatic sinusoidal obstruction syndrome, and to improve the diagnosis of the two diseases. Materials andMethods Reviewed the clinical and imaging data of 11 patients with hepatic amyloidosis and 20 patients with hepatic sinusoidal obstruction syndrome diagnosed pathologically in Beijing You'an Hospital from 2009 to 2019, and compared their differences.Results (1) The typical clinical features of hepatic amyloidosis were giant liver, slight liver damage but significant increased in ALP and GGT. Most patients with hepatic sinusoidal obstruction syndrome in China had taken tunotoginseng history. The clinical features were mostly jaundice with liver. Functional impairment, coagulation dysfunction and increased CA125 were the main manifestations. (2) Imaging examination: ①The stiffness of liver amyloidosis on ultrasound was extremely high (≥75 kPa), which was significantly higher than that of sinusoidal obstruction syndrome [(44.65±19.01) kPa]; ②Hepatic amyloidosis on MRI T2WI, the liver parenchymal signal was uniform and fine, and the liver "texture" was reduced; the enhanced liver parenchymal enhancement was reduced and the enhancement peak was delayed. The liver parenchyma in the venous phase shows "windows Linghua "-like changes, which might be accompanied by low blood flow in the spleen or kidneys. Signs of perfusion, on the other hand, the T2WI liver parenchymal signal of hepatic sinus obstruction syndrome was unevenly increased, showing irregular patches or "cloudy"-like slightly high signal shadows; enhanced scan portal phase liver parenchyma could show map-like enhancement, surrounding three hepatic veins "Clover"-like enhancement, the delayed phase enhancement range was enlarged; ③Amyloidosis, the hepatic artery and the main portal vein diameter were larger than the hepatic sinusoidal obstruction syndrome patients (P＜0.05); the common point of the images of the two cases was the venous phase Ⅲ. The branch hepatic veins were not visible or appear slender.Conclusions There are some differences on the cause, clinical characteristic, and characteristic of images between hepatic amyloidosis and hepatic sinusoidal obstructive syndrome, all of them contribute to differential diagnosis.
[Keywords] hepatic amyloidosis；hepatic sinusoidal obstructive syndrome；imaging features；differential diagnoses；magnetic resonance imaging

WANG Wei   LI Xueqin   ZHANG Haiying   WANG Xinxin   LI Hongjun*  

Medical Imaging Center of Beijing You 'an Hospital Affiliated to Capital Medical University, Beijing 100069, China

Li HJ, E-mail: lihongjun00113@ccmu.edu.cn

Conflicts of interest   None.

Received  2020-10-27
Accepted  2021-01-13
DOI: 10.12015/issn.1674-8034.2021.02.017
Cite this article as: Wang W, Li XQ, Zhang HY, et al. Clinical and imaging identification between hepatic amyloidosis and hepatic sinusoidal obstructive syndrome[J]. Chin J Magn Reson Imaging, 2021, 12(2): 74-78. DOI:10.12015/issn.1674-8034.2021.02.017.

1
Hu CB, Lu YF, Tang H. Multiple myeloma secondary to liver amyloidosis[J]. Chin Hepatol, 2018, 23(6): 564-565. DOI: 10.14000/j.cnki.issn.1008-1704.2018.06.038.
2
Wang SS, Zhao SX, Kong L, et al. Clinical characteristics of 6 cases with hepatic amyloidosis and literature review[J]. Chin J Liver Dis(Elect Edit), 2019, 11(2): 81-84. DOI: 10.3969/j.issn.1674-7380.2019.02.015.
3
Fan CL, Ding HG, Wang WJ, et al. Clinical features of patients with sinusoidal obstruction syndrome without hematopoietic stem cell transplantation[J]. Beijing Med, 2018, 40(10): 922-926. DOI: 10.15932/j.0253-9713.2018.10.005.
4
Li YS, Bao J, Xu Y, et al. Clinicopathological analysis of 16 cases of pyrrolizidine alkaloids-associated hepatic sinusoidal obstruction syndrome[J]. Chin J Hepatol, 2020, 28(4): 332-337. DOI: 10.3760/cma.j.cn501113-20190724-00269.
5
Yang LX, Lv H, Qian JM. Primaryhepaticamyloidosis: report of 4 cases and reviews of the literature in and abroad[J]. Chin J Pract Inter Med, 2006, 26(3): 217-219. DOI: 10.3969/j.issn.1005-2194.2006.03.024.
6
Yu SM, Wang YC, Zhu Y, et al. Clinical features of patients,with hepatic amyloidosis[J]. J Clin Hepatol, 2018, 34(4): 836-839. DOI: 10.3969/j.issn.1001-5256.2018.04.028.
7
Park MA, Mueller PS, Kyle RA, et al. Primary (AL) hepatic amyloidosis: clinical features and natural history in 98 patients[J]. Medicine, 2003, 82(5): 291-298. DOI: 10.1097/01.md.0000091183.93122.c7.
8
Culafić D, Perisić M, Boricić I, et al. Primary amyloidosis presenting with cholestasis and hyperkinetic portal hypertension[J]. J Gastrointestin Liver Dis, 2007, 16(2): 201-204.
9
Obici L, Perfetti V, Palladini G, et al. Clinical aspects of systemic amyloid diseases[J]. Biochim Biophys Acta, 2005, 1753(1): 11-22. DOI: 10.1016/j.bbapap.2005.08.014.
10
Chinese cooperative group on systemic amyloidosis, National center for clinical medical research in kidney disease. Guidelines for the diagnosis and treatment of systemic mild amyloidosis[J]. Natl Med J China, 2016, 96(44): 3540-3548. DOI: 10.3760/cma.j.issn.0376-2491.2016.44.002.
11
Wechalekar AD, Gillmore JD, Hawkins PN, et al. Systemic amyloidosis[J]. Lancet, 2016, 387(10038): 2641-2654. DOI: 10.1016/S0140-6736(15)01274-X.
12
Petäjä J, Pitkänen S, Vettenranta K, et al. Serum tumor marker CA 125 is an early and sensitive indicator of veno-occlusive disease in children undergoing bone marrow transplantation[J]. Clin Cancer Res, 2000, 6(2): 531-535.
13
Guo Y, Hu JH, Lin W, et al. Radiologic findings of hepatic amyloidosis: Two cases report and literature review[J]. J Pract Radiol, 2010, 26(3): 376-379. DOI: 10.3969/j.issn.1002-1671.2010.03.021.
14
Yu A, Lv WF, Zhou CZ, et al. CT and MRI features of hepatic sinusoidal obstruction syndrome[J]. Chin J Inter Imaging Therapy, 2020, 17(4): 220-223. DOI: 10.13929/j.issn.1672-8475.2020.04.007.
15
Li Z, Xu K, Hou JX, et al. The differential diagnosis of BCS (type II) and hepatic sinusoidal obstruction syndrome by CE-MRA[J]. Chin J CT & MRI, 2014(8): 95-98.
16
Yan Y, Sun Y, Wang RG, et al. The contrast-enhanced CT diagnostic value on hepatic sinusoidal obstruction syndrome[J]. Comput Tomography Theory Appli, 2019, 28(2): 263-270.
17
Yang XQ, Ye J, Li X, et al. Pyrrolizidine alkaloids-induced hepatic sinusoidal obstruction syndrome: Pathogenesis, clinical manifestations, diagnosis, treatment, and outcomes[J]. World J Gastroenterol, 2019, 25(28): 3753-3763. DOI: 10.3748/wjg.v25.i28.3753.
18
Zhuge Y, Liu Y, Xie W, et al. Chinese society of gastroenterology committee of hepatobiliary disease. Expert consensus on the clinical management of pyrrolizidine alkaloid-induced hepatic sinusoidal obstruction syndrome[J]. J Gastroenterol Hepatol, 2019, 34(4): 634-642. DOI: 10.1111/jgh.14612.
19
Trifanov DS, Dhyani M, Bledsoe JR, et al. Amyloidosis of the liver on shear wave elastography: case report and review of literature[J]. Abdominal Imaging, 2015, 40(8): 3078-3083. DOI: 10.1007/s00261-015-0519-4.
20
Loustaud-Ratti VR, Véronique CA, Rousseau A, et al. Non-invasive detection of hepatic amyloidosis: FibroScan, a new tool[J]. Amyloid, 2011, 18(1): 19-24. DOI: 10.3109/13506129.2010.543443.
21
Cooperative group of hepatobiliary diseases, digestive society of Chinese Medical Association. Expert consensus on diagnosis and treatment of pyrrolidine alkaloid associated hepatic sinusoidal obstruction syndrome (Nanjing, 2017)[J]. J Clin Hepatology, 2017, 33(9): 1627-1637. DOI: 10.3969/j.issn.1004-5511.2019.01.006.
22
Xu ZT, Ding H, Fu TT, et al. Ultrasonographic features of hepatic sinusoidal obstruction syndrome[J]. Chin J Med Ultrasound (Elect Edit), 2020, 17(7): 691-696.

PREV Compared study of the cerebral artery stenosis assessed by ZTE-MRA and TOF-MRA
NEXT Application of apparent diffusion coefficient histogram analysis in the grading of gastrointestinal stromaltumors
  


LINK


Tel & Fax: +8610-67113815    E-mail: editor@cjmri.cn