CT Features of Hepatic Veno-occlusive Disease

Rationale and Objective

The computed tomography (CT) features of hepatic veno-occlusive disease (HVOD) could play a role in its diagnosis. We aimed to perform a meta-analysis of studies examining the CT features of HVOD.

Methods

Relevant studies published up to May 3, 2017 were searched in major electronic databases. The extracted data included the proportion of various CT features in patients with HVOD. The meta-analysis was conducted using R 3.3.3 with the “meta” package.

Results

Eleven studies were included. The studies involved 326 patients with a mean age range of 50.2–58.9 years, and the proportion of female patients ranged from 20% to 57.5%. The meta-analysis showed the pooled proportion of CT features: hepatic parenchyma with heterogeneous hypoattenuation (81.05%, 95% confidence interval [CI]: 56.97%–93.25%), patchy enhancement in the portal venous phase (87.09%, 95% CI: 75.15%–93.77%) with or without a narrow or invisible hepatic vein (71.02% 95% CI: 42.09%–89.20%), gallbladder wall edema (65.51%, 95% CI: 28.98%–89.84%), and patchy heterogeneous enhancement in the arterial phase (44.36%, 95% CI: 29.98%–59.76%) with or without slightly enlarged hepatic artery (56.61%, 95% CI: 40.62%–71.33%).

Conclusion

Hepatic parenchyma with heterogeneous hypoattenuation and patchy enhancement with or without narrowing or an invisible hepatic vein in the portal venous or equilibrium phase may be the most important CT feature for diagnosing HVOD.

Introduction

In 1954, Jelliffe reported on hepatic veno-occlusive disease (HVOD), which is also known as hepatic sinusoidal obstruction syndrome (HSOS) . This disease is defined as an obstruction of the sublobular veins or the central veins of hepatic lobules, which results in intrahepatic or postsinusoidal portal hypertension .

The clinical manifestation of HVOD is characterized by upper right abdominal pain, hepatomegaly, ascites, weight gain, jaundice, malaise, vomiting, and other digestive dysfunctions . The clinical manifestation of HVOD has been divided into three stages: acute, subacute, and chronic . The pathology of HVOD is centered around injury to the hepatic sinusoids or venules, with eventual infiltration by collagen and fibrous proteins leading to obliteration, and portal hypertension .

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TABLE 1

The Seattle and Baltimore Criteria

The Seattle Criteria The Baltimore Criteria Major criteria Within 20 days of HSCT Total serum bilirubin ≥2 mg/dL within 21 days of HSCT At least two of the following criteria Total serum bilirubin ≥2 mg/dL Painful hepatomegaly Painful hepatomegaly Ascites Sudden weight gain (>2%) Sudden weight gain (>5%)

HSCT, hematopoietic stem cell transplantation.

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Materials and Methods

Data Sources and Search Strategy

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Inclusion and Exclusion Criteria

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Data Extraction

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Quality Assessment

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TABLE 2

Methodological Quality Assessment

Study \* Study Design Assessment Method Quality Score Overall Methodological Quality Shao 2015 Cross-sectional study AHRQ-Quality checklist 8 High Erturk 2006 Case-control study NOS checklist 6 Stars High Wu 2012 Cross-sectional study AHRQ-Quality checklist 8 High Tang 2012 Cross-sectional study AHRQ-Quality checklist 7 Moderate Zhang 2006 Cross-sectional study AHRQ-Quality checklist 9 High Hu 2011 Cross-sectional study AHRQ-Quality checklist 6 Moderate Zhu 2011 Cross-sectional study AHRQ-Quality checklist 6 Moderate Yang 2010 Cross-sectional study AHRQ-Quality checklist 7 Moderate Jin 2013 Cross-sectional study AHRQ-Quality checklist 7 Moderate Yin 2015 Cross-sectional study AHRQ-Quality checklist 8 High Kan 2016 Case-control study NOS checklist 6 Stars High

AHRQ-Quality checklist, quality checklist recommended by the Agency for Healthcare Research and Quality; NOS, Newcastle-Ottawa Scale.

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Statistical Analysis

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Results

Data Selection and Study Characteristics

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TABLE 3

Characteristics of the Included Studies

Study \* Location_n_ † Age in Years Male (%) Female (%) Stage of HVOD Causes of HVOD Shao 2015 China 39 55 (range: 33–73) 46.2% 53.8% Acute or subacute_Sedum aizoon_ Erturk 2006 United States 12 42.4 (range: 24–61) 55.6% 44.4% Acute or subacute GVHD Wu 2012 China 10 58.9 (range: 53–82) 50% 50% Acute or subacute_Gynura segetum_ Tang 2012 China 12 50.2 (range: 49–67) 66.7% 33.3% Acute_G. segetum_ Zhang 2006 China 14 56 (range: 41–73) 42.9% 57.1% Acute_G. segetum_ Hu 2011 China 5 Range: 40–60 80% 20% Subacute_S. aizoon_ Zhu 2011 China 3 Range: 50–57 66.7% 33.3% Acute or subacute_S. aizoon_ Yang 2010 China 32 50.2 (range: 22–71) 78.1% 21.9% 16 Acute;

10 Subacute

6 Chronic_S. aizoon_ Jin 2013 China 48 53.6 (range: 48–68) 62.5% 37.5% Acute NG Yin 2015 China 80 56.2 (range: 41–73) 42.5% 57.5% Acute or subacute_S. aizoon_ Kan 2016 China 71 56.48 ± 11.84 ‡ 67.6% 32.4% Acute or subacute PAs

GVHD, graft-versus-host disease; HVOD, hepatic veno-occlusive disease; NG, not given; PA, pyrrolizidine alkaloid; SD, standard deviation.

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Methodological Quality Assessment

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Publication Bias

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Meta-analysis Outcomes

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TABLE 4

CT Features of HVOD

Study \* Reference No.n † Hepatomegaly Ascites Gallbladder Wall Edema Heterogeneous Hypoattenuation In the Arterial Phase In the Portal Venous Phase Slightly Enlarged Hepatic Artery Patchy Heterogeneous Enhancement Narrow or Invisible Hepatic vein Patchy Heterogeneous Enhancement Shao 2015 39 100% 100% NG 92.31% NG NG NG 100% Erturk 2006 12 100% 83.33% 8.33% NG NG NG 75% NG Wu 2012 10 100% 100% 100% NG NG NG 100% NG Tang 2012 12 100% 100% NG NG 83.33% 83.33% 100% 75% Zhang 2006 14 100% 100% NG 78.57% 57.14% 57.14% 28.57% 85.71% Hu 2011 5 100% 100% NG NG 20% 20% 100% 100% Zhu 2011 3 100% 100% 100% 66.7% 66.67% 66.67% 100% 100% Yang 2010 32 81.25% 100% 43.75% 37.5% 43.75% 43.75% 87.5% 62.5% Jin 2013 48 100% NG NG NG 75.0% 20.83% 12.5% 79.17% Yin 2015 80 100% NG NG 80% 42.5% 42.5% 25% 100% Kan 2016 71 78.87% 100% 84.51% 100% ‡ NG NG 87.32% 92.96%

CT, computed tomography; HVOD, hepatic veno-occlusive disease; NG, not given.

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Other Radiological Findings

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Discussion

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CT Scanning

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Differential Diagnosis

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CT Features and Diagnosis

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Limitations

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Conclusion

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References

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CT Features of Hepatic Veno-occlusive Disease

Rationale and Objective

Methods

Results

Conclusion

Introduction

Materials and Methods

Data Sources and Search Strategy

Inclusion and Exclusion Criteria

Data Extraction

Quality Assessment

Statistical Analysis

Results

Data Selection and Study Characteristics

Methodological Quality Assessment

Publication Bias

Meta-analysis Outcomes

Other Radiological Findings

Discussion

CT Scanning

Differential Diagnosis

CT Features and Diagnosis

Limitations

Conclusion

References

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