Evaluation of liver injury with MRI after chemotherapy

Purpose: The aim of the study is to evaluate long-term liver injuries as sinusoidal obstruction syndrome (SOS) and chemotherapy-associated steatohepatitis (CASH) with functional MRI in patients with pancreatic ductal adenocarcinoma (PDAC) after neoadjuvant chemotherapy. Material and Methods: In this prospective study, 10 patients with borderline resectable/locally advanced PDAC underwent a MRI at 1.5T including gradient echo sequence (T2-FFE) before and after 12 weeks from the beginning of neoadjuvant chemotherapy (liposomal irinotecan + fluorouracil/leucovorin + oxaliplatin). Clinical parameters as body mass index, history of diabetes, hypertension and biological parameters including bilirubin levels, AST, ALT, GGT and drug administration dosage were recorded. A single region of interest (ROI) including the whole liver and other 10 ROIs for hepatic segments were reproduced obtaining a T2* mapping for each patient before and after treatment. T2* values were measured and compared with Wilcoxon test. Results: Significant decrease of T2* values was observed after treatment (p < 0.05), demonstrating a lower hepatic oxygenation, especially for II, VII and VIII hepatic segments. For each patient, III segment T2* values were stable. In 3 patients, no significant changes of T2* values were recorded before and after chemotherapy. Conclusion: Liver steatosis and fibrosis interpose with sinusoidal patency. Including T2* mapping in liver MRI protocol may supply estimation of liver functional changes after chemotherapy.