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Table 1 Table summarising adverse effects visible on imaging and most commonly associated cancer therapies

From: Cancer therapy related complications in the liver, pancreas, and biliary system: an imaging perspective

Adverse effect Associated therapy Laboratory findings Radiologic findings
Fatty liver Oxaliplatin, irinotecan, fluorouracil, methotrexate ↑ ALT
US: increased echogenicity and beam attenuation
CT: reduced liver attenuation
MR: reduced liver signal intensity in out-of-phase imaging
Sinusoidal obstruction syndrome (SOS) Oxaliplatin, fluorouracil, mercaptopurine, dacarbazine, azathioprine ↑ Bilirubin US: ascites, gallbladder wall thickening, hepatosplenomegaly
CT: ascites, decreased right hepatic vein diameter (<0.45 cm), perioesophageal varices, hepatosplenomegaly, and recanalisation of the umbilical vein
Pseudocirrhosis Gemcitabine None US, CT, MR: segmental volume loss, capsular retraction, fibrosis, enlargement of caudate lobe
Acute hepatitis Anastrozole, lapatinib ↑ ALT
US: “starry sky” sign
CT: Hepatosplenomegaly, thickened gallbladder wall, periportal oedema, decreased liver enhancement
Hepatic abscess TACE ↑ Alkaline phosphatase
CT: hypoattenuating lesion with peripheral rim enhancement
Hepatic failure TACE Thrombocytopenia
↑ Bilirubin
US: increased echogenicity, ascites, nodularity, segmental hypertrophy/atrophy
CT: surface and parenchymal nodularity, segmental hypertrophy/atrophy
Pancreatitis L-asparaginase, carboplatin, cisplatin, cytarabine, ifosfamide, paclitaxel, tretinoin, vinorelbine, TACE ↑ Amylase
↑ Lipase
US: peripancreatic fluid collection, hypoechoic lesions
CT: areas of low attenuation, diffuse pancreatic oedema
Pancreatic atrophy Sorafenib, sunitinib None CT: reduced pancreatic volume
Acute acalculous cholecystitis Everolimus, sunitinib, bevacizumab ↑ Alkaline phosphatase
↑ Bilirubin
US: gall bladder wall thickening, gallbladder distension, pericholecystic fluid collection
CT: gallbladder distension, fat stranding, hyperaemia, pericholecystic fluid
Biliary inflammation L-asparaginase, doxorubicin, epirubicin, paclitaxel None CT: biliary epithelial thickening and enhancement
Biliary sclerosis HAIPC w/ floxuridine ↑ Alkaline phosphatase
↑ Bilirubin
CT: thickened/enhanced bile duct wall, bile duct stricture with lumen <3 mm, periductal oedema
ERCP: dilatation and stricture of biliary tree
Biliary stasis Tamoxifen, doxorubicin ↑ Alkaline phosphatase
↑ Gamma-glutamyl transpeptidase
US: biliary dilatation
CT: tumefactive sludge
Bile duct injury TACE ↑ Alkaline phosphatase
↑ Gamma-glutamyl transpeptidase
↑ Bilirubin
CT: main bile duct dilatation, extrabiliary collection of bile
MRCP: biliary fluid collection and bile duct leaks