Table 1 Table summarising adverse effects visible on imaging and most commonly associated cancer therapies
Adverse effect | Associated therapy | Laboratory findings | Radiologic findings |
|---|---|---|---|
Fatty liver | Oxaliplatin, irinotecan, fluorouracil, methotrexate | ↑ ALT ↑ AST | 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 ↑ AST | US: “starry sky” sign CT: Hepatosplenomegaly, thickened gallbladder wall, periportal oedema, decreased liver enhancement |
Hepatic abscess | TACE | ↑ Alkaline phosphatase Hypoalbunaemia | CT: hypoattenuating lesion with peripheral rim enhancement |
Hepatic failure | TACE | Thrombocytopenia ↑ PT, INR ↑ ALT ↑ AST ↑ 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 |