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Table 3 Most common ChT-induced parenchymal and vascular hepatic changes

From: Imaging side effects and complications of chemotherapy and radiation therapy: a pictorial review from head to toe

Type of liver injury Main CT/MRI findings
Acute hepatocellular injury Hepatosplenomegaly, gallbladder wall thickening, reduced and heterogeneous liver enhancement, abdominal ascites, reduced portal flow, periportal edema
Chronic hepatocellular injury Capsular retraction, confluent fibrosis, pseudocirrhosis (i.e., liver surface nodularity, multifocal capsular retraction, decreased liver size, enlargement of the caudate lobe, signs of portal hypertension)
Nonalcoholic fatty liver disease Hepatic steatosis (lower attenuation of the hepatic parenchyma on CT, signal drop on opposed phase compared to the in-phase images on MRI)
Sinusoidal obstruction syndrome Diffuse form: patchy liver enhancement with a mosaic appearance, mainly in the periphery of the right lobe; focal form: lack of rim-enhancement in the arterial and portal venous phases, lack of diffusion restriction on DWI, intermingled hypointensity and ill-defined margins in the hepatobiliary phase
FNH-like lesions Usually multiple; homogenous arterial contrast enhancement and isoattenuation to the surrounding liver parenchyma in the portal venous and delayed phase; on hepatobiliary phase MRI iso or hyperintense or with a ring or doughnut-like appearance (i.e., hyperintense periphery and central hypointensity)