Imaging of the chemotherapy-induced hepatic damage: Yellow liver, blue liver, and pseudocirrhosis

Figure 4 Chemotherapy-associated diffuse steatosis in patients with liver metastatic colorectal cancer 6 mo after the beginning of chemotherapy with 5-fluorouracil + folinic acid + irinotecan. A-C: Unenhanced computed tomography axial scan (A), arterial (B) and portal phase (C) show severe inhomogeneous hepatic steatosis. Liver attenuation in steatotic areas is 8 HU (yellow ROI), less than that of the spleen (43 HU, red ROI), and the hepatic/splenic attenuation ratio is << 1. No nodules are visible; D-L: On magnetic resonance performed during the following week, gradient echo (GE) T1w in-phase (E) and out-of-phase (F) images confirm severe hepatic steatosis. On unenhanced fat sat GE 3D T1w images (G), arterial (H), portal (I), hepatobiliary (J) phases and high b-value diffusion-weighted images (K), multiple metastases are evident, some of which are characterized by rim enhancement (arrows). The T2-weighted image (D) and apparent diffusion coefficient map (L) are also shown.