Systematic Reviews
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 26, 2019; 7(18): 2746-2759
Published online Sep 26, 2019. doi: 10.12998/wjcc.v7.i18.2746
Sinusoidal obstruction syndrome: A systematic review of etiologies, clinical symptoms, and magnetic resonance imaging features
Yun Zhang, Han-Yu Jiang, Yi Wei, Bin Song
Yun Zhang, Han-Yu Jiang, Yi Wei, Bin Song, Department of Radiology, Sichuan University West China Hospital, Chengdu 610041, Sichuan Province, China
Author contributions: Zhang Y, Jiang HY, and Wei Y contributed equally to the work; Zhang Y conceptualized and designed the review together with Wei Y; Zhang Y and Jiang HY carried out the analysis; Zhang Y drafted the initial manuscript; Song B reviewed and approved the final manuscript as submitted.
Conflict-of-interest statement: The authors report no relevant conflicts of interest.
PRISMA 2009 Checklist statement: The manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Bin Song, MD, Chief Doctor, Director, Professor, Department of Radiology, Sichuan University West China Hospital, No. 37, Guoxue Alley, Chengdu 610041, Sichuan Province, China. cjr.songbin@vip.163.com
Telephone: +86-28-85423680 Fax: +86-28-85582499
Received: March 23, 2019
Peer-review started: March 26, 2019
First decision: August 1, 2019
Revised: August 17, 2019
Accepted: August 26, 2019
Article in press: August 27, 2019
Published online: September 26, 2019
Processing time: 185 Days and 2.4 Hours
Abstract
BACKGROUND

Sinusoidal obstruction syndrome (SOS) is a kind of rare liver disease which is characterized by damage to small hepatic vessels, affecting particularly the sinusoidal endothelium. Due to the special etiology and high mortality, early diagnosis of SOS is significant for clinical survival and prognosis.

AIM

To generalize the common etiologies and clinical symptoms of SOS and summarize the characteristic magnetic resonance imaging (MRI) features so as to provide more valuable information for early diagnosis of SOS.

METHOD

We searched PubMed, Web of science, Wanfang Data, China Knowledge Resource Integrated, VIP, and Cochrane Library databases without a limiting period and the types of articles. The search process mainly revolved around the etiologies, common clinical symptoms, and MRI imaging features of SOS. Ultimately, 29 full articles were included in this review and 222 articles were excluded.

RESULTS

Eleven case reports included 13 patients. The etiologies of these patients including chemotherapy (5/13), medicinal herbs containing pyrrolidine alkaloids (PAs, e.g. Tusanqi) (4/13), hematopoietic stem cell transplantation (HSCT) (2/13), drug toxicity (6-thioguanine) (1/13), and “poppers”, a recreational drug used during anal intercourse (1/13). Eighteen case series including 497 patients, and SOS in 465 (93.6%) patients was caused by PAs. Ascites, abdominal pain and swelling, jaundice were the most common clinical symptoms. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma-glutamyl transpeptidase (GGT), total bilirubin (TBil), direct bilirubin (DBil), and prothrombin time (PT) had varying degrees of elevation. Heterogeneous signals on T1 weighted imaging/T2 weighted imaging (T1WI/T2WI), heterogeneous enhancement of liver parenchyma, ascites, hepatomegaly, narrowing and blurring of intrahepatic inferior vena cava and three main hepatic veins, edema around the portal vein, and gallbladder wall edema were the most common MRI imaging features of SOS.

CONCLUSION

In the West, SOS was mostly secondary to HSCT. Some SOS developed in the process of chemotherapy for hepatic metastatic tumor. A few SOS were caused by toxicity of certain drugs. In the East, Tusanqi was a major cause of SOS. Ascites, abdominal pain and swelling, jaundice were the common clinical symptoms. Elevations of ALT, AST, GGT, ALP, TBil, and DBil could be used as predictors of liver function damage. Numerous characteristic MRI imaging features could provide more valuable information for early diagnosis of SOS.

Keywords: Sinusoidal obstruction syndrome; Hematopoietic stem cell transplantation; Chemotherapy; Tusanqi; Ascites

Core tip: In total, 11 case reports and 18 case series were systematically reviewed. These articles stated the main causes of sinusoidal obstruction syndrome (SOS) and summarized the common clinical symptoms and abnormal laboratory indicators. Numerous characteristic magnetic resonance imaging features could provide more valuable information for early diagnosis of SOS.