Published online Sep 26, 2019. doi: 10.12998/wjcc.v7.i18.2746
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
Sinusoidal obstruction syndrome (SOS), also referred to as veno-occlusive disease, is a rare liver vascular injury that is highly lethal. It is pathologically characterized by the damage of hepatic sinusoidal endothelial cells, impeded sinusoidal blood flow, congestive sinusoidal dilatation, and perisinusoidal fibrosis. Understanding the epidemiological characteristics and imaging features of SOS is vital for clinical diagnosis and treatment.
Although biopsy is the golden standard for SOS diagnosis, it is invasive and cannot be easily implemented in practice work. Currently, the diagnosis of SOS usually depends on clinical criteria, such as the Baltimore criteria and the modified Seattle criteria. However, the diagnosis of SOS only based on clinical criteria is lack of high specificity. In recent years, magnetic resonance imaging (MRI) has been increasingly used in the differential diagnosis of SOS and shows a good prospect. Combing clinical information and MRI features of SOS could greatly improve the efficiency of SOS diagnosis.
The main objective of this systematic review is to summarize the major etiologies, clinical symptoms, and MRI features of SOS.
Published articles on PubMed, Web of Science, Wanfang Data, China Knowledge Resource Integrated, VIP, and Cochrane Library databases were searched. The search process mainly revolved around the etiologies, common clinical symptoms, and MRI imaging features of SOS. Last search was performed on January 28, 2019.
In total, 11 case reports and 18 case series were systematically reviewed. Chemotherapy for patients with liver metastasis of colorectal cancer, intake of medicine herbs containing pyrrolidine alkaloids (PAs, e.g. Tusanqi), and condition treatment prior to haemopoietic stem cell transplantation were the main etiologies of SOS. Hepatomegaly, ascites, abdominal swelling, and jaundice were the frequent clinical symptoms of SOS. Some laboratory indexes, including alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, gamma-glutamyl transpeptidase, total bilirubin, and direct bilirubin had varying degrees of elevation. Hepatic parenchyma heterogeneity, ascites, hepatomegaly, narrowing of intrahepatic inferior vena cava and hepatic veins, edema around the portal vein, and gallbladder wall edema were the most common MRI imaging features of SOS.
Although this systematic review included not enough high-quality publications due to the low incidence of SOS, the findings of this review help clinicians to know about the epidemiological and imaging features of SOS and provide a more reliable and accurate diagnosis of SOS.
In the future, more high-quality prospective studies need to be conducted. Moreover, to further improve the diagnostic efficiency for SOS, some up-to-date imaging techniques, such as functional MRI, need to be developed and applied, including hepatobiliary scan of Gd-EOB MRI, susceptibility weighted imaging, and other functional imaging methods.