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

The liver is the major drug-metabolizing and drug-detoxifying organ. Many drugs can cause liver damage through various mechanisms; however, the liver response to injury includes a relatively narrow spectrum of alterations that, regardless of the cause, are represented by phlogosis, oxidative stress and necrosis. The combination of these alterations mainly results in three radiological findings: vascular alterations, structural changes and metabolic function reduction. Chemotherapy has changed in recent decades in terms of the drugs, protocols and duration, allowing patients a longer life expectancy. As a consequence, we are currently observing an increase in chemotherapy-associated liver injury patterns once considered unusual. Recognizing this form of damage in an early stage is crucial for reconsidering the therapy regimen and thus avoiding severe complications. In this frontier article, we analyze the role of imaging in detecting some of these pathological patterns, such as pseudocirrhosis, yellow liver due to chemotherapy-associated steatosis-steatohepatitis, and blue liver, including sinusoidal obstruction syndrome, veno-occlusive disease and peliosis.

Automated summary

The liver plays a crucial role in drug metabolism and detoxification, responding to injury with inflammation, oxidative stress, and necrosis. Advances in chemotherapy have improved patient survival but also increased the incidence of chemotherapy-associated liver injuries. Early recognition of these damages is essential for adjusting treatment regimens to prevent severe complications.