Pyrrolizidine alkaloids-induced hepatic sinusoidal obstruction syndrome: Pathogenesis, clinical manifestations, diagnosis, treatment, and outcomes

Figure 3 A 53-year-old man with pyrrolizidine alkaloids-induced hepatic sinusoidal obstruction syndrome (same patient) received gadoxetic acid-enhanced magnetic resonance imaging scan. A: T1-weighted imaging. Ascites (white star), heterogeneous hypointensity (white arrow) were shown; B and C: T2-weighted imaging. Imaging findings included ascites (black star, B), gallbladder wall thickening (white arrow, B), periportal edema (arrowhead, C), heterogeneous hypointensity (white arrow, C); D and E: T2*WI (D) and SWI (E). Heterogeneous hypointensity (white arrow) was observed, and distribution of hypointensity in SWI and T2*WI was similar; F: Image of portal venous phase. Patchy liver enhancement, “claw-shaped” enhancement surrounding hepatic veins (white arrow), stenosis of right hepatic vein (arrowhead) and inferior vena cava (black arrow); G: Image of hepatobiliary phase. Heterogeneous hypointensity (white arrow) was shown. SWI: Susceptibility-weighted imaging; T2*WI: T2*-weighted imaging.