Basic Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 21, 2020; 26(7): 706-716
Published online Feb 21, 2020. doi: 10.3748/wjg.v26.i7.706
Liver stiffness and perfusion changes for hepatic sinusoidal obstruction syndrome in rabbit model
Jaeseung Shin, Haesung Yoon, Yoon Jin Cha, Kyunghwa Han, Mi-Jung Lee, Myung-Joon Kim, Hyun Joo Shin
Jaeseung Shin, Haesung Yoon, Mi-Jung Lee, Myung-Joon Kim, Hyun Joo Shin, Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 03722, South Korea
Yoon Jin Cha, Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, South Korea
Kyunghwa Han, Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Seoul 03722, South Korea
Author contributions: Shin HJ designed the research; Shin HJ, Shin J, Yoon H and Cha YJ performed the research; Shin HJ and Han K analyzed the data; Shin HJ and Shin J wrote the paper; Shin HJ, Lee M-J, Kim M-J, Yoon H, and Shin J revised and edited manuscript.
Supported by a Faculty Research Grant of Yonsei University College of Medicine for 2017, No. 6-2017-0090.
Institutional animal care and use committee statement: This study was approved by the Institution’s Animal Care and Use Committee of Yonsei University Health System (IACUC approval no. 2017-0174).
Conflict-of-interest statement: Dr. Shin reports grants from Yonsei University College of Medicine, during the conduct of the study.
Data sharing statement: No additional data are available.
ARRIVE guidelines statement: The authors have read the ARRIVE guidelines, and the manuscript was prepared and revised according to the ARRIVE guidelines.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: Hyun Joo Shin, MD, PhD, Clinical Assistant Professor, Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea. lamer-22@yuhs.ac
Received: October 29, 2019
Peer-review started: October 29, 2019
First decision: December 23, 2019
Revised: January 8, 2020
Accepted: January 19, 2020
Article in press: January 19, 2020
Published online: February 21, 2020
ARTICLE HIGHLIGHTS
Research background

Hepatic sinusoidal obstruction syndrome (SOS) is a well-known serious complication of hematopoietic stem cell transplantation and is associated with chemotherapy. Noninvasive imaging methods are required for the early diagnosis and severity assessment of hepatic SOS.

Research motivation

In pediatric patients, SOS is the most common cause of death in patients with hematopoietic stem cell transplantation with nonspecific symptoms. Currently the diagnosis is primarily based on nonspecific clinical features and invasive liver biopsy. Therefore, noninvasive imaging methods are required for the early diagnosis and severity assessment of hepatic SOS. Supersonic shear wave imaging (SSI) is a recently introduced US elastography technique and is a noninvasive tool for evaluating liver stiffness. Dual energy computed tomography (DECT) could quantify tissue composition or iodine concentration. We postulated that these imaging studies could quantify liver stiffness and perfusion changes in hepatic SOS.

Research objectives

The purpose of the study was to determine the effectiveness of SSI and DECT for diagnosing hepatic SOS using a rabbit model.

Research methods

Among nine New Zealand white rabbits, three were in control group and six with 6-thioguanine ingestion were in SOS group. Liver stiffness was measured using SSI and liver perfusion was evaluated from virtual monochromatic images of 55 keV and iodine map using DECT on days 0, 3, 10, and 20. Liver stiffness and perfusion parameters were compared according to the groups, days, and pathology scores.

Research results

Compared to the control group, final pathology scores were significantly higher in the SOS group, while there were no gross morphologic changes using conventional imaging. Liver stiffness, Hounsfield Unit values, and iodine concentrations were higher in the SOS compared to the control group as disease progression.

Research conclusions

This study showed that liver stiffness on SSI and perfusion parameters on DECT were significantly increased according to SOS progression in a rabbit model. We suggested that quantitative imaging with SSI and DECT could aid in the early diagnosis of hepatic SOS.

Research perspectives

SSI and DECT could be the noninvasive imaging studies for early diagnosis and severity assessment of hepatic SOS. Because this study demonstrated the potential effectiveness of SSI and DECT for hepatic SOS, further large studies with patients are needed.