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
ARTICLE HIGHLIGHTS
Research background

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.

Research motivation

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.

Research objectives

The main objective of this systematic review is to summarize the major etiologies, clinical symptoms, and MRI features of SOS.

Research methods

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.

Research results

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.

Research conclusions

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.

Research perspectives

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.