Magnetic Resonance Imaging Findings in Patients With Pyrrolizidine Alkaloid–Induced Hepatic Sinusoidal Obstruction Syndrome Xin Li, Xiaoqian Yang, Dong.

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Magnetic Resonance Imaging Findings in Patients With Pyrrolizidine Alkaloid–Induced Hepatic Sinusoidal Obstruction Syndrome Xin Li, Xiaoqian Yang, Dong Xu, Qian Li, Xiangchuang Kong, Zhiwen Lu, Tao Bai, Keshu Xu, Jin Ye, Yuhu Song Clinical Gastroenterology and Hepatology Volume 15, Issue 6, Pages 955-957 (June 2017) DOI: 10.1016/j.cgh.2017.01.009 Copyright © 2017 AGA Institute Terms and Conditions

Figure 1 A 47-year-old man was diagnosed with PA-induced HSOS after the ingestion of Gynura segetum. He received contrast computed tomography scan, DCE MRI scan, and liver biopsy. (A and B) Fat-suppressed T2-weighted MRI. Ascites (star), parenchymal heterogeneity (arrowhead), periportal edema (A, arrow), and gallbladder wall thickening (B, arrow) were shown. (C and D) Image of portal venous phase during dynamic MRI scan. Axial (C) and coronal (D) images demonstrated heterogeneous hypointensity (black arrow). Enhancement surrounding hepatic veins (“claw-shaped” enhancement) (white arrows), and a compressed but patent inferior vena cava (white arrowhead). Heterogeneous hypointensity represents heterogeneous longer T1 signal intensity; liver parenchyma adjacent to heterogeneous hypoattenuation appeared inhomogeneous enhancement. (E) Image of equilibrium phase. Narrowing of right main hepatic vein (white arrow) and a compressed but patent inferior vena cava were demonstrated (black arrow). (F) Equilibrium phase of contrast computed tomography scan from the same patient also demonstrated similar claw-shaped enhancement (white arrows). (G and H) Pathologic examination demonstrates sinusoidal congestion and dilation, hepatocytes necrosis, and extensive extravasation of erythrocytes into pericentral parenchyma. Clinical Gastroenterology and Hepatology 2017 15, 955-957DOI: (10.1016/j.cgh.2017.01.009) Copyright © 2017 AGA Institute Terms and Conditions