ROLE OF IMAGING IN CHEMOTHERAPY-INDUCED HEPATIC PARENCHYMAL CHANGES

Abstract

Background: Chemotherapy-induced hepatic parenchymal changes (CIHPC) represent a significant complication in cancer patients receiving systemic therapy. These changes include hepatic steatosis, pseudocirrhosis, and hepatic fibrosis, which can impact treatment decisions and patient outcomes. Objective: To determine the role of imaging in detecting and characterizing chemotherapy-induced hepatic parenchymal changes in cancer patients. Methods: This descriptive observational study was conducted at the Department of Oncology and Radiology, INMOL Cancer Hospital, Lahore, Punjab, Pakistan, over six months. A total of 127 patients aged 18–60 years planned for chemotherapy with normal baseline liver parenchyma were enrolled using non-probability consecutive sampling. Baseline and post-treatment CT scans, ultrasound, and FibroScan measurements were performed. Hepatic steatosis was assessed using liver-to-spleen attenuation ratio on CT, pseudocirrhosis by morphological features, and hepatic fibrosis by FibroScan measured in kilopascals and graded according to METAVIR scale. Data were analyzed using SPSS version 25. Results: Among 127 patients (mean age 45.2 ± 11.8 years), 78 (61.4%) were female and 49 (38.6%) were male. Breast cancer was the most common malignancy (52.8%), followed by gastrointestinal (28.3%) and ovarian cancers (18.9%). Post-chemotherapy imaging revealed hepatic steatosis in 42 patients (33.1%), pseudocirrhosis in 18 patients (14.2%), and hepatic fibrosis in 31 patients (24.4%). Significant associations were found between hepatic steatosis and taxane-based regimens (p = 0.002), pseudocirrhosis and platinum-based regimens (p = 0.018), and hepatic fibrosis and elevated BMI (p = 0.031). The mean liver-to-spleen attenuation ratio decreased significantly from 1.18 ± 0.12 to 0.98 ± 0.15 (p < 0.001). Mean liver stiffness increased from 4.8 ± 1.2 kPa to 7.3 ± 2.1 kPa (p < 0.001). Conclusion: Imaging plays a crucial role in detecting chemotherapy-induced hepatic parenchymal changes. CT and FibroScan are valuable non-invasive tools for monitoring hepatic toxicity, enabling oncologists to modify treatment regimens and prevent further hepatic damage.