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Venkatesh SK, Harper KC, Borhani AA, Furlan A, Thompson SM, Chen EZM, Idilman IS, Miller FH, Hoodeshenas S, Navin PJ, Gu CN, Welle CL, Torbenson MS. Hepatic Sinusoidal Disorders. Radiographics 2024; 44:e240006. [PMID: 39146204 DOI: 10.1148/rg.240006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
Hepatic sinusoids are highly specialized microcirculatory conduits within the hepatic lobules that facilitate liver functions. The sinusoids can be affected by various disorders, including sinusoidal dilatation, sinusoidal obstruction syndrome (SOS), sinusoidal cellular infiltration, perisinusoidal infiltration, and endothelial neoplasms, such as hemangioendothelioma and angiosarcoma. While these disorders, particularly SOS and neoplasms, can be life threatening, their clinical manifestation is often nonspecific. Patients may present with right upper quadrant pain, jaundice, hepatomegaly, ascites, splenomegaly, and unexplained weight gain, although the exact manifestation depends on the cause, severity, and duration of the disease. Ultimately, invasive tests may be necessary to establish the diagnosis. A comprehensive understanding of imaging manifestations of various sinusoidal disorders contributes to early diagnosis and can help radiologists detect subclinical disease. Additionally, specific imaging features may assist in identifying the cause of the disorder, leading to a more focused and quicker workup. For example, a mosaic pattern of enhancement of the liver parenchyma is suggestive of sinusoidal dilatation; peripheral and patchy reticular hypointensity of the liver parenchyma on hepatobiliary MR images is characteristic of SOS; and associated diffuse multiple hyperintensities on diffusion-weighted images may be specific for malignant sinusoidal cellular infiltration. The authors provide an overview of the pathogenesis, clinical features, and imaging appearances of various hepatic sinusoidal disorders, with a special emphasis on SOS. ©RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
- Sudhakar K Venkatesh
- From the Department of Radiology, Abdominal Imaging Division, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (S.K.V., K.C.H., S.M.T., S.H., P.J.N., C.N.G., C.L.W.); Department of Medical Imaging, University of Ottawa, Ottawa, Ontario, Canada (K.C.H.); Department of Abdominal Imaging, Northwestern Memorial Hospital, Chicago, Ill (A.A.B.); Department of Abdominal Imaging, University of Pittsburgh, Pittsburgh, Pa (A.F., F.H.M.); Department of Anatomic Pathology, Mayo Clinic, Rochester, Minn (E.Z.M.C., M.S.T.); and Department of Radiology, Hacettepe University, Ankara, Turkey (I.S.I.)
| | - Kelly C Harper
- From the Department of Radiology, Abdominal Imaging Division, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (S.K.V., K.C.H., S.M.T., S.H., P.J.N., C.N.G., C.L.W.); Department of Medical Imaging, University of Ottawa, Ottawa, Ontario, Canada (K.C.H.); Department of Abdominal Imaging, Northwestern Memorial Hospital, Chicago, Ill (A.A.B.); Department of Abdominal Imaging, University of Pittsburgh, Pittsburgh, Pa (A.F., F.H.M.); Department of Anatomic Pathology, Mayo Clinic, Rochester, Minn (E.Z.M.C., M.S.T.); and Department of Radiology, Hacettepe University, Ankara, Turkey (I.S.I.)
| | - Amir A Borhani
- From the Department of Radiology, Abdominal Imaging Division, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (S.K.V., K.C.H., S.M.T., S.H., P.J.N., C.N.G., C.L.W.); Department of Medical Imaging, University of Ottawa, Ottawa, Ontario, Canada (K.C.H.); Department of Abdominal Imaging, Northwestern Memorial Hospital, Chicago, Ill (A.A.B.); Department of Abdominal Imaging, University of Pittsburgh, Pittsburgh, Pa (A.F., F.H.M.); Department of Anatomic Pathology, Mayo Clinic, Rochester, Minn (E.Z.M.C., M.S.T.); and Department of Radiology, Hacettepe University, Ankara, Turkey (I.S.I.)
| | - Alessandro Furlan
- From the Department of Radiology, Abdominal Imaging Division, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (S.K.V., K.C.H., S.M.T., S.H., P.J.N., C.N.G., C.L.W.); Department of Medical Imaging, University of Ottawa, Ottawa, Ontario, Canada (K.C.H.); Department of Abdominal Imaging, Northwestern Memorial Hospital, Chicago, Ill (A.A.B.); Department of Abdominal Imaging, University of Pittsburgh, Pittsburgh, Pa (A.F., F.H.M.); Department of Anatomic Pathology, Mayo Clinic, Rochester, Minn (E.Z.M.C., M.S.T.); and Department of Radiology, Hacettepe University, Ankara, Turkey (I.S.I.)
| | - Scott M Thompson
- From the Department of Radiology, Abdominal Imaging Division, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (S.K.V., K.C.H., S.M.T., S.H., P.J.N., C.N.G., C.L.W.); Department of Medical Imaging, University of Ottawa, Ottawa, Ontario, Canada (K.C.H.); Department of Abdominal Imaging, Northwestern Memorial Hospital, Chicago, Ill (A.A.B.); Department of Abdominal Imaging, University of Pittsburgh, Pittsburgh, Pa (A.F., F.H.M.); Department of Anatomic Pathology, Mayo Clinic, Rochester, Minn (E.Z.M.C., M.S.T.); and Department of Radiology, Hacettepe University, Ankara, Turkey (I.S.I.)
| | - Eric Z M Chen
- From the Department of Radiology, Abdominal Imaging Division, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (S.K.V., K.C.H., S.M.T., S.H., P.J.N., C.N.G., C.L.W.); Department of Medical Imaging, University of Ottawa, Ottawa, Ontario, Canada (K.C.H.); Department of Abdominal Imaging, Northwestern Memorial Hospital, Chicago, Ill (A.A.B.); Department of Abdominal Imaging, University of Pittsburgh, Pittsburgh, Pa (A.F., F.H.M.); Department of Anatomic Pathology, Mayo Clinic, Rochester, Minn (E.Z.M.C., M.S.T.); and Department of Radiology, Hacettepe University, Ankara, Turkey (I.S.I.)
| | - Ilkay S Idilman
- From the Department of Radiology, Abdominal Imaging Division, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (S.K.V., K.C.H., S.M.T., S.H., P.J.N., C.N.G., C.L.W.); Department of Medical Imaging, University of Ottawa, Ottawa, Ontario, Canada (K.C.H.); Department of Abdominal Imaging, Northwestern Memorial Hospital, Chicago, Ill (A.A.B.); Department of Abdominal Imaging, University of Pittsburgh, Pittsburgh, Pa (A.F., F.H.M.); Department of Anatomic Pathology, Mayo Clinic, Rochester, Minn (E.Z.M.C., M.S.T.); and Department of Radiology, Hacettepe University, Ankara, Turkey (I.S.I.)
| | - Frank H Miller
- From the Department of Radiology, Abdominal Imaging Division, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (S.K.V., K.C.H., S.M.T., S.H., P.J.N., C.N.G., C.L.W.); Department of Medical Imaging, University of Ottawa, Ottawa, Ontario, Canada (K.C.H.); Department of Abdominal Imaging, Northwestern Memorial Hospital, Chicago, Ill (A.A.B.); Department of Abdominal Imaging, University of Pittsburgh, Pittsburgh, Pa (A.F., F.H.M.); Department of Anatomic Pathology, Mayo Clinic, Rochester, Minn (E.Z.M.C., M.S.T.); and Department of Radiology, Hacettepe University, Ankara, Turkey (I.S.I.)
| | - Safa Hoodeshenas
- From the Department of Radiology, Abdominal Imaging Division, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (S.K.V., K.C.H., S.M.T., S.H., P.J.N., C.N.G., C.L.W.); Department of Medical Imaging, University of Ottawa, Ottawa, Ontario, Canada (K.C.H.); Department of Abdominal Imaging, Northwestern Memorial Hospital, Chicago, Ill (A.A.B.); Department of Abdominal Imaging, University of Pittsburgh, Pittsburgh, Pa (A.F., F.H.M.); Department of Anatomic Pathology, Mayo Clinic, Rochester, Minn (E.Z.M.C., M.S.T.); and Department of Radiology, Hacettepe University, Ankara, Turkey (I.S.I.)
| | - Patrick J Navin
- From the Department of Radiology, Abdominal Imaging Division, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (S.K.V., K.C.H., S.M.T., S.H., P.J.N., C.N.G., C.L.W.); Department of Medical Imaging, University of Ottawa, Ottawa, Ontario, Canada (K.C.H.); Department of Abdominal Imaging, Northwestern Memorial Hospital, Chicago, Ill (A.A.B.); Department of Abdominal Imaging, University of Pittsburgh, Pittsburgh, Pa (A.F., F.H.M.); Department of Anatomic Pathology, Mayo Clinic, Rochester, Minn (E.Z.M.C., M.S.T.); and Department of Radiology, Hacettepe University, Ankara, Turkey (I.S.I.)
| | - Chris N Gu
- From the Department of Radiology, Abdominal Imaging Division, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (S.K.V., K.C.H., S.M.T., S.H., P.J.N., C.N.G., C.L.W.); Department of Medical Imaging, University of Ottawa, Ottawa, Ontario, Canada (K.C.H.); Department of Abdominal Imaging, Northwestern Memorial Hospital, Chicago, Ill (A.A.B.); Department of Abdominal Imaging, University of Pittsburgh, Pittsburgh, Pa (A.F., F.H.M.); Department of Anatomic Pathology, Mayo Clinic, Rochester, Minn (E.Z.M.C., M.S.T.); and Department of Radiology, Hacettepe University, Ankara, Turkey (I.S.I.)
| | - Christopher L Welle
- From the Department of Radiology, Abdominal Imaging Division, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (S.K.V., K.C.H., S.M.T., S.H., P.J.N., C.N.G., C.L.W.); Department of Medical Imaging, University of Ottawa, Ottawa, Ontario, Canada (K.C.H.); Department of Abdominal Imaging, Northwestern Memorial Hospital, Chicago, Ill (A.A.B.); Department of Abdominal Imaging, University of Pittsburgh, Pittsburgh, Pa (A.F., F.H.M.); Department of Anatomic Pathology, Mayo Clinic, Rochester, Minn (E.Z.M.C., M.S.T.); and Department of Radiology, Hacettepe University, Ankara, Turkey (I.S.I.)
| | - Michael S Torbenson
- From the Department of Radiology, Abdominal Imaging Division, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (S.K.V., K.C.H., S.M.T., S.H., P.J.N., C.N.G., C.L.W.); Department of Medical Imaging, University of Ottawa, Ottawa, Ontario, Canada (K.C.H.); Department of Abdominal Imaging, Northwestern Memorial Hospital, Chicago, Ill (A.A.B.); Department of Abdominal Imaging, University of Pittsburgh, Pittsburgh, Pa (A.F., F.H.M.); Department of Anatomic Pathology, Mayo Clinic, Rochester, Minn (E.Z.M.C., M.S.T.); and Department of Radiology, Hacettepe University, Ankara, Turkey (I.S.I.)
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