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Identification of MRI features associated with injury type, severity, and prognosis in drug-induced liver injury

  • Magnetic Resonance
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To identify magnetic resonance imaging (MRI) features associated with injury type, severity, and liver transplantation (LT)/liver-related death (LRD) in drug-induced liver injury (DILI).

Methods

The eligible DILI patients (2016 to 2020) who underwent contrast abdominal MRI within 3 months of onset were retrospectively analysed at Beijing Friendship Hospital, Capital Medical University. The MRI features independently associated with severity and prognosis were identified by backwards logistic regression. Unadjusted odds ratios (ORs) and 95% confidence intervals (CIs) are given.

Results

The median age of 180 patients was 55.5 years, with 126 (70.0%) women. The injury types included hepatocellular (135 cases, 75.0%), mixed (23, 12.8%), and cholestatic (22, 12.2%). The proportion of periportal oedema in patients with hepatocellular and mixed injury was significantly higher than that in cholestatic injury (62.2%, 47.8% vs. 18.2%, p < 0.001). For severity, 157 (87.2%) patients had mild to moderate injury, and 23 (12.8%) had severe to fatal/LT. Irregularity of the liver surface (6.56 (95% CI, 1.27–22.84)), transient hepatic attenuation difference (THAD) (3.27 (95% CI, 1.14–9.36)), and splenomegaly (5.86 (95% CI, 1.96–17.53)) were independently associated with severity. Eight (4.4%) patients died/underwent LT. THAD (8.89 (95% CI, 1.35–58.43)), and ascites (64.63 (95% CI, 6.93–602.40)) were independently associated with LT/LRD. The prediction of the new model employing THAD and ascites for LT/LRD within 1 year was 0.959 (95% CI, 0.917–1.000).

Conclusions

Periportal oedema was associated with the type of injury. Irregularity of the liver surface, THAD, and splenomegaly were associated with severity. THAD and ascites may have potential clinical utility in predicting LT/LRD outcomes within 1 year.

Key Points

• Contrast abdominal magnetic resonance imaging features can help clinicians evaluate the type of injury, severity, and poor prognosis of drug-induced liver injury.

• Transient hepatic attenuation difference and ascites have potential clinical utility in the prediction of the poor prognosis of liver transplantation/liver-related death.

• The new model predicting poor prognosis has a relatively high sensitivity of 0.875 and a high specificity of 0.919.

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Abbreviations

CI:

Confidence interval

DILI:

Drug-induced liver injury

DWI:

Diffusion-weighted imaging

LRD:

Liver-related death

LT:

Liver transplantation

MRI:

Magnetic resonance imaging

THAD:

Transient hepatic attenuation difference

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Funding

This study has received funding from the National Natural Science Foundation of China. (No. 81900526; 82103902; 82071876).

Author information

Author notes

  1. Ting Wu and Dawei Yang contributed equally to this work.

Authors and Affiliations

  1. Liver Research Center, Beijing Friendship Hospital, Key Laboratory on Translational Medicine on Cirrhosis, National Clinical Research Center for Digestive Disease, Capital Medical University, Beijing, China

    Ting Wu, Yan Wang, Min Li, Liwei Liu, Kexin Li, Jidong Jia, Xinyan Zhao & Hong Ma

  2. Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China

    Dawei Yang, Xiaopei Wang & Zhenghan Yang

  3. Department of Pathology, National University Hospital, Singapore, Singapore

    Aileen Wee

  4. Clinical Epidemiology and Evidence Base Medicine Unit, Beijing Friendship Hospital, Capital Medical University, Beijing, China

    Min Li

  5. Department of Pathology and Molecular Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada

    Jimin Liu

Authors
  1. Ting Wu
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  4. Yan Wang
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Corresponding authors

Correspondence to Xinyan Zhao or Hong Ma.

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The scientific guarantor of this publication is Xinyan Zhao.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Min Li (Beijing, China) has kindly provided statistical advice for this manuscript.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

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• retrospective

• observational

• performed at one institution

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Wu, T., Yang, D., Wee, A. et al. Identification of MRI features associated with injury type, severity, and prognosis in drug-induced liver injury. Eur Radiol 33, 666–677 (2023). https://doi.org/10.1007/s00330-022-09041-6

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  • DOI: https://doi.org/10.1007/s00330-022-09041-6

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