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Computed tomography findings of hepatobiliary systems in patients with immune checkpoint inhibitor-induced liver injury

  • Hepatobiliary
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Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

The incidence of immune checkpoint inhibitor (ICI)-induced liver injury has increased recently; however, its imaging characteristics remain unclear. This study aimed to characterize the computed tomography (CT) findings of ICI-induced liver injury.

Methods

This was a single-center retrospective study of patients with ICI-induced liver injury who underwent CT between January 2020 and December 2021. Two board-certified radiologists independently evaluated the CT findings of the patients before the start of ICI therapy (pre-CT) and at the onset of ICI-induced liver injury (post-CT) to determine the presence or absence of imaging findings suggestive of hepatitis and cholangitis. ICI-induced liver injury was classified into three categories based on the CT findings: hepatitis alone, cholangitis alone, and overlapped (cholangitis plus hepatitis).

Results

A total of 19 patients were included in this study. Bile duct dilatation, bile duct wall thickening, non-edematous gallbladder wall thickening, hepatomegaly, periportal edema, and gallbladder wall edema were observed in the post-CT images of 12 (63.2%), 9 (60%), 11 (57.9%), 8 (42.1%), 6 (31.6%), and 2 (10.5%) patients, respectively. Wall thickening in the perihilar, distal, intrapancreatic bile duct and the cystic duct were observed in 53.3%, 60%, 46.7%, and 26.7% of the study population, respectively. Regarding the classification of ICI-induced liver injury, cholangitis alone was most common (36.8%), followed by overlapped (26.3%) and hepatitis alone (26.3%).

Conclusions

Patients with ICI-induced liver injury demonstrated a higher incidence of biliary abnormalities than hepatic abnormalities on CT images; nonetheless, future studies with larger sample sizes are needed to validate these findings.

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Funding

This study was supported by Canon Medical Systems.

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Author notes

  1. Sota Masuoka

    Present address: Department of Radiology, Jichi Medical University Hospital, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan

Authors and Affiliations

  1. Department of Diagnostic Radiology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan

    Sota Masuoka, Takashi Hiyama, Hirofumi Kuno, Tomoaki Sasaki, Shioto Oda, Yusuke Miyasaka, Masayuki Yamaguchi & Tatsushi Kobayashi

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  1. Sota Masuoka
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  2. Takashi Hiyama
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  3. Hirofumi Kuno
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  8. Tatsushi Kobayashi
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by SM and TH. The first draft of the manuscript was written by SM and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Sota Masuoka.

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Masuoka, S., Hiyama, T., Kuno, H. et al. Computed tomography findings of hepatobiliary systems in patients with immune checkpoint inhibitor-induced liver injury. Abdom Radiol 48, 3012–3021 (2023). https://doi.org/10.1007/s00261-023-03967-1

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  • DOI: https://doi.org/10.1007/s00261-023-03967-1

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