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Gastrointestinal Imaging |
1 From the Department of Diagnostic Radiology and the Research Institute of Radiological Science, Yonsei University College of Medicine, YongDong Severance Hospital, 146-92 Dogok-Dong, Gangnam-Gu, Seoul 135-270, South Korea. Received January 19, 2001; revision requested February 26; revision received April 19; accepted May 22. Address correspondence to J.S.Y., Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (e-mail: yjsrad97@yumc.yonsei.ac.kr).
PURPOSE: To document the computed tomographic (CT) findings of transcatheter arterial chemoembolization (TACE)–induced, localized bile duct injuries leading to portal vein branch obliteration in the liver and to elucidate the clinical implications with retrospective review of the authors’ experiences.
MATERIALS AND METHODS: Follow-up CT scans obtained in 11 patients with TACE-induced intrahepatic bile duct dilatation were reviewed retrospectively to evaluate serial changes in the adjacent portal vein branches and hepatic parenchyma. Clinical data, including time between TACE and CT and serum alkaline phosphatase levels, also were analyzed.
RESULTS: Of 11 patients with marked (n = 8) or mild (n = 3), lobar (n = 4) or segmental (n = 7) bile duct dilatation with or without bile collection in the tissue sheaths of the Glisson capsule or hepatic parenchyma, nine (82%) had bile duct changes at the first CT follow-up, within 1 month after TACE. Marked narrowing or obliteration of the adjacent intrahepatic portal vein branches in 10 (91%) patients resulted in progressive atrophy of the corresponding hepatic parenchyma in nine (82%) at variable times after TACE. The serum alkaline phosphatase level increased to more than 200 U/L in eight (89%) of nine patients 1 month after TACE.
CONCLUSION: TACE-induced intrahepatic bile duct injury resulting in obliteration of the adjacent portal vein branch seems to be one cause of hepatic parenchymal atrophic changes after TACE.
Index terms: Bile ducts, injuries, 768.458, 768.469 • Liver neoplasms, chemotherapeutic embolization, 768.1229, 768.1264, 768.1266 • Liver neoplasms, CT, 768.12111, 768.12112, 768.12114, 768.12115
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