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Published online before print September 27, 2006, 10.1148/radiol.2412051209
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(Radiology 2006;241:581-588.)
© RSNA, 2006

Vascular and Interventional Radiology

Diaphragmatic Weakness after Transcatheter Arterial Chemoembolization of Inferior Phrenic Artery for Treatment of Hepatocellular Carcinoma1

Sung Wook Shin, MD, Young Soo Do, MD, Sung Wook Choo, MD, Wei Chiang Lieu, MD, Sung Ki Cho, MD, Kwang Bo Park, MD, Byung Chul Yoo, MD, Eun Hae Kang, MD and In-Wook Choo, MD

1 From the Department of Radiology and Center for Imaging Sciences (S.W.S., Y.S.D., S.W.C., W.C.L., S.K.C., K.B.P., I.W.C.), Division of Gastroenterology (B.C.Y.), and Department of Medicine, Division of Pulmonary and Critical Care Medicine (E.H.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-ku, Seoul 135-710, Korea. Received July 19, 2005; revision requested September 22; revision received October 19; accepted November 17; final version accepted January 2, 2006. Address correspondence to Y.S.D. (e-mail: ysdo{at}smc.samsung.co.kr).

Purpose: To prospectively assess the diaphragmatic anatomic and functional consequences of transcatheter arterial chemoembolization (TACE) of the inferior phrenic artery in patients with hepatocellular carcinoma.

Materials and Methods: Informed consent and institutional review board approval were obtained. Fifteen patients (13 men, two women; mean age, 52 years; age range, 22–61 years) who underwent TACE of the inferior phrenic artery for treatment of hepatocellular carcinoma were enrolled. The right inferior phrenic artery was embolized in 14 patients, and the left inferior phrenic artery was embolized in one patient. Chest radiography, fluoroscopy, computed tomography (CT), and pulmonary function tests were performed before and after TACE of the inferior phrenic artery. The post-TACE examinations were performed 2–3 months after TACE, and the results were compared with those of the pre-TACE examinations. A paired t test or the Wilcoxon signed rank test was used for statistical analyses.

Results: At chest radiography and fluoroscopy, six of 15 patients (40%) had both elevation and movement abnormality of the ipsilateral hemidiaphragm after TACE of the inferior phrenic artery. The mean (± standard deviation) diaphragmatic thickness on CT scans changed from 9.11 mm ± 3.02 to 7.67 mm ± 2.27 after TACE (P = .048). The mean vital capacity also was significantly decreased after TACE, from 91.87% ± 18.52 to 82.27% ± 16.94 of the predicted value (P = .006). The decreases in diaphragmatic thickness and vital capacity were most pronounced in the patients with abnormal findings at chest radiography and fluoroscopy.

Conclusion: After TACE of the inferior phrenic artery, a substantial portion of patients showed functional and anatomic evidence of diaphragmatic weakness.

© RSNA, 2006