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Portal Vein Embolization with Polyvinyl Alcohol Particles and Coils in Preparation for Major Liver Resection for Hepatobiliary Malignancy: Safety and Effectiveness—Study in 26 Patients¹

¹ From the Departments of Diagnostic Imaging (D.C.M., M.E.H.), Surgical Oncology (E.K.A., J.N.V.), and Biostatistics (J.S.M.), University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Box 325, Houston, TX 77030-4009. Received December 7, 2001; revision requested February 22, 2002; final revision received July 29; accepted August 9. Address correspondence to M.E.H. (e-mail: mhicks@di.mdacc.tmc.edu).

View larger version (184K): [in a new window]   Figure 1. Normal anteroposterior flush portogram obtained before PVE by using a 6-F vascular sheath (white arrows) in the right portal vein branch and a 5-F pigtail catheter (large black arrow) in the superior mesenteric vein. An endoscopic plastic biliary endoprosthesis (small black arrow) was placed prior to evaluation for PVE. At CT before PVE, the patient had no biliary dilatation.

View larger version (186K): [in a new window]   Figure 2. Anteroposterior portogram obtained after right PVE demonstrates coils (large arrows) within branches of the right portal system and normal flow to left portal branches. Portal branches that supply segment IV are shown (small arrows).

View larger version (130K): [in a new window]   Figure 3a. (a) Transverse CT scan obtained in a 63-year-old man with hepatocellular carcinoma shows a 5-cm necrotic mass (arrow) in segments VI and VII. The TELV was 1,783 cm3. The FLRs for segments I-III and IV (arrowheads) were 398 and 676 cm3 before and after PVE, respectively. The FLR/TELV ratio before PVE was 22.3%. (b) Transverse CT scan obtained after PVE shows substantial increase in the size of the FLR (arrowheads). The FLR/TELV ratio was 37.9%, which represented an increase of 15.6%. The patient subsequently underwent successful right hepatic hepatectomy and pancreaticoduodenectomy.

View larger version (124K): [in a new window]   Figure 3b. (a) Transverse CT scan obtained in a 63-year-old man with hepatocellular carcinoma shows a 5-cm necrotic mass (arrow) in segments VI and VII. The TELV was 1,783 cm3. The FLRs for segments I-III and IV (arrowheads) were 398 and 676 cm3 before and after PVE, respectively. The FLR/TELV ratio before PVE was 22.3%. (b) Transverse CT scan obtained after PVE shows substantial increase in the size of the FLR (arrowheads). The FLR/TELV ratio was 37.9%, which represented an increase of 15.6%. The patient subsequently underwent successful right hepatic hepatectomy and pancreaticoduodenectomy.

View larger version (123K): [in a new window]   Figure 4a. (a) Transverse CT scan obtained in a 55-year-old man with cholangiocarcinoma shows tumor within the proximal common hepatic duct, just inferior to this CT section. The FLRs for segments I-III (arrowheads) were 301 and 463 cm3 before and after PVE, respectively. The TELV was 2,007 cm3. The FLR/TELV ratio before PVE was 17.0%. (b) Transverse CT scan obtained after PVE demonstrates hypertrophy. The FLR/TELV ratio was 25.1%, which represented an increase of 8.1%. The FLRs for segments I-III (arrowheads) are shown. The patient subsequently underwent successful right trisegmentectomy. (c) Transverse CT scan obtained after resection shows a massive liver remnant (arrows).

View larger version (114K): [in a new window]   Figure 4b. (a) Transverse CT scan obtained in a 55-year-old man with cholangiocarcinoma shows tumor within the proximal common hepatic duct, just inferior to this CT section. The FLRs for segments I-III (arrowheads) were 301 and 463 cm3 before and after PVE, respectively. The TELV was 2,007 cm3. The FLR/TELV ratio before PVE was 17.0%. (b) Transverse CT scan obtained after PVE demonstrates hypertrophy. The FLR/TELV ratio was 25.1%, which represented an increase of 8.1%. The FLRs for segments I-III (arrowheads) are shown. The patient subsequently underwent successful right trisegmentectomy. (c) Transverse CT scan obtained after resection shows a massive liver remnant (arrows).

View larger version (119K): [in a new window]   Figure 4c. (a) Transverse CT scan obtained in a 55-year-old man with cholangiocarcinoma shows tumor within the proximal common hepatic duct, just inferior to this CT section. The FLRs for segments I-III (arrowheads) were 301 and 463 cm3 before and after PVE, respectively. The TELV was 2,007 cm3. The FLR/TELV ratio before PVE was 17.0%. (b) Transverse CT scan obtained after PVE demonstrates hypertrophy. The FLR/TELV ratio was 25.1%, which represented an increase of 8.1%. The FLRs for segments I-III (arrowheads) are shown. The patient subsequently underwent successful right trisegmentectomy. (c) Transverse CT scan obtained after resection shows a massive liver remnant (arrows).

View larger version (147K): [in a new window]   Figure 5a. (a) Transverse CT scan obtained in a 66-year-old man with colon carcinoma and liver metastases (arrow). The FLRs for segments I-III (arrowheads) were 214 and 475 cm3 before and after PVE, respectively. The TELV was 1,982 cm3. The FLR/TELV ratio before PVE was 10.8%. (b) Transverse CT scan obtained after PVE demonstrates hypertrophy. The FLR/TELV ratio was 24.0%, which represented an increase of 13.2%. The FLRs for segments I-III (arrowheads) are shown. The patient subsequently underwent successful right trisegmentectomy.

View larger version (146K): [in a new window]   Figure 5b. (a) Transverse CT scan obtained in a 66-year-old man with colon carcinoma and liver metastases (arrow). The FLRs for segments I-III (arrowheads) were 214 and 475 cm3 before and after PVE, respectively. The TELV was 1,982 cm3. The FLR/TELV ratio before PVE was 10.8%. (b) Transverse CT scan obtained after PVE demonstrates hypertrophy. The FLR/TELV ratio was 24.0%, which represented an increase of 13.2%. The FLRs for segments I-III (arrowheads) are shown. The patient subsequently underwent successful right trisegmentectomy.