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Preoperative Portal Vein Embolization with a New Liquid Embolic Agent¹

¹ From the Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-Dong, Songpa-Ku, Seoul 138-736, Korea. From the 2001 RSNA scientific assembly. Received October 17, 2001; revision requested January 9, 2002; final revision received August 23; accepted August 27. Address correspondence to K.B.S. (e-mail: kbsung@amc.seoul.kr).

View larger version (158K): [in a new window]   Figure 1a. Images in a 54-year-old man with a Klatskin tumor. (a) Anteroposterior main portal venogram obtained before embolization of the right portal venous branches. (b) Anteroposterior abdominal conventional radiograph obtained after right portal vein embolization. Note radiopaque Embol-78 (arrowheads) in the right portal venous branches. (c) Anteroposterior direct portal venogram obtained after embolization shows a total occlusion (arrow) of the portal venous branches in the right lobe. (d) CT scans obtained before embolization show patent right (arrows) and left (arrowheads) portal venous branches. (e) CT scans obtained 2 weeks after portal vein embolization show complete occlusion of the right anterior and posterior portal venous branches. Note radiopaque embolic material in the right portal venous branches (arrowheads).

View larger version (144K): [in a new window]   Figure 1b. Images in a 54-year-old man with a Klatskin tumor. (a) Anteroposterior main portal venogram obtained before embolization of the right portal venous branches. (b) Anteroposterior abdominal conventional radiograph obtained after right portal vein embolization. Note radiopaque Embol-78 (arrowheads) in the right portal venous branches. (c) Anteroposterior direct portal venogram obtained after embolization shows a total occlusion (arrow) of the portal venous branches in the right lobe. (d) CT scans obtained before embolization show patent right (arrows) and left (arrowheads) portal venous branches. (e) CT scans obtained 2 weeks after portal vein embolization show complete occlusion of the right anterior and posterior portal venous branches. Note radiopaque embolic material in the right portal venous branches (arrowheads).

View larger version (132K): [in a new window]   Figure 1c. Images in a 54-year-old man with a Klatskin tumor. (a) Anteroposterior main portal venogram obtained before embolization of the right portal venous branches. (b) Anteroposterior abdominal conventional radiograph obtained after right portal vein embolization. Note radiopaque Embol-78 (arrowheads) in the right portal venous branches. (c) Anteroposterior direct portal venogram obtained after embolization shows a total occlusion (arrow) of the portal venous branches in the right lobe. (d) CT scans obtained before embolization show patent right (arrows) and left (arrowheads) portal venous branches. (e) CT scans obtained 2 weeks after portal vein embolization show complete occlusion of the right anterior and posterior portal venous branches. Note radiopaque embolic material in the right portal venous branches (arrowheads).

View larger version (86K): [in a new window]   Figure 1d. Images in a 54-year-old man with a Klatskin tumor. (a) Anteroposterior main portal venogram obtained before embolization of the right portal venous branches. (b) Anteroposterior abdominal conventional radiograph obtained after right portal vein embolization. Note radiopaque Embol-78 (arrowheads) in the right portal venous branches. (c) Anteroposterior direct portal venogram obtained after embolization shows a total occlusion (arrow) of the portal venous branches in the right lobe. (d) CT scans obtained before embolization show patent right (arrows) and left (arrowheads) portal venous branches. (e) CT scans obtained 2 weeks after portal vein embolization show complete occlusion of the right anterior and posterior portal venous branches. Note radiopaque embolic material in the right portal venous branches (arrowheads).

View larger version (89K): [in a new window]   Figure 1e. Images in a 54-year-old man with a Klatskin tumor. (a) Anteroposterior main portal venogram obtained before embolization of the right portal venous branches. (b) Anteroposterior abdominal conventional radiograph obtained after right portal vein embolization. Note radiopaque Embol-78 (arrowheads) in the right portal venous branches. (c) Anteroposterior direct portal venogram obtained after embolization shows a total occlusion (arrow) of the portal venous branches in the right lobe. (d) CT scans obtained before embolization show patent right (arrows) and left (arrowheads) portal venous branches. (e) CT scans obtained 2 weeks after portal vein embolization show complete occlusion of the right anterior and posterior portal venous branches. Note radiopaque embolic material in the right portal venous branches (arrowheads).

View larger version (138K): [in a new window]   Figure 2a. Images in a 57-year-old man with a Klatskin tumor. (a) Anteroposterior main portal venogram obtained before embolization of the right portal venous branches. (b) Anteroposterior left portal venogram obtained before embolization of the right portal venous branches. (c) Anteroposterior abdominal conventional radiograph obtained immediately after right portal vein embolization. Note radiopaque Embol-78 (arrowheads) in the right portal venous branches. (d) Anteroposterior main portal venogram obtained after embolization of the right portal venous branches. Note an inadvertently occluded portal venous branch (arrow) in the left lobe.

View larger version (135K): [in a new window]   Figure 2b. Images in a 57-year-old man with a Klatskin tumor. (a) Anteroposterior main portal venogram obtained before embolization of the right portal venous branches. (b) Anteroposterior left portal venogram obtained before embolization of the right portal venous branches. (c) Anteroposterior abdominal conventional radiograph obtained immediately after right portal vein embolization. Note radiopaque Embol-78 (arrowheads) in the right portal venous branches. (d) Anteroposterior main portal venogram obtained after embolization of the right portal venous branches. Note an inadvertently occluded portal venous branch (arrow) in the left lobe.

View larger version (141K): [in a new window]   Figure 2c. Images in a 57-year-old man with a Klatskin tumor. (a) Anteroposterior main portal venogram obtained before embolization of the right portal venous branches. (b) Anteroposterior left portal venogram obtained before embolization of the right portal venous branches. (c) Anteroposterior abdominal conventional radiograph obtained immediately after right portal vein embolization. Note radiopaque Embol-78 (arrowheads) in the right portal venous branches. (d) Anteroposterior main portal venogram obtained after embolization of the right portal venous branches. Note an inadvertently occluded portal venous branch (arrow) in the left lobe.

View larger version (143K): [in a new window]   Figure 2d. Images in a 57-year-old man with a Klatskin tumor. (a) Anteroposterior main portal venogram obtained before embolization of the right portal venous branches. (b) Anteroposterior left portal venogram obtained before embolization of the right portal venous branches. (c) Anteroposterior abdominal conventional radiograph obtained immediately after right portal vein embolization. Note radiopaque Embol-78 (arrowheads) in the right portal venous branches. (d) Anteroposterior main portal venogram obtained after embolization of the right portal venous branches. Note an inadvertently occluded portal venous branch (arrow) in the left lobe.