Bile duct complications of hepatic arterial infusion chemotherapy evaluated by helical CT.
OBJECTIVE
To describe the imaging findings of bile duct complications of hepatic arterial infusion chemotherapy (HAIC) using helical CT, to set diagnostic criteria, to develop a CT grading system, and to correlate these with clinical findings and laboratory data.


METHODS
Follow-up helical CT of the abdomen was performed every 3 months for 60 patients receiving HAIC. Three radiologists reviewed all CT studies before and after treatment, using either the picture archiving and communication system or hard copies. The findings of bile duct abnormalities were correlated with findings from other imaging techniques, clinical symptoms and laboratory data.


RESULTS
Bile duct abnormalities developed in 34 (57%) of cases either during HAIC or 1 to 12 months after treatment. In 14 (41%) of these 34 patients, enhancement of the hepatic parenchyma along the dilated bile duct or in the segmental or lobar distribution was observed. In 43 cases (72%), normal or abnormal alkaline phosphatase levels were consistent with normal or abnormal CT findings, respectively. Increasing alkaline phosphatase and bilirubin levels were related to CT grade.


CONCLUSIONS
Imaging findings of bile duct complications of HAIC are similar to those of primary sclerosing cholangitis, and correlate well with abnormal clinical and laboratory data. In the presence of such clinical abnormalities, thin-section helical CT with careful review of the imaging studies helps to determine the correct diagnosis, monitor the changes and guide appropriate treatment.
Phongkitkarun
S
S
Department of Diagnostic Radiology, University of Texas M. D. Anderson Cancer Center, Houston, TX, USA. rasih@mahidol.ac.th
Kobayashi
S
S
Varavithya
V
V
Huang
X
X
Curley
S A
SA
Charnsangavej
C
C
D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000556:secondary; D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001649:Bile Duct Diseases / Q000097:blood / Q000000981:diagnostic imaging* / Q000209:etiology*; D001663:Bilirubin / Q000097:blood; D002758:Cholangiography / Q000379:methods*; D015179:Colorectal Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy; D005260:Female; D005467:Floxuridine / Q000009:adverse effects / Q000627:therapeutic use; D005500:Follow-Up Studies; D006499:Hepatic Artery; D006801:Humans; D007261:Infusions, Intra-Arterial / Q000009:adverse effects; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
D000970:Antineoplastic Agents; D005467:Floxuridine; D000469:Alkaline Phosphatase; D001663:Bilirubin