[Investigation of bile duct injury after transcatheter arterial chemoembolization].
OBJECTIVE
To investigate the image findings of bile duct injury after transcatheter arterial chemoembolization (TACE) for hepatic malignancy.


METHODS
During the past 3 years, 1240 patients with different hepatic malignancies had undergone a total of 2680 TACE procedures. Eighteen patients (1.4%) developed bile duct injuries from 3 weeks to 3 months after TACE. All of the 18 patients received follow-up CT and ultra-sonography, 14 MRI and 15 digital subtract angiography (DSA). The image data was retrospectively reviewed, with the potential predisposing factors correlated to TACE-induced bile duct injury.


RESULTS
TACE-induced bile duct injuries developed in 13 of 148 patients with liver metastasis (8.8%), 5 of 1092 patients with hepatocellular carcinoma (HCC) (0.5%). On image examination, focal peripheral intrahepatic bile duct dilatation was detected in 4 cases, multiple bile duct dilatations with segmental or sub-segmental distribution in 8, and a large lobular cystic lesion or biloma in 6 cases, and progressive atrophy of the corresponding hepatic parenchyma in 6 patients in whom the TACE induced-bile injury developed at different intervals after TACE. The incidence of bile duct injury was higher in non-cirrhotic patients with metastatic liver lesions than in patients with hepatocellular carcinoma associated with cirrhosis (P < 0.01), and it was also higher in patients using an emulsion of lipiodol-cisplatin or carboplatin than in patients using other emboliging agents (P < 0.01). The incidence was higher either in patients with hypovascular lesions than in patients with hypervascular lesions (P < 0.05).


CONCLUSIONS
Biliary abnormalities, including focal and multiple intrahepatic bile duct dilatation, and cystic lesion or biloma, may develop and can be detected during the follow-up examination imaging in patients with hepatic malignancy after TACE. Noncirrhotic liver and intact function, due to the lack of peri-biliany collateral circulation, are the significant predisposing factors to the development of TACE-induced bile duct injury.
Wang
Mao-qiang
MQ
Department of Interventional Radiology, Chinese PLA General Hospital, Beijing 100853, China. wangmq@vip.sina.com
Shao
Ru-hong
RH
Ye
Hui-yi
HY
Wang
Zhi-qiang
ZQ
Wang
Zhong-pu
ZP
Liu
Feng-yong
FY
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D001652:Bile Ducts / Q000000981:diagnostic imaging / Q000473:pathology*; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects*; D002758:Cholangiography; D002945:Cisplatin / Q000008:administration & dosage; D004108:Dilatation, Pathologic / Q000209:etiology; D015251:Epirubicin / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D007459:Iodized Oil / Q000008:administration & dosage; D008113:Liver Neoplasms / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D014463:Ultrasonography
D015251:Epirubicin; D016685:Mitomycin; D007459:Iodized Oil; D002945:Cisplatin; D005472:Fluorouracil