title: Diaphragmatic weakness after transcatheter arterial chemoembolization of inferior phrenic artery for treatment of hepatocellular carcinoma.
abstract: OBJECTIVE
  To prospectively assess the diaphragmatic anatomic and functional consequences of transcatheter arterial chemoembolization (TACE) of the inferior phrenic artery in patients with hepatocellular carcinoma.
  
  
  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.
  
  
  CONCLUSIONS
  After TACE of the inferior phrenic artery, a substantial portion of patients showed functional and anatomic evidence of diaphragmatic weakness.
authors.affiliation: Department of Radiology and Center for Imaging Sciences, Division of Gastroenterology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-ku, Seoul 135-710, Korea.
authors.forename: Sung Wook
authors.initials: SW
authors.lastname: Shin
authors.forename: Young Soo
authors.initials: YS
authors.lastname: Do
authors.forename: Sung Wook
authors.initials: SW
authors.lastname: Choo
authors.forename: Wei Chiang
authors.initials: WC
authors.lastname: Lieu
authors.forename: Sung Ki
authors.initials: SK
authors.lastname: Cho
authors.forename: Kwang Bo
authors.initials: KB
authors.lastname: Park
authors.forename: Byung Chul
authors.initials: BC
authors.lastname: Yoo
authors.forename: Eun Hae
authors.initials: EH
authors.lastname: Kang
authors.forename: In-Wook
authors.initials: IW
authors.lastname: Choo
mesh_terms: D000328:Adult; D001158:Arteries; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects*; D003964:Diaphragm / Q000098:blood supply* / Q000293:injuries*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008113:Liver Neoplasms / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012129:Respiratory Function Tests; D018709:Statistics, Nonparametric; D036542:Tomography, Spiral Computed; D016896:Treatment Outcome