HEPATIC LOBAR ATROPHY - ASSOCIATION WITH IPSILATERAL PORTAL-VEIN OBSTRUCTION

OBJECTIVE. This study was performed to evaluate the association betwee n hepatic lobar atrophy, bile duct obstruction, and portal vein obstru ction. MATERIALS AND METHODS, Thirty cases of hepatic lobar atrophy id entified on angiography with CT during arterial portography from Augus t 1992 to March 1995 were retrospectively reviewed by two independent observers. Cases were evaluated for vascular patency and bile duct obs truction. Malignant diagnoses were present in 28 of 30 patients. RESUL TS. Twenty-two patients (73%) had atrophy in the left lobe and eight p atients (27%) had right lobar atrophy. Portal vein obstruction was uni lateral and confined to the atrophic lobe in 26 patients (87%). In con trast, bile duct obstruction was bilateral in 23 patients (77%) and in only four patients (13%) was it isolated to the atrophic lobe. The co rrelation between atrophy and portal vein obstruction was significant, with 90% sensitivity, 97% specificity, and 96% positive predictive va lue (p <.00001). For the correlation between atrophy and biliary obstr uction, the sensitivity of angiography with CT during arterial portogr aphy was 90%, specificity was 23%, and positive predictive value was 5 4% (p =.17). CONCLUSION. Hepatic lobar atrophy usually occurs in the s etting of combined biliary and portal vein obstruction. A significant correlation exists between hepatic lobar atrophy and ipsilateral porta l vein obstruction.