Bile duct injuries leading to portal vein obliteration after transcatheterarterial chemoembolization in the liver: CT findings and initial observations

PURPOSE: To document the computed tomographic (CT) findings of transcathete r arterial chemoembolization (TACE)-induced, localized bile duct injuries l eading to portal vein branch obliteration in the liver and to elucidate the clinical implications with retrospective review of the authors' experience s. MATERIALS AND METHODS: Follow-up CT scans obtained in 11 patients with TACE -induced intrahepatic bile duct dilatation were reviewed retrospectively to evaluate serial changes in the adjacent portal vein branches and hepatic p arenchyma. Clinical data, including time between TACE and CT and serum alka line phosphatase levels, also were analyzed. RESULTS: Of 11 patients with marked (n = 8) or mild (n = 3), lobar (n = 4) or segmental (n = 7) bile duct dilatation with or without bile collection i n the tissue sheaths of the Glisson capsule or hepatic parenchyma, nine (82 %) had bile duct changes at the first CT follow-up, within 1 month after TA CE. Marked narrowing or obliteration of the adjacent intrahepatic portal ve in branches in 10 (91%) patients resulted in progressive atrophy of the cor responding hepatic parenchyma in nine (82%) at variable times after TACE. T he serum alkaline phosphatase level increased to more than 200 U/L in eight (89%) of nine patients 1 month after TALE. CONCLUSION: TACE-induced intrahepatic bile duct injury resulting in obliter ation of the adjacent portal vein branch seems to be one cause of hepatic p arenchymal atrophic changes after TACE.