Bile duct complications of hepatic arterial infusion chemotherapy evaluated by helical CT
S Phongkitkarun1, S Kobayashi, V Varavithya
1Department of Diagnostic Radiology, University of Texas M. D. Anderson Cancer Center, Houston, TX, USA. rasih@mahidol.ac.th
Insights
Bile duct complications from hepatic arterial infusion chemotherapy (HAIC) are common, appearing on CT scans. These findings correlate with clinical symptoms and lab results, aiding diagnosis and treatment.
Area of Science:
- Radiology
- Oncology
- Hepatology
Background:
- Hepatic arterial infusion chemotherapy (HAIC) is a treatment for liver cancer.
- Bile duct complications can arise as a side effect of HAIC.
Purpose of the Study:
- To detail CT imaging findings of bile duct complications from HAIC.
- To establish diagnostic criteria and a CT grading system.
- To correlate imaging findings with clinical and laboratory data.
Main Methods:
- Helical CT scans of 60 patients receiving HAIC were reviewed.
- Radiologists assessed CT studies before and after treatment.
- Bile duct abnormalities were correlated with other imaging, clinical symptoms, and lab data.
Main Results:
- Bile duct abnormalities occurred in 57% of patients during or after HAIC.
- Hepatic parenchymal enhancement was seen in 41% of affected patients.
- Abnormal alkaline phosphatase and bilirubin levels correlated with CT findings and grade.
Conclusions:
- HAIC-related bile duct complications resemble primary sclerosing cholangitis on imaging.
- CT findings correlate well with clinical and laboratory abnormalities.
- Thin-section helical CT aids in diagnosing, monitoring, and guiding treatment for these complications.
Aim:
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.
Conclusion:
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.
