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. 2021 Aug;46(8):4046-4055.
doi: 10.1007/s00261-021-03048-1. Epub 2021 Mar 29.

Radioembolization versus portal vein embolization for contralateral liver lobe hypertrophy: effect of cirrhosis

Heiner Nebelung  1 , Thomas Wolf  2 , Sebastian Bund  2 , Christoph Georg Radosa  2 , Verena Plodeck  2 , Sabine Grosche-Schlee  3 , Carina Riediger  4 , Ralf-Thorsten Hoffmann  2 , Jens-Peter Kühn  2
Affiliations

Radioembolization versus portal vein embolization for contralateral liver lobe hypertrophy: effect of cirrhosis

Heiner Nebelung et al. Abdom Radiol (NY). 2021 Aug.

Abstract

Purpose: Preoperative hypertrophy induction of future liver remnant (FLR) reduces the risk of postoperative liver insufficiency after partial hepatectomy. One of the most commonly used methods to induce hypertrophy of FLR is portal vein embolization (PVE). Recent studies have shown that transarterial radioembolization (TARE) also induces hypertrophy of the contralateral liver lobe. The aim of our study was to evaluate contralateral hypertrophy after TARE versus after PVE taking into account the effect of cirrhosis.

Methods: Forty-nine patients undergoing PVE before hemihepatectomy and 24 patients with TARE as palliative treatment for liver malignancy were retrospectively included. Semi-automated volumetry of the FLR/contralateral liver lobe before and after intervention (20 to 65 days) was performed on CT or MRI, and the relative increase in volume was calculated. Cirrhosis was evaluated independently by two radiologists on CT/MRI, and interrater reliability was calculated.

Results: Hypertrophy after PVE was significantly more pronounced than after TARE (25.3% vs. 7.4%; p < 0.001). In the subgroup of patients without cirrhosis, the difference was also statistically significant (25.9% vs. 8.6%; p = 0.002), whereas in patients with cirrhosis, the difference was not statistically significant (18.2% vs. 7.4%; p = 0.212). After PVE, hypertrophy in patients without cirrhosis was more pronounced than in patients with cirrhosis (25.9% vs. 18.2%; p = 0.203), while after TARE, hypertrophy was comparable in patients with and without cirrhosis (7.4% vs. 8.6%; p = 0.928).

Conclusion: TARE induces less pronounced hypertrophy of the FLR compared to PVE. Cirrhosis seems to be less of a limiting factor for hypertrophy after TARE, compared to PVE.

Keywords: Hepatic artery; Hypertrophy; Liver cirrhosis; Portal vein; Therapeutic embolization.

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Figures

Fig. 1
Fig. 1
Study population. After applying exclusion criteria, 49 of 118 patients who underwent PVE from 08/2015 to 12/2019 and 24 of 153 patients who underwent TARE from 10/2013 to 02/2019 were included
Fig. 2
Fig. 2
CT scans before (left) and about two months after PVE (right) with volumetry of the FLR (blue)
Fig. 3
Fig. 3
CT scans before (left) and about two months after TARE (right) with volumetry of the contralateral liver lobe (blue)
Fig. 4
Fig. 4
Contralateral liver lobe hypertrophy in patients who underwent PVE and in patients who underwent TARE
Fig. 5
Fig. 5
Contralateral liver lobe hypertrophy in patients with cirrhosis and without (after PVE and after TARE)
See this image and copyright information in PMC

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