Arterial portography during transarterial chemoembolization: still a necessity in the age of contrast-enhanced cross-sectional imaging?

Abstract

Purpose: To evaluate the necessity of arterial portography (AP) if a patent portal vein is seen on imaging before transarterial chemoembolization.

Materials and methods: All patients who underwent transarterial chemoembolization between January 2004 and July 2011 were retrospectively recruited. The study included 131 patients (100 men, 31 women) undergoing 243 transarterial chemoembolization procedures. AP was performed during 93 procedures. The mean time interval between imaging performed before transarterial chemoembolization and the transarterial chemoembolization procedure was 46.5 days (range, 0-161 d).

Results: AP did not detect any new cases of portal vein thrombosis (PVT) when imaging performed transarterial chemoembolization showed a patent portal vein. Imaging performed after transarterial chemoembolization revealed one main PVT, one left PVT extending into the main portal vein, two left PVT, and one right PVT. When imaging performed before transarterial chemoembolization showed a patent portal vein and AP was omitted, imaging performed after transarterial chemoembolization showed one case of main PVT, two right PVT, and two left PVT. In both groups, there was no significant difference in mortality (P = .673) or morbidity (P = .581) related to transarterial chemoembolization.

Conclusions: AP is unnecessary if transarterial chemoembolization is performed within a reasonable time frame following computed tomography or magnetic resonance imaging that showed a patent portal vein. Omitting AP potentially reduces contrast material and radiation burden to both the patient and the operator.

Keywords: AP; HCC; PVT; arterial portography; hepatocellular carcinoma; portal vein thrombosis.