Purpose: To evaluate biliary complications after irreversible electroporation (IRE) of hepatic malignancies.
Materials and methods: In 24 patients (17 men; mean age, 59.3 y), bile ducts were located within a 1.0-cm radius of the ablation zone at subacute follow-up (ie, 1–3 d) after percutaneous IRE of 53 hepatic tumors (primary hepatic tumors, n = 14). MR imaging, conducted with a hepatocyte-specific contrast agent before and after treatment, was examined for evidence of bile duct injury. Serum bilirubin and alkaline phosphatase levels measured at subacute and short-term follow-up (ie, 1–2 mo after IRE) were analyzed for evidence of biliary injury. Correlations between bile duct injury and characteristics of patients, lesions, and ablation procedures were assessed by generalized linear models.
Results: Fifty-five bile ducts were located within 1.0 cm of an ablation defect. Locations relative to the ablation area were as follows: 33 were encased, 14 were abutting, and 8 were located within a radius of 0.1–1.0 cm of the ablation zone. Subacute follow-up MR images showed 15 bile duct injuries (narrowing, n = 8; dilation, n = 7). At subacute follow-up, three patients showed transient abnormalities of laboratory values (bilirubin, 1.6–5.2 mg/dL). Short-term laboratory values were abnormal in one patient (increase in alkaline phosphatase of 533 U/L vs baseline) as a result of local tumor recurrence. Patient age (continuous, P = .026; < 65 y vs ≥ 65 y, P = .001) was independently associated with post-IRE bile duct injury.
Conclusions: Bile ducts adjacent to an IRE ablation area remain largely unaffected by this procedure.