Diagnostic and Interventional Radiology
Interventional Radiology - Original Article

Coil volume embolization ratio for preventing recanalization after portal vein embolization

1.

Department of Radiology, Shimane University Faculty of Medicine, Enya cho Izumo, Japan

2.

Department of Hepato-Biliary-Pancreatic Surgery, Shimane University Faculty of Medicine, Enya cho, Izumo, Japan

Diagn Interv Radiol 2021; 27: 366-371
DOI: 10.5152/dir.2021.20043
Read: 389 Downloads: 112 Published: 27 May 2020

PURPOSE 
The purpose of this study was to evaluate the optimum volume embolization ratio (VER) for the prevention of recanalization after portal vein embolization (PVE) and the influence of recanalization on future liver remnant (FLR) function using technetium-99m galactosyl human serum albumin single-photon emission computed tomography (99mTc-GSA SPECT/CT) fusion imaging.

METHODS
We analyzed procedural data of 18 patients who underwent PVE from 2015 to 2018. A total of 29 portal branches were embolized (12 anterior branch, 11 posterior branch, 4 left branch, 2 right branch) with absolute ethanol and coils. Portal vein recanalization was evaluated three weeks after PVE by contrast-enhanced CT. We classified the treated portal branches as non-recanalized and recanalized. VER was compared between the groups. In addition, for each patient, we calculated and evaluated the ratio of FLR volume to total liver volume (volumetric %FLR), FLR count to total liver count on 99mTc-GSA SPECT/CT fusion imaging (functional %FLR), and functional-volumetric ratio (functional %FLR/ volumetric %FLR).

RESULTS
Twenty-six portal branches showed no recanalization (non-recanalized group, n=26, 89.7%), while three portal branches showed recanalization (recanalized group, n=3, 10.3%). The median VER was 4.94% (3.12%–11.1%) in the non-recanalized group and 3.49% (2.76%–4.32%) in the recanalized group, which was significantly different between the groups (p = 0.045, Mann-Whitney U test). The median functional-volumetric ratio was 1.16 (1.03–1.50) in 
non-recanalized patients (n=15, 83.3%) and 1.01 (0.96–1.13) in recanalized patients (n=3, 16.7%), and it was significantly higher in the non-recanalized patients (p = 0.021, Mann-Whitney U test).

CONCLUSION
The VER for preventing recanalization after PVE was approximately 5% (> 4.94%). 99mTc-GSA SPECT/CT fusion imaging revealed a decrease in FLR function due to recanalization after PVE.

You may cite this article as: Maruyama M, Yoshizako T, Ando S, Nakamura M, Tajima Y, Kitagaki H. Coil volume embolization ratio for preventing recanalization after portal vein embolization. Diagn Interv Radiol 2021; 27:366–371

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