Hemodynamic and morphologic changes after portal vein embolization: Differential effects in central and peripheral zones in the liver on multiphasic computed tomography

Objective: To evaluate hemodynamic and morphologic effects in the liver after portal vein embolization (PVE). Methods: Hepatic computed tomography scans of 7 patients who had undergone preoperative PVE were retrospectively reviewed. Pre- and post-PVE computed tomography densities were evaluated for the unenhanced, late arterial, and portal venous phases in peripheral and central hepatic regions and in the 3 main hepatic veins. Relative changes in areas in these regions were assessed in 5 evaluable patients with serial post-PVE scans. Results: During the late arterial phase, enhancement was significantly higher after PVE than it was before PVE in the peripheral hepatic regions, and it was higher in the peripheral regions than in the central regions. Enhancement was also significantly higher in the right main hepatic vein than in the middle and left hepatic veins during the late arterial phase. The ratio of areas of the peripheral/central regions decreased significantly after PVE. Conclusions: Zonal enhancement in the late arterial phase changed after PVE and seemed to be associated with differential parenchymal atrophy. We speculate that the hepatic arterial supply increases peripherally and that peribiliary/periportal plexuses maintain the portal supply centrally.