Biliary Abnormality on Imaging During Lenvatinib Plus Hepatic Arterial Infusion Chemotherapy With Cisplatin for Hepatocellular Carcinoma: A Pilot Descriptive Study

AIM: To evaluate the frequency, imaging characteristics, associated factors, and clinical significance of biliary abnormalities on imaging in patients receiving lenvatinib (LEN) plus cisplatin hepatic arterial infusion chemotherapy (HAIC) for hepatocellular carcinoma (HCC). METHODS: This retrospective single-center study included 62 patients with HCC treated with LEN + Cisplatin HAIC. Three radiologists reviewed dynamic contrast-enhanced CT and gadoxetic acid-enhanced MRI to identify biliary findings. The incidence, associated factors, and clinical courses were examined. RESULTS: Sixty-two patients with HCC underwent 295 CT and 59 MRI examinations during a median follow-up of 21 weeks. Biliary abnormalities were observed in 58.1% (36/62) of patients at a median of 6 weeks after treatment initiation. Hilar bile duct wall thickening occurred in 24.2% (15/62), hilar bile duct stricture in 14.5% (9/62), biloma in 1.6% (1/62), and gallbladder wall thickening in 35.5% (22/62). Initial treatment response per mRECIST was associated with biliary abnormalities (adjusted odds ratio: 5.19, p = 0.011). Symptoms developed in 22.2% (8/36) of patients with imaged biliary abnormalities. Symptom occurrence varied by imaging patterns: all 15 patients with bile duct wall thickening remained asymptomatic, whereas 40% (4/10) of those with bile duct stricture or biloma developed jaundice or cholangitis, requiring biliary interventions in three patients. Cholecystitis occurred in 18.2% (4/22) of patients with gallbladder wall thickening. CONCLUSIONS: A substantial proportion of patients treated with LEN + Cisplatin HAIC developed biliary abnormalities on imaging, particularly those with an initial treatment response. Most abnormalities were asymptomatic; however, bile duct stricture may represent a crucial imaging finding even in the absence of symptoms.