Clinical study
Contrast-enhanced Ultrasound as a Predictor of Treatment Efficacy within 2 Weeks after Transarterial Chemoembolization of Hepatocellular Carcinoma

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Purpose

To determine whether contrast-enhanced ultrasound (CEUS) can aid in assessing treatment efficacy within the first 2 weeks after transarterial chemoembolization for hepatocellular carcinoma.

Materials and methods

Contrast-enhanced ultrasound was performed to detect residual tumor blood flow after 42 transarterial chemoembolization procedures in 33 patients who had hepatocellular carcinomas, and the results were compared with final tumor outcome. Twenty-nine CEUS studies were performed within 2 weeks after treatment and the remainder within 1 month. Phase-inversion low-mechanical-index real-time and intermittent imaging were performed after the intravenous injection of 0.5–2 mL US contrast medium by experienced radiologists blind to all other imaging findings.

Results

Nine tumors did not reach final outcome—patients were lost to follow-up or died without autopsy (n = 6) or tumors were retreated before final outcome was established (n = 3). Of the remaining 33 tumors, outcome was established by histology (n = 9), angiography (n = 14), tumor growth (n = 2), or by computed tomography and/or magnetic resonance imaging performed more than 6 months after treatment (n = 8). Twenty-three tumors were studied by CEUS within 2 weeks and 10 within 1 month after treatment. Of these 33 tumors, there were no false-negative results and one false-positive result. The only error occurred when the CEUS study was performed within 1 day after treatment.

Conclusions

Residual tumor blood flow on CEUS performed at 2 or more days after transarterial chemoembolization may be predictive of tumor outcome that currently requires 3 months to be reliably detected by computed tomography and/or magnetic resonance imaging.

Section snippets

Patients

Thirty-three cirrhotic patients (21 male, 12 female) with known HCC scheduled for TACE were included. The diagnosis of HCC was confirmed via biopsy and/or liver transplantation in 18 patients: needle biopsy or aspiration (n = 9), liver transplantation (n = 5), autopsy (n = 2), and resection (n = 2). The other 15 patients had probable diagnosis via characteristic imaging finding with increased tumor marker (AFP >400 ng/mL and/or PIVKA-II >100 mAU/mL) (15) (n = 7) and presumed diagnosis via more

Results

Each CEUS study consisted of an average of 4.7 ± 1.6 injections of 0.5 to 2 mL USCM for an average total volume of 6.2 ± 2.6 mL per study. No change in blood pressure, pulse rate, or temperature was observed in any patient, and there were no symptoms or untoward effects reported. Optison and Imagent were used in 11 and 31 studies, respectively. The two sonologists performing the CEUS agreed with regard to the presence or absence of residual tumor flow in all cases in this study.

Although we did

Discussion

If CEUS performed within days after TACE is as sensitive and specific as we have shown in this study, it would not only be superior to CECT and CEMRI performed in the same time period but would also be a more attractive alternative, as sonography is practical, inexpensive, accessible, and can be performed repeatedly at the bedside. Based on our results, we believe that CEUS would be an ideal test for selecting patients with unresectable tumors and those awaiting liver transplantation for

Acknowledgments

This work was supported in part by an American Liver Foundation Scholar Award (Y.K.); by IMCOR Pharmaceutical Corp. (San Diego, Calif), which provided contrast media; and by Siemens Ultrasound (Issaquah, Wash), which provided equipment. The paper was presented at the Radiological Society of North America (RSNA) meeting in November 2004.

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    None of the authors have identified a conflict of interest.

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