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The usefulness of contrast-enhanced ultrasonography in the early detection of hepatocellular carcinoma viability after transarterial chemoembolization: pilot study.

Cho YZ, Park SY, Choi EH, Baik SK, Kwon SO, Kim YJ, Cha SH, Kim MY - Clin Mol Hepatol (2015)

Bottom Line: Five of the eight patients with positive CEUS findings at 4 weeks had negative results on the 4-week MDCT scan.Four (50%) of these eight patients did not have MRI positivity at 4 weeks and were ultimately confirmed as having residual HCC tissue at the 12-week MRI.In the assessment of the response to TACE, CEUS at 4 weeks showed excellent results for detecting residual viable HCC, which suggests that CEUS can be used as an early additive diagnosis tool when deciding early additional treatment with TACE.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea. ; Department of Cell Therapy and Tissue Engineering, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea.

ABSTRACT

Background/aims: The therapeutic effect of transarterial chemoembolization (TACE) against hepatocellular carcinoma (HCC) is usually assessed using multidetector computed tomography (MDCT). However, dense lipiodol depositions can mask the enhancement of viable HCC tissue in MDCT. Contrast-enhanced ultrasonography (CEUS) could be effective in detecting small areas of viability and patency in vessels. We investigated whether arterial enhancement in CEUS after treatment with TACE can be used to detect HCC viability earlier than when using MDCT.

Methods: Twelve patients received CEUS, MDCT, and gadoxetic-acid-enhanced dynamic magnetic resonance imaging (MRI) at baseline and 4 and 12 weeks after TACE. The definition of viable HCC was defined as MRI positivity after 4 or 12 weeks.

Results: Eight of the 12 patients showed MRI positivity at 4 or 12 weeks. All patients with positive CEUS findings at 4 weeks (n=8) showed MRI positivity and residual viable HCC at 4 or 12 weeks. Five of the eight patients with positive CEUS findings at 4 weeks had negative results on the 4-week MDCT scan. Four (50%) of these eight patients did not have MRI positivity at 4 weeks and were ultimately confirmed as having residual HCC tissue at the 12-week MRI. Kappa statistics revealed near-perfect agreement between CEUS and MRI (κ=1.00) and substantial agreement between MDCT and MRI (κ=0.67).

Conclusions: In the assessment of the response to TACE, CEUS at 4 weeks showed excellent results for detecting residual viable HCC, which suggests that CEUS can be used as an early additive diagnosis tool when deciding early additional treatment with TACE.

No MeSH data available.


Related in: MedlinePlus

Flow chart of the study. CEUS, contrast-enhanced ultrasonography; MDCT, multidetector computer tomography; MRI, magnetic resonance imaging; TACE, transarterial chemoembolization.
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Figure 1: Flow chart of the study. CEUS, contrast-enhanced ultrasonography; MDCT, multidetector computer tomography; MRI, magnetic resonance imaging; TACE, transarterial chemoembolization.

Mentions: The baseline evaluation of the patients included CEUS, MDCT and Gadoxetic acid-enhanced dynamic MRI examination. All patients were treated with TACE within 7 days of the baseline study. To assess the effectiveness of TACE, all patients underwent CEUS, MDCT and MRI evaluation at 4 and 12 weeks after receiving TACE. MRI was used as a standard method of diagnosis, and the definition of residual or recurrent viable HCC was defined as MRI positivity at 4 or 12 weeks. At 4 weeks, patients with MRI positivity immediately underwent additional treatment with TACE or another agent. In patients with MRI negativity at 4 weeks, CEUS, MDCT and MRI were repeated at 12 weeks. A flow diagram of patient examinations and the treatment design is shown in Figure 1.


The usefulness of contrast-enhanced ultrasonography in the early detection of hepatocellular carcinoma viability after transarterial chemoembolization: pilot study.

Cho YZ, Park SY, Choi EH, Baik SK, Kwon SO, Kim YJ, Cha SH, Kim MY - Clin Mol Hepatol (2015)

Flow chart of the study. CEUS, contrast-enhanced ultrasonography; MDCT, multidetector computer tomography; MRI, magnetic resonance imaging; TACE, transarterial chemoembolization.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4493360&req=5

Figure 1: Flow chart of the study. CEUS, contrast-enhanced ultrasonography; MDCT, multidetector computer tomography; MRI, magnetic resonance imaging; TACE, transarterial chemoembolization.
Mentions: The baseline evaluation of the patients included CEUS, MDCT and Gadoxetic acid-enhanced dynamic MRI examination. All patients were treated with TACE within 7 days of the baseline study. To assess the effectiveness of TACE, all patients underwent CEUS, MDCT and MRI evaluation at 4 and 12 weeks after receiving TACE. MRI was used as a standard method of diagnosis, and the definition of residual or recurrent viable HCC was defined as MRI positivity at 4 or 12 weeks. At 4 weeks, patients with MRI positivity immediately underwent additional treatment with TACE or another agent. In patients with MRI negativity at 4 weeks, CEUS, MDCT and MRI were repeated at 12 weeks. A flow diagram of patient examinations and the treatment design is shown in Figure 1.

Bottom Line: Five of the eight patients with positive CEUS findings at 4 weeks had negative results on the 4-week MDCT scan.Four (50%) of these eight patients did not have MRI positivity at 4 weeks and were ultimately confirmed as having residual HCC tissue at the 12-week MRI.In the assessment of the response to TACE, CEUS at 4 weeks showed excellent results for detecting residual viable HCC, which suggests that CEUS can be used as an early additive diagnosis tool when deciding early additional treatment with TACE.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea. ; Department of Cell Therapy and Tissue Engineering, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea.

ABSTRACT

Background/aims: The therapeutic effect of transarterial chemoembolization (TACE) against hepatocellular carcinoma (HCC) is usually assessed using multidetector computed tomography (MDCT). However, dense lipiodol depositions can mask the enhancement of viable HCC tissue in MDCT. Contrast-enhanced ultrasonography (CEUS) could be effective in detecting small areas of viability and patency in vessels. We investigated whether arterial enhancement in CEUS after treatment with TACE can be used to detect HCC viability earlier than when using MDCT.

Methods: Twelve patients received CEUS, MDCT, and gadoxetic-acid-enhanced dynamic magnetic resonance imaging (MRI) at baseline and 4 and 12 weeks after TACE. The definition of viable HCC was defined as MRI positivity after 4 or 12 weeks.

Results: Eight of the 12 patients showed MRI positivity at 4 or 12 weeks. All patients with positive CEUS findings at 4 weeks (n=8) showed MRI positivity and residual viable HCC at 4 or 12 weeks. Five of the eight patients with positive CEUS findings at 4 weeks had negative results on the 4-week MDCT scan. Four (50%) of these eight patients did not have MRI positivity at 4 weeks and were ultimately confirmed as having residual HCC tissue at the 12-week MRI. Kappa statistics revealed near-perfect agreement between CEUS and MRI (κ=1.00) and substantial agreement between MDCT and MRI (κ=0.67).

Conclusions: In the assessment of the response to TACE, CEUS at 4 weeks showed excellent results for detecting residual viable HCC, which suggests that CEUS can be used as an early additive diagnosis tool when deciding early additional treatment with TACE.

No MeSH data available.


Related in: MedlinePlus