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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

A typical hepatocellular carcinoma showing the characteristic arterial-phase hypervascularity and late-phase washout. (A) multidetector computed tomography (MDCT) finding, arterial phase (B) grey-scale ultrasonography, (C) contrast-enhanced ultrasonography (CEUS), arterial phase, (D) CEUS, late phase.
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Figure 2: A typical hepatocellular carcinoma showing the characteristic arterial-phase hypervascularity and late-phase washout. (A) multidetector computed tomography (MDCT) finding, arterial phase (B) grey-scale ultrasonography, (C) contrast-enhanced ultrasonography (CEUS), arterial phase, (D) CEUS, late phase.

Mentions: CEUS was performed using a second-generation sulfur hexafluoride microbubbles-based ultrasonography contrast agent (SonoVue®, Bracco, Milan, Italy). A 2.4-mL bolus injection of SonoVue® was administered for 1 second and was immediately followed by a rapid flush of normal saline (5 mL) through a three-way tap for 2 seconds through a 20-gauge intravenous catheter that had been inserted into the cubital vein at the level of the left antecubital fossa. After the SonoVue® injection, the enhancement pattern of the tumor was scanned for 240 sec. Patients held their breath for a few seconds if necessary (observation of the arterial, portal, and late phases). Each of the 12 patients underwent this CEUS examination using the same imaging plane within 7 days prior to receiving TACE, as well as at 4 weeks and 12 weeks after TACE (Fig. 2). The imaging data were recorded on the hard drive of the ultrasonography device and reviewed by the same expert. In each stage, all CEUS examinations were performed prior to MDCT and MRI, and the CEUS exam was performed and interpreted without any information regarding the MDCT or MRI results. At the examinations at 4 and 12 weeks, no enhancement was interpreted as complete tumor necrosis (CEUS-negative, complete response). The lesions were considered to have viable and non-necrotized tissue when they showed partial or entire enhancement behavior characteristic of the baseline mass (CEUS-positive, incomplete response).


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)

A typical hepatocellular carcinoma showing the characteristic arterial-phase hypervascularity and late-phase washout. (A) multidetector computed tomography (MDCT) finding, arterial phase (B) grey-scale ultrasonography, (C) contrast-enhanced ultrasonography (CEUS), arterial phase, (D) CEUS, late phase.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: A typical hepatocellular carcinoma showing the characteristic arterial-phase hypervascularity and late-phase washout. (A) multidetector computed tomography (MDCT) finding, arterial phase (B) grey-scale ultrasonography, (C) contrast-enhanced ultrasonography (CEUS), arterial phase, (D) CEUS, late phase.
Mentions: CEUS was performed using a second-generation sulfur hexafluoride microbubbles-based ultrasonography contrast agent (SonoVue®, Bracco, Milan, Italy). A 2.4-mL bolus injection of SonoVue® was administered for 1 second and was immediately followed by a rapid flush of normal saline (5 mL) through a three-way tap for 2 seconds through a 20-gauge intravenous catheter that had been inserted into the cubital vein at the level of the left antecubital fossa. After the SonoVue® injection, the enhancement pattern of the tumor was scanned for 240 sec. Patients held their breath for a few seconds if necessary (observation of the arterial, portal, and late phases). Each of the 12 patients underwent this CEUS examination using the same imaging plane within 7 days prior to receiving TACE, as well as at 4 weeks and 12 weeks after TACE (Fig. 2). The imaging data were recorded on the hard drive of the ultrasonography device and reviewed by the same expert. In each stage, all CEUS examinations were performed prior to MDCT and MRI, and the CEUS exam was performed and interpreted without any information regarding the MDCT or MRI results. At the examinations at 4 and 12 weeks, no enhancement was interpreted as complete tumor necrosis (CEUS-negative, complete response). The lesions were considered to have viable and non-necrotized tissue when they showed partial or entire enhancement behavior characteristic of the baseline mass (CEUS-positive, incomplete response).

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