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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 76-year-old patient with an hepatocellular carcinoma (HCC) on segment 5 at 4 weeks after transarterial chemoembolization (TACE). The image shows positivity for viable tissue in contrast-enhanced ultrasonography (CEUS) and gadoxetic-acid-enhanced dynamic magnetic resonance imaging (MRI) without evidence of viable tissue on multidetector computed tomography (MDCT). (A) Arterial phase and (B) late phase of CEUS. These showed slight enhancements (arrow) of peripheral portions of HCC in the arterial phase and wash-out in the late phase of CEUS. (C) Arterial and (D) delayed phase of MDCT. These showed compact lipiodol retention without viable tissue. (E) Arterial phase and (F) hepatobiliary phase of T1 weighted-MRI. The MRI shows intratumoral enhancement in the posterior aspect of the lesion (arrow: same aspect of CEUS enhancements) in the arterial phase and more defi nite hypointensity in the hepatobiliary phase image, which suggests an incomplete tumor response.
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Figure 3: A 76-year-old patient with an hepatocellular carcinoma (HCC) on segment 5 at 4 weeks after transarterial chemoembolization (TACE). The image shows positivity for viable tissue in contrast-enhanced ultrasonography (CEUS) and gadoxetic-acid-enhanced dynamic magnetic resonance imaging (MRI) without evidence of viable tissue on multidetector computed tomography (MDCT). (A) Arterial phase and (B) late phase of CEUS. These showed slight enhancements (arrow) of peripheral portions of HCC in the arterial phase and wash-out in the late phase of CEUS. (C) Arterial and (D) delayed phase of MDCT. These showed compact lipiodol retention without viable tissue. (E) Arterial phase and (F) hepatobiliary phase of T1 weighted-MRI. The MRI shows intratumoral enhancement in the posterior aspect of the lesion (arrow: same aspect of CEUS enhancements) in the arterial phase and more defi nite hypointensity in the hepatobiliary phase image, which suggests an incomplete tumor response.

Mentions: Among the 8 patients who were confirmed via MRI as having residual HCC viability, 5 had negative findings on the 4-week MDCT scan. Of these 5 patients, 1 who showed positivity in both the CEUS and MRI at 4 weeks discontinued the study to receive additional treatment (Fig. 3). Three patients showed positivity at the 12-week MDCT, but 1 patient could not be confirmed to have viable HCC at 12 weeks (Table 2).


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 76-year-old patient with an hepatocellular carcinoma (HCC) on segment 5 at 4 weeks after transarterial chemoembolization (TACE). The image shows positivity for viable tissue in contrast-enhanced ultrasonography (CEUS) and gadoxetic-acid-enhanced dynamic magnetic resonance imaging (MRI) without evidence of viable tissue on multidetector computed tomography (MDCT). (A) Arterial phase and (B) late phase of CEUS. These showed slight enhancements (arrow) of peripheral portions of HCC in the arterial phase and wash-out in the late phase of CEUS. (C) Arterial and (D) delayed phase of MDCT. These showed compact lipiodol retention without viable tissue. (E) Arterial phase and (F) hepatobiliary phase of T1 weighted-MRI. The MRI shows intratumoral enhancement in the posterior aspect of the lesion (arrow: same aspect of CEUS enhancements) in the arterial phase and more defi nite hypointensity in the hepatobiliary phase image, which suggests an incomplete tumor response.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: A 76-year-old patient with an hepatocellular carcinoma (HCC) on segment 5 at 4 weeks after transarterial chemoembolization (TACE). The image shows positivity for viable tissue in contrast-enhanced ultrasonography (CEUS) and gadoxetic-acid-enhanced dynamic magnetic resonance imaging (MRI) without evidence of viable tissue on multidetector computed tomography (MDCT). (A) Arterial phase and (B) late phase of CEUS. These showed slight enhancements (arrow) of peripheral portions of HCC in the arterial phase and wash-out in the late phase of CEUS. (C) Arterial and (D) delayed phase of MDCT. These showed compact lipiodol retention without viable tissue. (E) Arterial phase and (F) hepatobiliary phase of T1 weighted-MRI. The MRI shows intratumoral enhancement in the posterior aspect of the lesion (arrow: same aspect of CEUS enhancements) in the arterial phase and more defi nite hypointensity in the hepatobiliary phase image, which suggests an incomplete tumor response.
Mentions: Among the 8 patients who were confirmed via MRI as having residual HCC viability, 5 had negative findings on the 4-week MDCT scan. Of these 5 patients, 1 who showed positivity in both the CEUS and MRI at 4 weeks discontinued the study to receive additional treatment (Fig. 3). Three patients showed positivity at the 12-week MDCT, but 1 patient could not be confirmed to have viable HCC at 12 weeks (Table 2).

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