Korean J Radiol.  2013 Oct;14(5):754-763. 10.3348/kjr.2013.14.5.754.

Pretreatment Evaluation with Contrast-Enhanced Ultrasonography for Percutaneous Radiofrequency Ablation of Hepatocellular Carcinomas with Poor Conspicuity on Conventional Ultrasonography

• Kim AY
• Lee MW
• Rhim H
• Cha DI
• Choi D
• Kim YS
• Lim HK
• Cho SW

• KMID: 1711429
• DOI: http://doi.org/10.3348/kjr.2013.14.5.754

Abstract

OBJECTIVE
To determine whether pretreatment evaluation with contrast-enhanced ultrasonography (CEUS) is effective for percutaneous radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) with poor conspicuity on conventional ultrasonography (US).
MATERIALS AND METHODS
This retrospective study was approved by the institutional review board and informed consent was waived. From June 2008 to July 2011, 82 patients having HCCs (1.2 +/- 0.4 cm) with poor conspicuity on planning US for RFA were evaluated with CEUS prior to percutaneous RFA. We analyzed our database, radiologic reports, and US images in order to determine whether the location of HCC candidates on planning US coincide with that on CEUS. To avoid incomplete ablation, percutaneous RFA was performed only when HCC nodules were identified on CEUS. The rate of technical success was assessed. The cumulative rate of local tumor progression was estimated with the use of the Kaplan-Meier method (mean follow-up: 24.0 +/- 13.0 months).
RESULTS
Among 82 patients, 73 (89%) HCCs were identified on CEUS, whereas 9 (11%) were not. Of 73 identifiable HCCs on CEUS, the location of HCC on planning US corresponded with that on CEUS in 64 (87.7%), whereas the location did not correspond in 9 (12.3%) HCCs. Technical success was achieved for all 73 identifiable HCCs on CEUS in a single (n = 72) or two (n = 1) RFA sessions. Cumulative rates of local tumor progression were estimated as 1.9% and 15.4% at 1 and 3 years, respectively.
CONCLUSION
Pretreatment evaluation with CEUS is effective for percutaneous RFA of HCCs with poor conspicuity on conventional US.

Keyword

Hepatocellular carcinoma; Ultrasonography; Radiofrequency ablation; Contrast-enhanced ultrasonography; SonoVue

MeSH Terms

Carcinoma, Hepatocellular/surgery/*ultrasonography
Catheter Ablation/*methods
Contrast Media/*diagnostic use
Female
Follow-Up Studies
Humans
Liver Neoplasms/surgery/*ultrasonography
Male
Middle Aged
Neoplasm Staging
Preoperative Period
Retrospective Studies
Contrast Media

Figure

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  Fig. 1 Flowchart of this study.

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  Fig. 2 Fifty eight-year-old man with 1.6-cm-sized hepatocellular carcinoma (HCC) in segment VII of liver. This patient has history of hepatic resection and chemoembolization due to HCCs. A. Arterial phase MR image (TR/TE, 3.1/1.5; flip angle, 10°; matrix size, 228 × 211; bandwidth, 724.1 Hz/pixel) shows 1.6-cm-sized enhancing lesion (arrow) in segment VII of liver. B. Small HCC candidate is seen as low echoic nodule (arrow) in segment VII of liver on planning ultrasonography (US). However, surrounding liver (arrowheads) has heterogeneous echo texture. Therefore, it is unclear whether lesion (arrow) is true index tumor. C. On CEUS, which was conducted to preclude mistargeting, small enhancing nodule (arrows) was identified in different location from that on planning US. Therefore, lesion identified on planning US was considered to be pseudolesion. D. Re-evaluation with conventional B-mode US reveals small echogenic nodule (arrow) at same site as (C). E. Arterial phase CT image obtained immediately after RFA shows technical success with sufficient ablative margin (arrowheads).

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  Fig. 3 Fifty nine-year-old man with 1 cm-sized hepatocellular carcinoma (HCC) in segment VII of liver. A. Arterial phase MR image (TR/TE, 3.1/1.5; flip angle, 10°; matrix size, 228 × 211; bandwidth, 724.1 Hz/pixel) shows 1.1 cm-sized enhancing HCC (white arrow) in segment VII of liver. Black arrow indicates previous radiofrequency ablation (RFA) zone. B. Small HCC candidate is seen as subtle low echoic nodule (arrow) with poor conspicuity in segment VII of liver on planning ultrasonography. C. On CEUS, which was performed to be certain, small enhancing nodule (arrow) was identified at same site as (B), suggestive of HCC. Asterisks indicate arterioportal shunts around index tumor. D. Arterial phase CT image obtained immediately after RFA shows large ablation zone (arrowheads) with sufficient ablative margin. Arrow indicates previous RFA zone.

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  Fig. 4 Local tumor progression rate of 73 hepatocellular carcinomas after percutaneous radiofrequency ablation. Cumulative rates of local tumor progression were estimated as 1.9% and 15.4% at 1 and 3 years, respectively. '+' marks indicate censored data.

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