Clin Mol Hepatol.  2015 Jun;21(2):165-174. 10.3350/cmh.2015.21.2.165.

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

• KMID: 2164367
• DOI: http://doi.org/10.3350/cmh.2015.21.2.165

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 (kappa=1.00) and substantial agreement between MDCT and MRI (kappa=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.

Keyword

Hepatocellular carcinoma; Transarterial chemoembolization; Contrast-enhanced ultrasonography; Computed tomography; Magnetic resonance imaging

MeSH Terms

Aged
Aged, 80 and over
Antineoplastic Agents/administration & dosage
Carcinoma, Hepatocellular/pathology/therapy/*ultrasonography
Chemoembolization, Therapeutic
Contrast Media/*chemistry
Female
Gadolinium DTPA/chemistry
Humans
Liver Neoplasms/pathology/therapy/*ultrasonography
Magnetic Resonance Imaging
Male
Middle Aged
Pilot Projects
Tomography, X-Ray Computed
Treatment Outcome
Antineoplastic Agents
Contrast Media
Gadolinium DTPA