Korean J Radiol.  2019 Jul;20(7):1114-1123. 10.3348/kjr.2018.0932.

Microvascular Flow Imaging of Residual or Recurrent Hepatocellular Carcinoma after Transarterial Chemoembolization: Comparison with Color/Power Doppler Imaging

Affiliations
  • 1Department of Radiology, Seoul National University Hospital, Seoul, Korea. jmsh@snu.ac.kr
  • 2Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
  • 3Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea.
  • 4Samsung Medison Co., Ltd., Seoul, Korea.
  • 5Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.

Abstract


OBJECTIVE
To determine the feasibility of microvascular flow imaging (MVFI) in comparison with color/power Doppler imaging (CDI/PDI) for detection of intratumoral vascularity in suspected post-transarterial chemoembolization (TACE) residual or recurrent hepatocellular carcinomas (HCCs) by using contrast-enhanced ultrasonography (CEUS) or hepatic angiography (HA) findings as the reference standard.
MATERIALS AND METHODS
One hundred HCCs (mean size, 2.2 cm) in 100 patients treated with TACE were included in this prospective study. CDI, PDI, and MVFI were performed in tandem for evaluating intratumoral vascularity of the lesions by using an RS85 ultrasound scanner (Samsung Medison Co., Ltd.). Intratumoral vascularity in each technique was assessed by two radiologists in consensus by using a 5-point scale. Then, one of the two radiologists and another radiologist performed additional image review in the reverse order (MVFI-PDI-CDI) for evaluation of intra- and interobserver agreements. Results were then compared with those of either HA or CEUS as the reference. The McNemar test, logistic regression analysis, and intraclass correlation coefficient (ICC) were used.
RESULTS
CEUS or HA revealed intratumoral vascularity in 87% (87/100) of the tumors. Sensitivity (79.3%, 69/87) and accuracy (80.0%, 80/100) of MVFI were significantly higher than those of CDI (sensitivity, 27.6% [24/87]; accuracy, 37.0% [37/100]) or PDI (sensitivity, 36.8% [32/87]; accuracy, 44.0% [44/100]) (all p < 0.05). CDI, PDI, and MVFI presented excellent intraobserver (ICCs > 0.9) and good interobserver agreements (ICCs > 0.6).
CONCLUSION
MVFI demonstrated significantly higher sensitivity and accuracy than did CDI and PDI for the detection of intratumoral vascularity in suspected residual or recurrent HCCs after TACE.

Keyword

Hepatocellular carcinoma; Transarterial chemoembolization; Microvascular flow imaging; Doppler imaging; Blood flow

MeSH Terms

Angiography
Carcinoma, Hepatocellular*
Consensus
Humans
Logistic Models
Prospective Studies
Ultrasonography

Figure

  • Fig. 1 Flow diagram of patient population.CDI = color Doppler imaging, CEUS = contrast-enhanced ultrasonography, HCC = hepatocellular carcinoma, LI-RADS = Liver Imaging Reporting And Data System, MVFI = microvascular flow imaging, PDI = power Doppler imaging, TACE = transarterial chemoembolization, US = ultrasonography

  • Fig. 2 Graphs showing subjective vascularity scores for intratumoral flow detection on CDI, PDI, and MVFI.A. Intratumoral flow score in MVFI (3.59 ± 1.51) was shown to be significantly higher than that in CDI (1.76 ± 1.20, p < 0.001) and PDI (1.95 ± 1.26, p < 0.001). B. When reviewing images and videos in reverse order, intratumoral flow score was still significantly high in MVFI (3.05 ± 1.55) than in CDI (1.75 ± 1.20, p < 0.001) and PDI (2.07 ± 1.31, p < 0.001). *p < 0.05, **p < 0.001.

  • Fig. 3 73-year-old woman with 1.5-cm intrahepatic remote recurrent tumor in segment 6 who had previously been treated with TACE for HCC in another segment (not shown).On CDI (A) and PDI (B), intratumoral flow was detected and was graded as score of 4. On MVFI (C, D), multiple intratumoral vessels were visualized and were graded as 5.

  • Fig. 4 Graphs showing sensitivity of intratumoral flow detection on CDI, PDI, and MVFI.A. MVFI showed 79.3% sensitivity for intratumoral flow detection, which was significantly higher than that of CDI (27.6%, p < 0.001) or PDI (36.8%, p < 0.001). B. Likewise, when reviewing images and videos in reverse order, sensitivity of MVFI was 69.0%, which was significantly higher than that of CDI (30.0%, p < 0.001) or PDI (42.5%, p < 0.001). **p < 0.001.

  • Fig. 5 72-year-old man with suspicious residual HCC in medial aspect of lipiodolized nodule.On lipiodol CT (non-contrast CT after TACE) (A), defect in medial aspect of lipiodolized nodule (arrow) (A) was shown and that area presented arterial phase hyperenhancement on follow-up liver MRI (arrow) (B), suggestive of residual HCC after TACE. On CEUS (C), there was enhancing area in arterial phase (arrow); however, no intratumoral flow was detected on CDI (D) and PDI (E). On MVFI (F), multiple intratumoral vessels (arrows) were noted and were graded as 5.


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