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Cox DRA, Chung W, Grace J, Wong D, Kutaiba N, Ranatunga D, Khor R, Perini MV, Fink M, Jones R, Goodwin M, Dobrovic A, Testro A, Muralidharan V. Evaluating treatment response following locoregional therapy for hepatocellular carcinoma: A review of the available serological and radiological tools for assessment. JGH OPEN 2023; 7:249-260. [PMID: 37125252 PMCID: PMC10134770 DOI: 10.1002/jgh3.12879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 02/01/2023] [Accepted: 02/09/2023] [Indexed: 04/05/2023]
Abstract
Hepatocellular carcinoma (HCC) is an aggressive primary malignancy of the liver and is the third most common cause of cancer-related global mortality. There has been a steady increase in treatment options for HCC in recent years, including innovations in both curative and non-curative therapies. These advances have brought new challenges and necessary improvements in strategies of disease monitoring, to allow early detection of HCC recurrence. Current serological and radiological strategies for post-treatment monitoring and prognostication and their limitations will be discussed and evaluated in this review.
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Affiliation(s)
- Daniel R A Cox
- Department of Surgery (Austin Precinct) The University of Melbourne Melbourne Victoria Australia
- Hepatopancreatobiliary and Liver Transplant Surgery Unit Austin Health Melbourne Victoria Australia
| | - William Chung
- Department of Medicine (Austin Precinct) The University of Melbourne Melbourne Victoria Australia
- Liver Transplant Unit, Department of Gastroenterology and Hepatology Austin Health Melbourne Victoria Australia
| | - Josephine Grace
- Department of Medicine (Austin Precinct) The University of Melbourne Melbourne Victoria Australia
- Liver Transplant Unit, Department of Gastroenterology and Hepatology Austin Health Melbourne Victoria Australia
| | - Darren Wong
- Department of Medicine (Austin Precinct) The University of Melbourne Melbourne Victoria Australia
- Liver Transplant Unit, Department of Gastroenterology and Hepatology Austin Health Melbourne Victoria Australia
| | - Numan Kutaiba
- Department of Radiology Austin Health Melbourne Victoria Australia
| | - Dinesh Ranatunga
- Department of Radiology Austin Health Melbourne Victoria Australia
| | - Richard Khor
- Department of Radiation Oncology Austin Health Melbourne Victoria Australia
- School of Molecular Sciences, La Trobe University Melbourne Victoria Australia
- Department of Medical Imaging and Radiation Sciences Monash University Melbourne Victoria Australia
| | - Marcos V Perini
- Department of Surgery (Austin Precinct) The University of Melbourne Melbourne Victoria Australia
- Hepatopancreatobiliary and Liver Transplant Surgery Unit Austin Health Melbourne Victoria Australia
| | - Michael Fink
- Department of Surgery (Austin Precinct) The University of Melbourne Melbourne Victoria Australia
- Hepatopancreatobiliary and Liver Transplant Surgery Unit Austin Health Melbourne Victoria Australia
| | - Robert Jones
- Department of Surgery (Austin Precinct) The University of Melbourne Melbourne Victoria Australia
- Hepatopancreatobiliary and Liver Transplant Surgery Unit Austin Health Melbourne Victoria Australia
- Liver Transplant Unit, Department of Gastroenterology and Hepatology Austin Health Melbourne Victoria Australia
| | - Mark Goodwin
- Department of Radiology Austin Health Melbourne Victoria Australia
| | - Alex Dobrovic
- Department of Surgery (Austin Precinct) The University of Melbourne Melbourne Victoria Australia
| | - Adam Testro
- Department of Medicine (Austin Precinct) The University of Melbourne Melbourne Victoria Australia
- Liver Transplant Unit, Department of Gastroenterology and Hepatology Austin Health Melbourne Victoria Australia
| | - Vijayaragavan Muralidharan
- Department of Surgery (Austin Precinct) The University of Melbourne Melbourne Victoria Australia
- Hepatopancreatobiliary and Liver Transplant Surgery Unit Austin Health Melbourne Victoria Australia
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2
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Dong Y, Zhang Q, Chen H, Jin Y, Ji Z, Han H, Wang W. Radiomics of Multi-modality Ultrasound in Rabbit VX2 Liver Tumors: Differentiating Residual Tumors from Hyperemic Rim After Ablation. J Med Biol Eng 2022. [DOI: 10.1007/s40846-022-00763-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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3
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Inzerillo A, Meloni MF, Taibbi A, Bartolotta TV. Loco-regional treatment of hepatocellular carcinoma: Role of contrast-enhanced ultrasonography. World J Hepatol 2022; 14:911-922. [PMID: 35721286 PMCID: PMC9157715 DOI: 10.4254/wjh.v14.i5.911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/26/2021] [Accepted: 04/21/2022] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the few cancers for which locoregional treatments (LRTs) are included in international guidelines and are considered as a valid alternative to conventional surgery. According to Barcelona Clinic Liver Cancer classification, percutaneous treatments such as percutaneous ethanol injection, radiofrequency ablation and microwave ablation are the therapy of choice among curative treatments in patients categorized as very early and early stage, while transcatheter arterial chemoembolization is considered the better option for intermediate stage HCC. A precise assessment of treatment efficacy and surveillance is essential to optimize survival rate, whereas residual tumor requires additional treatment. Imaging modalities play a key role in this task. Currently, contrast-enhanced computed tomography/magnetic resonance imaging are considered the standard imaging modalities for this purpose. Contrast enhanced ultrasound (CEUS), using second generation contrast agents, plays an increasingly important role in detecting residual disease after LRTs. CEUS is a straightforward to perform, repeatable and cost-effective imaging modality for patients with renal failure or iodine allergies. Due to the ability to focus on single regions, CEUS can also provide high temporal resolution. Moreover, several studies have reported the same or better diagnostic accuracy as contrast-enhanced computed tomography for assessing tumor vascularity 1 mo after LRTs, and recently three-dimensional (3D)-CEUS has been reported as a promising technique to improve the evaluation of tumor response to therapy. Furthermore, CEUS could be used early after procedures in monitoring HCC treatments, but nowadays this indication is still debated, and data from literature are conflicting, especially after transcatheter arterial chemoembolization procedure.
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Affiliation(s)
- Agostino Inzerillo
- Department of Radiology, University Hospital "Paolo Giaccone", Palermo 90127, Italy
| | | | - Adele Taibbi
- Department of Radiology, University Hospital "Paolo Giaccone", Palermo 90127, Italy
| | - Tommaso Vincenzo Bartolotta
- Department of Radiology, University Hospital "Paolo Giaccone", Palermo 90127, Italy
- Department of Radiology, Fondazione Istituto G. Giglio Hospital, Cefalù 90015, Italy
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4
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Del Cura JL, Del Cura G, Zabala R, Korta I. Contrast-enhanced ultrasonography to guide diagnostic and therapeutic interventional procedures. RADIOLOGIA 2022; 64:277-288. [PMID: 35676061 DOI: 10.1016/j.rxeng.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 02/08/2021] [Indexed: 11/18/2022]
Abstract
Although not necessary for the vast majority of ultrasound-guided procedures, intravenous contrast agents can be useful for procedures aimed at lesions that require contrast enhancement to be seen on ultrasonography. Using contrast-enhanced ultrasonography to guide procedures has two drawbacks: first, because enhancement from ultrasound contrast agents is short lived, it is often necessary to plan several injections; second, because the needle is poorly seen on contrast-enhanced ultrasonography, a dual image display format is necessary. Contrast-enhanced ultrasonography can be used for planning and monitoring diagnostic and therapeutic procedures, for guiding the procedures, and for follow-up. Using contrast-enhanced ultrasonography enables better results in both types of procedures; moreover, it can be used within cavities.
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Affiliation(s)
- J L Del Cura
- Servicio de Radiodiagnóstico, Hospital Universitario Donostia, Donostia-San Sebastián, Spain.
| | - G Del Cura
- Servicio de Radiodiagnóstico, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain
| | - R Zabala
- Servicio de Radiodiagnóstico, Hospital Universitario Basurto, Bilbao, Bizkaia, Spain
| | - I Korta
- Servicio de Radiodiagnóstico, Hospital Universitario Basurto, Bilbao, Bizkaia, Spain
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5
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Hai Y, Savsani E, Chong W, Eisenbrey J, Lyshchik A. Meta-analysis and systematic review of contrast-enhanced ultrasound in evaluating the treatment response after locoregional therapy of hepatocellular carcinoma. Abdom Radiol (NY) 2021; 46:5162-5179. [PMID: 34410432 DOI: 10.1007/s00261-021-03248-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE Contrast-enhanced ultrasound (CEUS) is a useful tool to assess treatment response after percutaneous ablation or transarterial chemoembolization (TACE) of hepatocellular carcinoma (HCC). Here, we performed a systematic review and meta-analysis to evaluate the usefulness of CEUS in identifying residual tumor after locoregional therapy. METHODS PubMed, Scopus, and Cochrane library databases were searched from their inception until March 8, 2021, for diagnostic test accuracy studies comparing CEUS to a reference standard for identifying residual tumors after locoregional therapy of HCC. The pooled sensitivity, specificity, accuracy, and diagnostic odds ratio (DOR) were obtained using a bivariate random effects model. Subgroup analyses were performed by stratifying the studies based on study design, type of locoregional therapy, CEUS criteria for residual tumor, timing of CEUS follow up, and type of standard reference. RESULTS Two reviewers independently evaluated 1479 publications. After full-text review, 142 studies were found to be relevant, and 43 publications (50 cohorts) were finally included. The overall sensitivity of CEUS in detection of residual disease estimated from the bivariate random effects model was 0.85 (95% CI 0.80-0.89). Similarly, the overall specificity was 0.94 (95% CI 0.91-0.96). The diagnostic accuracy was 93.5%. The DOR was 70.1 (95% CI 62.2-148), and the AUROC was 0.95. Importantly, subgroup analysis showed no apparent differences in the diagnostic performance between locoregional therapy (TACE vs. ablation) and criteria used to define residual enhancement, timing of performing CEUS, study design, or type of reference standard. CONCLUSION CEUS is a highly accurate method to identify HCC residual tumor after TACE or percutaneous ablation.
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Affiliation(s)
- Yang Hai
- Department of Radiology, Thomas Jefferson University, 132 South 10th Street, 763G Main Building, Philadelphia, PA, 19107, USA
| | - Esika Savsani
- Department of Radiology, Thomas Jefferson University, 132 South 10th Street, 763G Main Building, Philadelphia, PA, 19107, USA
| | - Weelic Chong
- Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut St, Suite 100, Philadelphia, PA, USA
- Department of Medical Oncology, Thomas Jefferson University, 1025 Walnut St, Suite 727, Philadelphia, PA, USA
| | - John Eisenbrey
- Department of Radiology, Thomas Jefferson University, 132 South 10th Street, 763G Main Building, Philadelphia, PA, 19107, USA
| | - Andrej Lyshchik
- Department of Radiology, Thomas Jefferson University, 132 South 10th Street, 763G Main Building, Philadelphia, PA, 19107, USA.
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Del Cura JL, Del Cura G, Zabala R, Korta I. Contrast-enhanced ultrasonography to guide diagnostic and therapeutic interventional procedures. RADIOLOGIA 2021; 64:S0033-8338(21)00067-9. [PMID: 33773773 DOI: 10.1016/j.rx.2021.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 01/23/2021] [Accepted: 02/08/2021] [Indexed: 10/21/2022]
Abstract
Although not necessary for the vast majority of ultrasound-guided procedures, intravenous contrast agents can be useful for procedures aimed at lesions that require contrast enhancement to be seen on ultrasonography. Using contrast-enhanced ultrasonography to guide procedures has two drawbacks: first, because enhancement from ultrasound contrast agents is short lived, it is often necessary to plan several injections; second, because the needle is poorly seen on contrast-enhanced ultrasonography, a dual image display format is necessary. Contrast-enhanced ultrasonography can be used for planning and monitoring diagnostic and therapeutic procedures, for guiding the procedures, and for follow-up. Using contrast-enhanced ultrasonography enables better results in both types of procedures; moreover, it can be used within cavities.
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Affiliation(s)
- J L Del Cura
- Servicio de Radiodiagnóstico, Hospital Universitario Donostia, Donostia-San Sebastián, España.
| | - G Del Cura
- Servicio de Radiodiagnóstico, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, España
| | - R Zabala
- Servicio de Radiodiagnóstico, Hospital Universitario Basurto, Bilbao, Bizkaia, España
| | - I Korta
- Servicio de Radiodiagnóstico, Hospital Universitario Basurto, Bilbao, Bizkaia, España
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de Nucci G, della Corte C, Reati R, Imperatore N, Arena I, Larghi A, Manes G. Endoscopic ultrasound-guided radiofrequency ablation for hepatocellular carcinoma in cirrhosis: a case report test for efficacy and future perspectives. Endosc Int Open 2020; 8:E1713-E1716. [PMID: 33140029 PMCID: PMC7581477 DOI: 10.1055/a-1236-3105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/15/2020] [Indexed: 12/18/2022] Open
Abstract
Background The percutaneous approach allows for effective and safe treatment of liver lesions. But in case of subcapsular or left segments location, this approach seems to be less effective or unsafe. Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) is a new technique used to treat pancreatic and neuroendocrine tumors in patients unfit for surgery. Methods Hereby, we describe the case of a 70-year-old patient with cirrhosis with a large subcapsular hepatocellular carcinoma (HCC) in II-III-IVb segments, in which surgery or percutaneous therapies were not feasible, treated with EUS-RFA. The HCC was treated using an EUS-RFA (EUSRA) system, which consists of a 19G water-cooled monopolar RFA needle and a dedicated generator system. Results After a multidisciplinary discussion, the lesion was ablated in two different sessions, which resulted in destruction of about 70 % of neoplastic tissue. A second step surgery was required but initially refused by the patient. Conclusions EUS-RFA could be an effective way to treat left hepatic lesions not manageable with conventional percutaneous methods. This case report does not highlight concerns about safety of this approach and this observation needs to be validated in a larger cohort of patients with cirrhosis.
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Affiliation(s)
- Germana de Nucci
- Gastroenterology and Digestive Endoscopy Unit, ASST Rhodense, Garbagnate Milanese, Milan, Italy
| | | | - Raffaella Reati
- Gastroenterology and Digestive Endoscopy Unit, ASST Rhodense, Garbagnate Milanese, Milan, Italy
| | - Nicola Imperatore
- Gastroenterology and Digestive Endoscopy Unit, AORN Cardarelli, Naples, Italy
| | - Ilaria Arena
- Gastroenterology and Digestive Endoscopy Unit, ASST Rhodense, Rho, Milan, Italy
| | - Alberto Larghi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
| | - Gianpiero Manes
- Gastroenterology and Digestive Endoscopy Unit, ASST Rhodense, Garbagnate Milanese, Milan, Italy,Gastroenterology and Digestive Endoscopy Unit, ASST Rhodense, Rho, Milan, Italy
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Páez-Carpio A, Vollmer I, Paredes P. Evaluación de la respuesta al tratamiento con radiofrecuencia de un nódulo pulmonar mediante ecografía con contraste (CEUS). Arch Bronconeumol 2020; 56:531-532. [DOI: 10.1016/j.arbres.2020.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/10/2020] [Accepted: 03/05/2020] [Indexed: 11/25/2022]
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Characterization of Indeterminate Liver Lesions on CT and MRI With Contrast-Enhanced Ultrasound: What Is the Evidence? AJR Am J Roentgenol 2020; 214:1295-1304. [DOI: 10.2214/ajr.19.21498] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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10
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Ju JX, Zeng QJ, Xu EJ, He XQ, Tan L, Huang QN, Li K, Zheng RQ. Intraprocedural contrast-enhanced ultrasound-CT/MR fusion imaging assessment in HCC thermal ablation to reduce local tumor progression: compared with routine contrast-enhanced ultrasound. Int J Hyperthermia 2020; 36:785-793. [PMID: 31431086 DOI: 10.1080/02656736.2019.1640899] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Purpose: To evaluate whether local tumor progression (LTP) would be further reduced when contrast-enhanced ultrasound (CEUS)-CT/MR fusion imaging was used as intraprocedural assessment method in hepatocellular carcinoma (HCC) thermal ablation compared with routine CEUS. Materials and methods: This prospective non-randomized study was conducted from December 2010 to July 2012. CEUS-CT/MR fusion imaging and routine CEUS were used for treatment response assessment in the ablation procedure of 146 HCCs and 122 HCCs, respectively. Supplementary ablations were performed immediately if necessary. The primary technique efficacy rate, LTP rate and overall survival (OS) rate were calculated. Results: For CEUS-CT/MR fusion imaging and routine CEUS, the technical success rate, technique efficacy rate and supplementary ablation rate were 86.3% (126/146) and 98.4% (120/122) (p = .000), 99.2% (125/126) and 94.2% (113/120) (p = .032), and 14.3% (18/126) and 4.2% (5/120) (p = .006), respectively. The cumulative LTP rate and OS rate were not significantly different between fusion imaging group and routine CEUS group. However, for lesions that were larger than 3 cm or close to major vessels (41 lesions in fusion imaging group and 44 lesions in routine CEUS group, who received transcatheter arterial chemoembolization before ablation), the cumulative LTP rate was significantly lower in fusion imaging group than in routine CEUS group (p = .032). Conclusion: Although intraprocedural CEUS-CT/MR fusion imaging has certain limitations in application, it might provide a potential more efficient method compared with routine CEUS in reducing LTP in HCC thermal ablation, especially for difficult ablation lesions.
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Affiliation(s)
- Jin-Xiu Ju
- Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University , Guangzhou , China
| | - Qing-Jing Zeng
- Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University , Guangzhou , China
| | - Er-Jiao Xu
- Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University , Guangzhou , China
| | - Xu-Qi He
- Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University , Guangzhou , China
| | - Lei Tan
- Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University , Guangzhou , China
| | - Qian-Nan Huang
- Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University , Guangzhou , China
| | - Kai Li
- Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University , Guangzhou , China
| | - Rong-Qin Zheng
- Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University , Guangzhou , China
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Díaz-González Á, Vilana R, Bianchi L, García-Criado Á, Rimola J, Rodríguez de Lope C, Ferrer J, Ayuso C, Da Fonseca LG, Reig M, Forner A. Thermal Ablation for Intrahepatic Cholangiocarcinoma in Cirrhosis: Safety and Efficacy in Non-Surgical Patients. J Vasc Interv Radiol 2019; 31:710-719. [PMID: 31685360 DOI: 10.1016/j.jvir.2019.06.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/12/2019] [Accepted: 06/15/2019] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To assess the effectiveness, safety, and overall survival (OS) of thermal ablation as upfront treatment of intrahepatic colangiocarcinoma (ICC) in patients with cirrhosis. MATERIALS AND METHODS This was a retrospective analysis of all biopsy-confirmed ICC in cirrhotic patients treated in the authors' unit from 2001 to 2017. Baseline characteristics, ablation procedures, and complications were recorded, and time to recurrence (TTR) and OS were calculated. Twenty-seven patients were identified. Seventy percent had Child-Pugh A disease, and most had clinically significant portal hypertension. Median tumor size was 21 mm. Twenty-one cases were uninodular, and 10 were single ≤ 2 cm. RESULTS Complete radiologic necrosis was achieved in 25 cases (92.6%). Median OS was 30.6 months (95% confidence interval [CI], 22.6-46.5), and recurrence was detected in 21 cases (77.8%) with a TTR of 10.1 months (95% CI, 7.7-20.9). In those patients with single ≤ 2-cm ICC, the OS was 94.5 months (95% CI, 11.7-not reached). Differences in OS were statistically significant between patients with single ICC ≤ 2 cm and patients with single ICC > 2 cm (P = .04) and between patients with single ICC > 2 cm and patients with multinodular ICC (P = .02). Only 1 patient had a treatment-related complication. CONCLUSIONS Thermal ablation is a safe and effective treatment for ICC in patients with cirrhosis who are not candidates for surgery. The OS is similar to that reported in surgical series, but the initial treatment success is hampered by a high rate of tumor recurrence. Encouraging long-term survival after thermal ablation is achieved in patients with single ≤ 2-cm ICC.
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Affiliation(s)
- Álvaro Díaz-González
- Barcelona Clinic Liver Cancer Group, Liver Unit, Hospital Clínic of Barcelona, Fundació Clínic per a la Recerca Biomédica (FCRB), IDIBAPS, University of Barcelona, Villarroel 170. Escala 11, 4(a) planta, Barcelona 08036, Spain
| | - Ramón Vilana
- Radiology Department, Liver Unit, Hospital Clínic of Barcelona, Fundació Clínic per a la Recerca Biomédica (FCRB), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel 170. Escala 11, 4(a) planta, Barcelona 08036, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Luis Bianchi
- Radiology Department, Liver Unit, Hospital Clínic of Barcelona, Fundació Clínic per a la Recerca Biomédica (FCRB), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel 170. Escala 11, 4(a) planta, Barcelona 08036, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Ángeles García-Criado
- Radiology Department, Liver Unit, Hospital Clínic of Barcelona, Fundació Clínic per a la Recerca Biomédica (FCRB), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel 170. Escala 11, 4(a) planta, Barcelona 08036, Spain
| | - Jordi Rimola
- Radiology Department, Liver Unit, Hospital Clínic of Barcelona, Fundació Clínic per a la Recerca Biomédica (FCRB), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel 170. Escala 11, 4(a) planta, Barcelona 08036, Spain
| | - Carlos Rodríguez de Lope
- Barcelona Clinic Liver Cancer Group, Liver Unit, Hospital Clínic of Barcelona, Fundació Clínic per a la Recerca Biomédica (FCRB), IDIBAPS, University of Barcelona, Villarroel 170. Escala 11, 4(a) planta, Barcelona 08036, Spain
| | - Joana Ferrer
- Barcelona Clinic Liver Cancer Group, Liver Unit, Hospital Clínic of Barcelona, Fundació Clínic per a la Recerca Biomédica (FCRB), IDIBAPS, University of Barcelona, Villarroel 170. Escala 11, 4(a) planta, Barcelona 08036, Spain
| | - Carmen Ayuso
- Radiology Department, Liver Unit, Hospital Clínic of Barcelona, Fundació Clínic per a la Recerca Biomédica (FCRB), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel 170. Escala 11, 4(a) planta, Barcelona 08036, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Leonardo G Da Fonseca
- Barcelona Clinic Liver Cancer Group, Liver Unit, Hospital Clínic of Barcelona, Fundació Clínic per a la Recerca Biomédica (FCRB), IDIBAPS, University of Barcelona, Villarroel 170. Escala 11, 4(a) planta, Barcelona 08036, Spain
| | - María Reig
- Barcelona Clinic Liver Cancer Group, Liver Unit, Hospital Clínic of Barcelona, Fundació Clínic per a la Recerca Biomédica (FCRB), IDIBAPS, University of Barcelona, Villarroel 170. Escala 11, 4(a) planta, Barcelona 08036, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Alejandro Forner
- Barcelona Clinic Liver Cancer Group, Liver Unit, Hospital Clínic of Barcelona, Fundació Clínic per a la Recerca Biomédica (FCRB), IDIBAPS, University of Barcelona, Villarroel 170. Escala 11, 4(a) planta, Barcelona 08036, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.
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12
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Darnell A, Belmonte E, Reig M, Brú C. Evaluating the response to locoregional and systemic treatment for hepatocellular carcinoma. RADIOLOGIA 2018; 60:424-436. [PMID: 30196841 DOI: 10.1016/j.rx.2018.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 02/14/2018] [Accepted: 05/29/2018] [Indexed: 11/28/2022]
Abstract
Evaluating the response to different treatments is a decisive factor in the clinical management of patients with hepatocellular carcinoma because it can determine the efficacy of the treatment and because it can detect the recurrence of treated tumors or the appearance of new lesions that can be candidates for new treatments. When locoregional treatments that induce necrosis or molecular therapies are applied, the treated lesions usually change their behavior on imaging studies. It is important to point out that the size of the lesions does not usually decrease, at least initially, and some lesions can even appear to increase in size. For this reason, it is essential to know the mechanisms of action for each treatment applied and the spectrum of findings that these treatments can cause in the different imaging techniques used to assess the response.
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Affiliation(s)
- A Darnell
- Radiología abdominal, CDI, Unidad de Oncología Hepática, (Barcelona Clinic Liver Cancer), Hospital Clinic, Universitat de Barcelona, Barcelona, España.
| | - E Belmonte
- Radiología abdominal, CDI, Unidad de Oncología Hepática, (Barcelona Clinic Liver Cancer), Hospital Clinic, Universitat de Barcelona, Barcelona, España
| | - M Reig
- Servicio de Hepatología, Unidad de Oncología Hepática (Barcelona Clinic Liver Cancer), Hospital Clínic, Barcelona. IDIBAPS, Universitat de Barcelona. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, España
| | - C Brú
- Radiología abdominal, CDI, Unidad de Oncología Hepática (Barcelona Clinic Liver Cancer), Hospital Clínic, Barcelona. IDIBAPS, Universitat de Barcelona, Barcelona, España
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13
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Korcakova E, Mirka H, Liska V, Hosek P, Bajcurova K. Monitoring after radiofrequency ablation of liver tumors: contrast-enhanced ultrasound (CEUS) vs. contrast-enhanced computer tomography (CECT), two days after procedure. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2018; 162:304-309. [PMID: 29790488 DOI: 10.5507/bp.2018.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
AIM Our research evaluated the ability of contrast-enhanced ultrasound (CEUS) and contrast enhanced computer tomography (CECT), performed 48 h after radiofrequency ablation (RFA), to detect residual tumor tissue. As recently published studies have evaluated periprocedural CEUS performed within 24 h after procedure and their results were not satisfactory, it seems that postponing the control test by one day could increase the sensitivity of both methods. PATIENTS AND METHODS We evaluated 33 patients with 37 lesions, who met the criteria for our study. The criteria were 1) the treated lesion is sonographically viewable and 2) the patient underwent both CEUS and CECT control 48 h after treatment and additional follow-up 3 months later by CECT. Presence of residual tumor tissue and the size of necrosis were recorded and compared to the results of 3-months CECT. RESULTS Nine residues were present in our group. CEUS and CECT showed similar sensitivity (66.7% and 77.8%, respectively) and identical specificity (both 96.4%) for detection of residual tumor tissue. CEUS significantly underestimated the size of necrosis in comparison to CECT (on average by 2.4 mm, P=0.0005). Over the 3-months follow-up period the size of necrosis decreased in all patients (on average by 7.2 mm, P<0.0001). CONCLUSION The quality of tumor residue detection in 48-h CEUS was comparable to that of 48-h CECT. This finding suggests the CEUS being a feasible substitute for CECT. Both methods show reasonable sensitivity; therefore this timing seems to be appropriate for the first post-treatment control while also allowing for early retreatment if residual tumor tissue is found.
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Affiliation(s)
- Eva Korcakova
- Department of Imaging Methods, Teaching Hospital in Pilsen and Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Hynek Mirka
- Department of Imaging Methods, Teaching Hospital in Pilsen and Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Vaclav Liska
- Department of Surgery, Teaching Hospital in Pilsen and Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Petr Hosek
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Kristyna Bajcurova
- Department of Imaging Methods, Teaching Hospital in Pilsen and Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
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Nishigori S, Numata K, Irie K, Fukuda H, Chuma M, Maeda S. Fusion imaging with contrast-enhanced ultrasonography for evaluating the early therapeutic efficacy of radiofrequency ablation for small hypervascular hepatocellular carcinomas with iso-echoic or unclear margins on conventional ultrasonography. J Med Ultrason (2001) 2018; 45:405-415. [PMID: 29362966 DOI: 10.1007/s10396-018-0861-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 12/26/2017] [Indexed: 12/21/2022]
Abstract
PURPOSE We evaluated the efficacy of fusion imaging combining contrast-enhanced ultrasonography (CEUS) images and arterial phase contrast-enhanced CT (CECT) or hepatobiliary phase magnetic resonance imaging with gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (EOB-MRI) images for the early evaluation of the effectiveness of radiofrequency ablation (RFA) for small hypervascular hepatocellular carcinoma (HCC) with iso-echoic or unclear margins on conventional US. METHODS Forty HCCs (22 iso-echoic and 18 unclear margin lesions) with mean diameters of 13.7 mm were treated using RFA under the guidance of fusion imaging with CEUS. The adequacy of RFA was evaluated using fusion imaging with CEUS 1 day after RFA. CECT or EOB-MRI was performed 1 month after RFA. We reviewed the images obtained using both modalities. RESULTS When the 1-month CECT or EOB-MRI scans were used as the reference standard, the sensitivity, specificity, and accuracy of the 1-day fusion imaging for the diagnosis of the adequate ablation of these HCCs were 97, 100, and 98%, respectively; the kappa value for the agreement between the findings using the two modalities was 0.655. CONCLUSION Fusion imaging with CEUS appears to be a useful method for the early evaluation of the efficacy of RFA for the treatment of HCCs with iso-echoic or unclear margins on conventional US.
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Affiliation(s)
- Shuhei Nishigori
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Kazushi Numata
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan.
| | - Kuniyasu Irie
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Hiroyuki Fukuda
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Makoto Chuma
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Shin Maeda
- Division of Gastroenterology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
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15
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Diagnostic accuracy of contrast-enhanced ultrasound in assessing the therapeutic response to radio frequency ablation for liver tumors: systematic review and meta-analysis. Surg Endosc 2017; 32:2067-2075. [DOI: 10.1007/s00464-017-5903-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 09/17/2017] [Indexed: 02/07/2023]
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16
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Contrast-Enhanced Ultrasound of the Liver: Optimizing Technique and Clinical Applications. AJR Am J Roentgenol 2017; 210:320-332. [PMID: 29220210 DOI: 10.2214/ajr.17.17843] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The purpose of this article is to review the general principles, technique, and clinical applications of contrast-enhanced ultrasound of the liver. CONCLUSION Proper technique and optimization of contrast-enhanced ultrasound require a balance between maintaining the integrity of the microbubble contrast agent and preserving the ultrasound signal. Established and emerging applications in the liver include diagnosis of focal lesions, aiding ultrasound-guided intervention, monitoring of therapy, and aiding surgical management.
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17
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Management consensus guideline for hepatocellular carcinoma: 2016 updated by the Taiwan Liver Cancer Association and the Gastroenterological Society of Taiwan. J Formos Med Assoc 2017; 117:381-403. [PMID: 29074347 DOI: 10.1016/j.jfma.2017.09.007] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 08/16/2017] [Accepted: 09/13/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related mortality in Taiwan. To help clinical physicians to manage patients with HCC, the Taiwan Liver Cancer Association and the Gastroenterological Society of Taiwan produced the management consensus guideline for HCC. METHODS The recommendations focus on nine important issues on management of HCC, including surveillance, diagnosis, staging, surgery, local ablation, transarterial chemoembolization/transarterial radioembolization/hepatic arterial infusion chemotherapy, systemic therapy, radiotherapy, and prevention. RESULTS The consensus statements were discussed, debated and got consensus in each expert team. And then the statements were sent to all of the experts for further discussion and refinement. Finally, all of the experts were invited to vote for the statements, including the level of evidence and recommendation. CONCLUSION With the development of the management consensus guideline, HCC patients could benefit from the optimal therapeutic modality.
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18
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Evaluation of hepatocellular carcinoma tumor vascularity using contrast-enhanced ultrasonography as a predictor for local recurrence following radiofrequency ablation. Eur J Radiol 2016; 89:234-241. [PMID: 28034569 DOI: 10.1016/j.ejrad.2016.12.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 11/21/2016] [Accepted: 12/19/2016] [Indexed: 12/18/2022]
Abstract
PURPOSE The purpose of this study was to evaluate whether the hypervascularity of hepatocellular carcinomas (HCCs) on contrast-enhanced ultrasonography (CEUS) prior to radiofrequency ablation (RFA) is a significant risk factor for local recurrence after RFA. MATERIALS AND METHODS Institutional review board approval and informed consent were obtained. Overall, 208 patients (mean age, 71.7 years; range, 50-87 years; 137 men, 71 women) with 282 HCCs treated with RFA were analyzed retrospectively. The mean maximum tumor diameter was 15.7mm. We compared the abilities of CEUS and contrast-enhanced computed tomography (CECT) to detect hypervascularity in HCCs. We then classified the HCCs into two groups according to the arterial-phase CEUS findings: a "hypervascular group" with whole or partial hypervascular areas within the lesions compared with the surrounding liver parenchyma, and a "non-hypervascular group" with isovascular or hypovascular areas within the lesions. We assessed the cumulative rate of local recurrence after RFA, and we also evaluated the risk factors for local recurrence using a univariate analysis. RESULTS The detection rate for hypervascular HCCs was significantly higher using CEUS (78%, 221/282) than that using CECT (66%, 186/282) (P<0.001). Using the CEUS findings, the cumulative rate of local recurrence was significantly higher in the hypervascular group (41.2%, 56/221) than in the non-hypervascular group (18.4%, 6/61) (P=0.007). A univariate analysis revealed that hypervascularity on CEUS was an independent risk factor for local recurrence (P=0.010). CONCLUSION Hypervascularity in HCCs as observed using CEUS is a significant risk factor for local recurrence after RFA.
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Roccarina D, Garcovich M, Ainora ME, Riccardi L, Pompili M, Gasbarrini A, Zocco MA. Usefulness of contrast enhanced ultrasound in monitoring therapeutic response after hepatocellular carcinoma treatment. World J Hepatol 2015; 7:1866-1874. [PMID: 26207168 PMCID: PMC4506944 DOI: 10.4254/wjh.v7.i14.1866] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 03/13/2015] [Accepted: 07/14/2015] [Indexed: 02/06/2023] Open
Abstract
In the last years, the development in the oncology field has been huge and rapid. In particular, the evaluation of response to anti-tumour treatments has been being object of intense research, producing significant changes. Response assessment after therapy in solid neoplasias has always used radiological imaging techniques, with tumour size reduction representing a presumed therapeutic efficacy. However, with the introduction of anti-angiogenetic drugs the evaluation of tumour size has become unsuitable because some tumours, under treatment, show only tumour perfusion changes rather than lesion shrinkage. Between different imaging techniques with contrast-enhancement, contrast-enhanced ultrasound (CEUS) and, in particular, dynamic CEUS have arisen as a promising and non-invasive device for monitoring cancer treatments. Moreover, the introduction of perfusion software has even more refined the technique since it is able to provide quantitative parameters related to blood flow and blood volume that can be associated with tumour response and clinical outcome such as the progression free survival and the overall survival. Here, we give an overview of the current status of CEUS in monitoring hepatocellular carcinoma response to different kind of treatments.
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Meloni MF, Smolock A, Cantisani V, Bezzi M, D'Ambrosio F, Proiti M, Lee F, Aiani L, Calliada F, Ferraioli G. Contrast enhanced ultrasound in the evaluation and percutaneous treatment of hepatic and renal tumors. Eur J Radiol 2015; 84:1666-74. [PMID: 26094868 DOI: 10.1016/j.ejrad.2015.06.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 05/13/2015] [Accepted: 06/03/2015] [Indexed: 12/21/2022]
Abstract
Image-guided percutaneous ablation techniques are increasingly being used for the treatment of malignant tumors of the liver and kidney. Contrast enhanced ultrasound (CEUS) is a real-time dynamic imaging technique that plays an important role in the pre-, intra-, and post-procedural management of these patients. This review will focus on the role of CEUS in the evaluation of patients undergoing treatment with percutaneous ablation for hepatic or renal tumors.
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Affiliation(s)
| | - Amanda Smolock
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Vito Cantisani
- Department of Radiology, Oncology and Anatomo-Pathology "Sapienza" University of Rome, Rome, Italy
| | - Mario Bezzi
- Department of Radiology, Oncology and Anatomo-Pathology "Sapienza" University of Rome, Rome, Italy
| | - Ferdinando D'Ambrosio
- Department of Radiology, Oncology and Anatomo-Pathology "Sapienza" University of Rome, Rome, Italy
| | - Maria Proiti
- Department of Internal Medicine, Vittorio-Emanuele University Hospital, Catania, Italy
| | - Fred Lee
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Luca Aiani
- Department of Radiology, Ospedale Valduce, Como, Italy
| | - Fabrizio Calliada
- Department of Radiology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Giovanna Ferraioli
- Ultrasound Unit, Infectious Diseases Department, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
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The Role of Contrast-Enhanced Ultrasound in Guiding Radiofrequency Ablation of Hepatocellular Carcinoma. Can Assoc Radiol J 2015; 66:171-8. [DOI: 10.1016/j.carj.2014.11.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 11/19/2014] [Indexed: 02/06/2023] Open
Abstract
Purpose The objective of the study was to determine the efficacy of contrast-enhanced ultrasound (CEUS) using ultrasound (US)-specific microbubbles in guiding radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC). Methods A retrospective analysis of 50 patients with HCC treated with CEUS guided RFA using perflutren at our institution was performed. CEUS images were first compared to B-mode US images performed at the same RFA session to determine the ability of CEUS to increase the conspicuity of lesions. A qualitative score (1 = poor, 2 = fair, 3 = excellent) was used to grade the ability to visualize the lesions. The preprocedure CEUS images were then evaluated using the most recent prior contrast enhanced computed tomography (CT) or magnetic resonance imaging (MRI). The efficacy of the treatment was evaluated with short-term follow-up imaging (median 1 month) for presence of residual or recurrent disease. Results CEUS allows at least fair visualization (score ≥2) in 78% (reader 1) and 80% (reader 2) of the lesions not visualized by B-mode US, and 50% (reader 1) and 42% (reader 2) of the lesions poorly visualized by B-mode US. Lesion appearances on CEUS are largely concordant with those on CT or MRI: 88% for reader 1, 96% for reader 2. With CEUS-guided RFA, complete response was achieved in the vast majority of the lesions at short-term follow-up: 82% for reader 1, 94% for reader 2. Conclusions CEUS increases the conspicuity and provides better characterization of hypervascular HCC that are either not seen or poorly seen on B-mode US, and CEUS provides real-time guidance of RFA with good short-term treatment responses.
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22
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de la Serna S, Vilana R, Sánchez-Cabús S, Calatayud D, Ferrer J, Molina V, Fondevila C, Bruix J, Fuster J, García-Valdecasas JC. Results of laparoscopic radiofrequency ablation for HCC. Could the location of the tumour influence a complete response to treatment? A single European centre experience. HPB (Oxford) 2015; 17:387-93. [PMID: 25545319 PMCID: PMC4402048 DOI: 10.1111/hpb.12379] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 11/21/2014] [Indexed: 02/06/2023]
Abstract
INTRODUCTION In selected patients, radiofrequency ablation (RFA) is a well-established treatment for hepatocellular carcinoma (HCC). However, subcapsular or lesions close to adjacent viscera preclude a percutaneous approach. In this setting laparoscopic-RFA (LRFA) is a potential alternative. The aim of this study was to analyse the safety and feasibility of LRFA in patients with HCC. PATIENTS AND METHODS Retrospective study of patients with HCC meeting strict inclusion criteria who underwent LRFA at a single Institution from December 2000 to March 2013. RESULTS Forty-one patients underwent 42 LRFA of 51 nodules. The median size of the nodule was 2.5 (range 1.2-4.7) cm. Thirty-one tumours were subcapsular and 17 located near the gallbladder. Major complications occurred in 17 patients. The initial complete response (ICR) rate was 94% and was lower among tumours located adjacent to the gallbladder. At the end of the follow-up period, the sustained complete response (SCR) rate was 70% and was lower in tumours adjacent to the gallbladder while increased for subcapsular tumours. The 1-, 3- and 5-year overall survival rate was 92.6%, 64.5% and 43%, respectively. CONCLUSION LRFA of HCC is safe, feasible and achieves excellent results in selected patients. LRFA should be the first-line technique for subcapsular lesions as it minimizes the risk of tumoural seeding and improves ICR. Proximity to gallbladder interferes in treatment efficacy (lower rate of ICR and lower rate of SCR).
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Affiliation(s)
- Sofía de la Serna
- HBP Surgery and Liver Transplantation Unit, University of BarcelonaBarcelona, Spain
| | - Ramón Vilana
- Barcelona Clinic Liver Cancer (BCLC), University of BarcelonaBarcelona, Spain
- Department of Radiology, Institut de Malalties Digestives i Metabòliques, IDIBAPS, University of BarcelonaBarcelona, Spain
| | | | - David Calatayud
- HBP Surgery and Liver Transplantation Unit, University of BarcelonaBarcelona, Spain
| | - Joana Ferrer
- HBP Surgery and Liver Transplantation Unit, University of BarcelonaBarcelona, Spain
- Barcelona Clinic Liver Cancer (BCLC), University of BarcelonaBarcelona, Spain
| | - Victor Molina
- HBP Surgery and Liver Transplantation Unit, University of BarcelonaBarcelona, Spain
| | | | - Jordi Bruix
- Barcelona Clinic Liver Cancer (BCLC), University of BarcelonaBarcelona, Spain
- Liver Unit, Hospital Clínic i Provincial, CIBERehd, University of BarcelonaBarcelona, Spain
| | - Josep Fuster
- HBP Surgery and Liver Transplantation Unit, University of BarcelonaBarcelona, Spain
- Barcelona Clinic Liver Cancer (BCLC), University of BarcelonaBarcelona, Spain
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Li S, Lin S, Cheng Y, Matsunaga TO, Eckersley RJ, Tang MX. Quantifying activation of perfluorocarbon-based phase-change contrast agents using simultaneous acoustic and optical observation. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:1422-31. [PMID: 25656747 PMCID: PMC5706456 DOI: 10.1016/j.ultrasmedbio.2014.12.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 12/01/2014] [Accepted: 12/15/2014] [Indexed: 05/05/2023]
Abstract
Phase-change contrast agents in the form of nanoscale droplets can be activated into microbubbles by ultrasound, extending the contrast beyond the vasculature. This article describes simultaneous optical and acoustical measurements for quantifying the ultrasound activation of phase-change contrast agents over a range of concentrations. In experiments, decafluorobutane-based nanodroplets of different dilutions were sonicated with a high-pressure activation pulse and two low-pressure interrogation pulses immediately before and after the activation pulse. The differences between the pre- and post-interrogation signals were calculated to quantify the acoustic power scattered by the microbubbles activated over a range of droplet concentrations. Optical observation occurred simultaneously with the acoustic measurement, and the pre- and post-microscopy images were processed to generate an independent quantitative indicator of the activated microbubble concentration. Both optical and acoustic measurements revealed linear relationships to the droplet concentration at a low concentration range <10(8)/mL when measured at body temperature. Further increases in droplet concentration resulted in saturation of the acoustic interrogation signal. Compared with body temperature, room temperature was found to produce much fewer and larger bubbles after ultrasound droplet activation.
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Affiliation(s)
- Sinan Li
- Department of Bioengineering, Imperial College London, London, UK
| | - Shengtao Lin
- Department of Bioengineering, Imperial College London, London, UK
| | - Yi Cheng
- Department of Bioengineering, Imperial College London, London, UK
| | - Terry O Matsunaga
- Department of Medical Imaging, University of Arizona, Tucson, Arizona, USA
| | | | - Meng-Xing Tang
- Department of Bioengineering, Imperial College London, London, UK.
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Minami Y, Kudo M. Imaging Modalities for Assessment of Treatment Response to Nonsurgical Hepatocellular Carcinoma Therapy: Contrast-Enhanced US, CT, and MRI. Liver Cancer 2015; 4:106-14. [PMID: 26697413 PMCID: PMC4682875 DOI: 10.1159/000367733] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Tumor response and time to progression have been considered pivotal for surrogate assessment of treatment efficacy for patients with hepatocellular carcinoma (HCC). Recent advancements in imaging modalities such as contrast-enhanced ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) are playing an important role in assessing the therapeutic effects of HCC treatments. According to some HCC clinical guidelines, post-therapeutic evaluation of HCC patients is based exclusively on contrast-enhanced dynamic imaging criteria. The recommended techniques are contrast-enhanced CT or contrast-enhanced MRI. Contrast-enhanced US is employed more in the positive diagnosis of HCC than in post-therapeutic monitoring. Although contrast enhancement is an important finding on imaging, enhancement does not necessarily depict the same phenomenon across modalities. We need to become well acquainted with the characteristics of each modality, including not only contrast-enhanced CT and MRI but also contrast-enhanced US. Many nonsurgical treatment options are now available for unresectable HCC, and accurate assessment of tumor response is essential to achieve favorable outcomes. For the assessment of successful radiofrequency ablation (RFA), the achievement of a sufficient ablation margin as well the absence of tumor vascular enhancement is essential. To evaluate the response to transcatheter arterial chemoembolization (TACE), enhanced tumor shrinkage is relied on as a measure of antitumor activity. Here, we give an overview of the current status of imaging assessment of HCC response to nonsurgical treatments including RFA and TACE.
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Affiliation(s)
| | - Masatoshi Kudo
- *Masatoshi Kudo, MD, PhD, Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-sayama, Osaka 589-8511 (Japan), Tel. +81 72 366 0221 (Ext. 3525), E-Mail
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Palmieri VO, Santovito D, Marano G, Minerva F, Ricci L, D'Alitto F, Angelelli G, Palasciano G. Contrast-enhanced ultrasound in the diagnosis of hepatocellular carcinoma. Radiol Med 2015; 120:627-33. [PMID: 25599661 DOI: 10.1007/s11547-014-0494-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 10/27/2014] [Indexed: 12/17/2022]
Abstract
PURPOSE The American Association for the Study of Liver Diseases and the European Association for the Study of the Liver exclude any role of contrast-enhanced ultrasound (CEUS) in the diagnosis of hepatocellular carcinoma (HCC) while the Italian Association for the Study of the Liver suggests its use for larger HCC. This study evaluated the accuracy of CEUS in comparison with computed tomography (CT) in the diagnosis of HCC and of residual of HCC after treatment. MATERIALS AND METHODS We retrospectively evaluated 124 patients with 148 HCC nodules: 34 small (≤20 mm) and 114 large nodules (>20 mm). Ninety-three patients underwent treatment [one resection, 23 transcatheter arterial chemoembolisation (TACE), 37 radiofrequency ablation (RFA), 32 TACE/RFA combined with sorafenib]. The diagnosis of HCC on CEUS was confirmed by the typical pattern of arterial enhancement and portal and/or venous phase washout. RESULTS We performed 90 CEUS for the initial diagnosis of HCC in 85 patients and 107 CEUS for the diagnosis of residual HCC after 1-month treatment in 92 patients. Sensitivity, specificity, positive predictive value, negative predictive value of CEUS and CT in the initial diagnosis of HCC were: 63 vs 92, 100 vs 100, 100 vs 100, 9 vs 25 for small HCC; 77 vs 92, 100 vs 100, 100 vs 100, 13 vs 22 for large HCC. In the diagnosis of residual of HCC, CEUS had a sensitivity of 70 % for small nodules and 76 % for large nodules, with an overall specificity of 100 %. CONCLUSION CEUS is useful in the initial diagnosis and in the assessment of necrosis after RFA and TACE of HCC nodules.
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Affiliation(s)
- Vincenzo O Palmieri
- Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy,
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Minami Y, Nishida N, Kudo M. Therapeutic response assessment of RFA for HCC: Contrast-enhanced US, CT and MRI. World J Gastroenterol 2014; 20:4160-4166. [PMID: 24764654 PMCID: PMC3989952 DOI: 10.3748/wjg.v20.i15.4160] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 02/27/2014] [Indexed: 02/06/2023] Open
Abstract
Radiofrequency ablation (RFA) is commonly applied for the treatment of hepatocellular carcinoma (HCC) because of the facile procedure, and the safety and effectiveness for the treatment of this type of tumor. On the other hand, it is believed that HCC cells should spread predominantly through the blood flow of the portal vein, which could lead to the formation of intrahepatic micrometastases. Therefore, monitoring tumor response after the treatment is quite important and accurate assessment of treatment response is critical to obtain the most favorable outcome after the RFA. Indeed, several reports suggested that even small HCCs of ≤ 3 cm in diameter might carry intrahepatic micrometastases and/or microvascular invasion. From this point of view, for preventing local recurrences, RFA should be performed ablating a main tumor as well as its surrounding non-tumorous liver tissue where micrometastases and microvascular invasion might exist. Recent advancement of imaging modalities such as contrast-enhanced ultrasonic, computed tomography, and magnetic resonance imaging are playing an important role on assessing the therapeutic effects of RFA. The local recurrence rate tends to be low in HCC patients who were proven to have adequate ablation margin after RFA; namely, not only disappearance of vascular enhancement of main tumor, but also an adequate ablation margin. Therefore, contrast enhancement gives important findings for the diagnosis of recurrent HCCs on each imaging. However, hyperemia of non-tumorous liver surrounding the ablated lesion, which could be attributed to an inflammation after RFA, may well obscure the findings of local recurrence of HCCs after RFA. Therefore, we need to carefully address to these imaging findings given the fact that diagnostic difficulties of local recurrence of HCC. Here, we give an overview of the current status of the imaging assessment of HCC response to RFA.
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Mauri G, Porazzi E, Cova L, Restelli U, Tondolo T, Bonfanti M, Cerri A, Ierace T, Croce D, Solbiati L. Intraprocedural contrast-enhanced ultrasound (CEUS) in liver percutaneous radiofrequency ablation: clinical impact and health technology assessment. Insights Imaging 2014; 5:209-16. [PMID: 24563244 PMCID: PMC3999370 DOI: 10.1007/s13244-014-0315-7] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 01/20/2014] [Accepted: 01/24/2014] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To assess the clinical and the economic impacts of intraprocedural use of contrast-enhanced ultrasound (CEUS) in patients undergoing percutaneous radiofrequency ablation for small (<2.5 cm) hepatocellular carcinomas. METHODS One hundred and forty-eight hepatocellular carcinomas in 93 patients were treated by percutaneous radiofrequency ablation and immediate assessment by intraprocedural CEUS. Clinical impact, cost effectiveness, and budget, organisational and equity impacts were evaluated and compared with standard treatment without intraprocedural CEUS using the health technology assessment approach. RESULTS Intraprocedural CEUS detected incomplete ablation in 34/93 (36.5 %) patients, who underwent additional treatment during the same session. At 24-h, complete ablation was found in 88/93 (94.6 %) patients. Thus, a second session of treatment was spared in 29/93 (31.1 %) patients. Cost-effectiveness analysis revealed an advantage for the use of intraprocedural CEUS in comparison with standard treatment (4,639 vs 6,592) with a 21.9 % reduction of the costs to treat the whole sample. Cost per patient for complete treatment was <euro> 4,609 versus <euro> 5,872 respectively. The introduction of intraprocedural CEUS resulted in a low organisational impact, and in a positive impact on equity CONCLUSIONS Intraprocedural use of CEUS has a relevant clinical impact, reducing the number of re-treatments and the related costs per patient. TEACHING POINTS • CEUS allows to immediately asses the result of ablation. • Intraprocedural CEUS decreases the number of second ablative sessions. • Intraprocedural CEUS may reduce cost per patient for complete treatment. • Use of intraprocedural CEUS may reduce hospital budget. • Its introduction has low organisational impact, and relevant impact on equity.
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Affiliation(s)
- Giovanni Mauri
- IRCCS Policlinico San Donato, Unit of Radiology, Piazza Malan 2-20097 San Donato Milanese, Milano, Italy,
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Kondo T, Maruyama H, Sekimoto T, Shimada T, Takahashi M, Chiba T, Kanai F, Yokosuka O, Yamaguchi T. Natural history of postvascular-phase iso-enhanced lesions on the sonogram in chronic liver diseases. J Gastroenterol Hepatol 2014; 29:165-72. [PMID: 24224484 DOI: 10.1111/jgh.12449] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/16/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIM This study examined the natural history of postvascular-phase iso-enhanced lesions (PIELs) on contrast-enhanced sonograms to determine the potential risk and predictive factors for developing hepatocellular carcinoma (HCC) in chronic liver diseases. METHODS This prospective study included 87 PIELs on contrast-enhanced sonograms (postvascular-phase: 10 min post-injection of perflubutane microbubbles) in 72 patients with chronic liver diseases (45 males and 27 females; age 65.0 ± 10.8y; PIEL diameter 12.5 ± 4.2 mm). The PIELs were followed up by ultrasound/contrast-enhanced ultrasound, computed tomography, or magnetic resonance imaging at 3 to 6 months intervals. RESULTS Twenty patients developed HCCs during the study period (median, 22.0 months). The cumulative risk of HCC occurrence was 7.9% at 1 year and 36.0% at 3 years. The presence of coexistent HCC (hazard ratio [HR], 4.975; 95% confidence interval [CI], 1.729-14.316; P = 0.003) and alpha-fetoprotein > 20 ng/mL (HR, 4.104; 95% CI, 1.621-10.392; P = 0.003) were significant factors for the risk of HCC occurrence. Fourteen of these lesions were diagnosed as HCCs that developed from iso-enhanced lesions. Cumulative HCC occurrence rates from PIEL > 14 mm was 23.5% at 1 year and 46.3% at 3 years. Cox regression analysis showed that PIEL > 14 mm (HR, 6.780; 95% CI, 2.060-22.32; P = 0.002) and alpha-fetoprotein > 20 ng/mL (HR, 4.892; 95% CI, 1.559-15.350; P = 0.007) were statistically significant factors for HCC occurrence. CONCLUSIONS Patients with coexistent HCC, alpha-fetoprotein > 20 ng/mL, or PIEL > 14 mm should be carefully monitored because of the high potential for HCC occurrence.
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Affiliation(s)
- Takayuki Kondo
- Department of Gastroenterology and Hepatology, Chiba University Graduate School of Medicine, Chiba, Japan
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Andreano A, Galimberti S, Franza E, Knavel EM, Sironi S, Lee FT, Meloni MF. Percutaneous microwave ablation of hepatic tumors: prospective evaluation of postablation syndrome and postprocedural pain. J Vasc Interv Radiol 2013; 25:97-105.e1-2. [PMID: 24286938 DOI: 10.1016/j.jvir.2013.09.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 09/01/2013] [Accepted: 09/04/2013] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To prospectively investigate the frequency and severity of postablation syndrome (PAS) and postprocedural pain in a cohort of patients undergoing hepatic microwave ablation. MATERIALS AND METHODS From March 2009 to November 2011, 54 consecutive patients undergoing microwave ablation for liver tumors were enrolled. A questionnaire was administered to investigate PAS and pain at 1, 7, and 40 days after ablation. Four patients did not complete all three questionnaires and were excluded from the analysis. Additionally, laboratory tests with results known to significantly increase or decrease after ablation were performed, and ablation parameters were recorded. Potential predictors of PAS and pain at 1 and 7 days were evaluated by a logistic regression model. RESULTS Fifty patients underwent a single microwave ablation session, 33 for hepatocellular carcinoma (HCC) and 17 for liver metastasis. Median ablation volumes on computed tomography were 31 cm(3) for HCC and 42 cm(3) for metastasis. Sixty percent of patients experienced PAS in the first week. Aspartate aminotransferase (AST) levels after ablation were significantly associated with PAS during postprocedure days 1-7. Median visual analog scale scores for pain at the puncture site were 1 and 0.24 at 1 and 7 days, respectively. The risk of having at least moderate pain in the first week was significantly related to ablation volume and time and postablation increase in AST level. CONCLUSIONS The incidence and severity of PAS with hepatic microwave ablation is similar to that reported for radiofrequency ablation, with the best predictive factor being postablation AST level elevation. Postablation pain was best predicted by total ablation volume and AST level.
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Affiliation(s)
- Anita Andreano
- Department of Health Sciences, University of Milano-Bicocca, Monza; Centre of Biostatistics for Clinical Epidemiology, University of Milano-Bicocca, Monza
| | - Stefania Galimberti
- Department of Health Sciences, University of Milano-Bicocca, Monza; Centre of Biostatistics for Clinical Epidemiology, University of Milano-Bicocca, Monza
| | - Elvira Franza
- Department of Health Sciences, University of Milano-Bicocca, Monza
| | - Erica M Knavel
- Department of Radiology, University of Wisconsin, Madison, Wisconsin
| | - Sandro Sironi
- Department of Health Sciences, University of Milano-Bicocca, Monza
| | - Fred T Lee
- Department of Radiology, University of Wisconsin, Madison, Wisconsin
| | - Maria Franca Meloni
- Department of Health Sciences, University of Milano-Bicocca, Monza; Department of Radiology, Ospedale Valduce, via Dante 11, Como 22100, Italy.
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Wu H, Wilkins LR, Ziats NP, Haaga JR, Exner AA. Real-time monitoring of radiofrequency ablation and postablation assessment: accuracy of contrast-enhanced US in experimental rat liver model. Radiology 2013; 270:107-16. [PMID: 23912621 DOI: 10.1148/radiol.13121999] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE To examine the accuracy of the unenhanced zone at contrast material-enhanced ultrasonography (US) in predicting coagulative necrosis during and 21 days after radiofrequency (RF) ablation by using radiologic-pathologic comparison. MATERIALS AND METHODS Animal studies were approved by the Institutional Animal Care and Use Committee. The livers of 28 rats underwent US-guided RF ablation. In four animals, contrast-enhanced US was performed during ablation and 2 hours and 2, 7, 14, and 21 days after ablation. The unenhanced zone area on US images was measured. DiI-labeled microbubbles were administered during ablation at 2, 4, and 6 minutes or at 2 hours and 2, 7, 14, and 21 days after ablation in the remaining 24 animals (n = 3 at each time point). One minute later, the animal was euthanized, and the ablated liver was harvested. Tissue samples were imaged to quantify total fluorescence, and NADH staining was performed on the same slice. Hematoxylin-eosin staining was also performed. The findings on fluorescence images, NADH-stained images, and hematoxylin-eosin-stained images were compared. The areas of DiI bubble-negative zones, NADH-negative zones, and lightly NADH-staining zones were measured. Data were analyzed by using one-way analysis of variance. RESULTS The area of the unenhanced zone on contrast-enhanced US images increased during RF ablation and reached a maximum within 2 days after ablation. At histopathologic examination, a transition zone manifested adjacent to the coagulation zone until 2 days after ablation. The DiI-bubble negative zone on fluorescence images and the damaged zone (transition zone plus coagulation zone) on NADH-stained images increased rapidly within 2 hours after ablation, then slowly reached the maximum on day 2. The ratios of the mean areas of these two zones at hour 2 to those at day 2 were 94.6% and 95.6%, respectively. High uniformity between the damaged zone on NADH-stained images and the DiI bubble-negative zone on fluorescence images was noted at all time points. CONCLUSION The temporary transition zone in NADH staining is partially damaged and should transition to nonviability 2 days after ablation. These results demonstrate that contrast-enhanced US can help delineate the maximum area of cell damage (to within 5% of the maximum) as early as 2 hours after ablation. Contrast-enhanced US may be a simple and accurate tool for monitoring the effects of RF ablation and quantifying the size of thermal damage after treatment.
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Affiliation(s)
- Hanping Wu
- From Departments of Radiology (H.W., J.R.H., A.A.E.) and Pathology (N.P.Z.), Case Western Reserve University, 11100 Euclid Ave, Bishop s610, Cleveland, OH 44106; and Department of Radiology, University of Virginia, Charlottesville, Va (L.R.W.)
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Bolondi L, Cillo U, Colombo M, Craxì A, Farinati F, Giannini EG, Golfieri R, Levrero M, Pinna AD, Piscaglia F, Raimondo G, Trevisani F, Bruno R, Caraceni P, Ciancio A, Coco B, Fraquelli M, Rendina M, Squadrito G, Toniutto P. Position paper of the Italian Association for the Study of the Liver (AISF): the multidisciplinary clinical approach to hepatocellular carcinoma. Dig Liver Dis 2013; 45:712-23. [PMID: 23769756 DOI: 10.1016/j.dld.2013.01.012] [Citation(s) in RCA: 123] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 01/16/2013] [Indexed: 12/11/2022]
Abstract
Patients with hepatocellular carcinoma should be managed with a multidisciplinary approach framed in a network where all the diagnostic techniques and therapeutic resources are available in order to provide the optimal level of care. Given this assumption, the Coordinating Committee of the Italian Association for the Study of the Liver nominated a panel of experts to elaborate practical recommendations for the multidisciplinary management of hepatocellular carcinoma aiming to provide: (1) homogeneous and efficacious diagnostic and staging work-up, and (2) the best treatment choice tailored to patient status and tumour stage at diagnosis. The 2010 updated American Association for the Study of Liver Disease Guidelines for hepatocellular carcinoma were selected as the reference document. For each management issue, the American Association for the Study of Liver Disease recommendations were briefly summarised and discussed, according to both the scientific evidence published after their release and the clinical expertise of the Italian centres taking care of these patients. The Italian Association for the Study of the Liver expert panel recommendations are finally reported.
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Alzaraa A, Gravante G, Chung WY, Al-Leswas D, Morgan B, Dennison A, Lloyd D. Contrast-enhanced ultrasound in the preoperative, intraoperative and postoperative assessment of liver lesions. Hepatol Res 2013; 43:809-19. [PMID: 23745715 DOI: 10.1111/hepr.12044] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2012] [Revised: 12/04/2012] [Accepted: 12/10/2012] [Indexed: 12/12/2022]
Abstract
The use of contrast agents (CA) with liver ultrasound (US) has gained recently an established role for the diagnosis of various hepatic diseases due to their safety, high versatility and low costs (contrast-enhanced ultrasound: CEUS). The purpose of this review is to provide a state-of-the-art summary of the available evidence for their use in the characterization of focal liver lesions. A published work search was conducted for all preclinical and clinical studies involving CA on hepatic US imaging. CEUS increases the sensitivity for lesion detection and the specificity to differentiate between benign and malignant diseases due to the enhanced visualization of the tumor microcirculation. Results achieved seem at least equivalent to those of spiral computed tomography or magnetic resonance imaging. The association of CA with intraoperative ultrasound has changed the surgical approach in 25% of patients and guarantees complete ablations by a single session in most of them. CEUS provides detailed information about tumor vasculature, improves the preoperative characterization and therefore the therapeutic strategy, and can evaluate the intraoperative completeness of the ablation.
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Affiliation(s)
- Ahmed Alzaraa
- Department of General Surgery, William Harvey Hospital, Ashford
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Jang JY, Kim MY, Jeong SW, Kim TY, Kim SU, Lee SH, Suk KT, Park SY, Woo HY, Kim SG, Heo J, Baik SK, Kim HS, Tak WY. Current consensus and guidelines of contrast enhanced ultrasound for the characterization of focal liver lesions. Clin Mol Hepatol 2013; 19:1-16. [PMID: 23593604 PMCID: PMC3622850 DOI: 10.3350/cmh.2013.19.1.1] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Revised: 03/08/2012] [Accepted: 03/14/2012] [Indexed: 12/12/2022] Open
Abstract
The application of ultrasound contrast agents (UCAs) is considered essential when evaluating focal liver lesions (FLLs) using ultrasonography (US). Microbubble UCAs are easy to use and robust; their use poses no risk of nephrotoxicity and requires no ionizing radiation. The unique features of contrast enhanced US (CEUS) are not only noninvasiveness but also real-time assessing of liver perfusion throughout the vascular phases. The later feature has led to dramatic improvement in the diagnostic accuracy of US for detection and characterization of FLLs as well as the guidance to therapeutic procedures and evaluation of response to treatment. This article describes the current consensus and guidelines for the use of UCAs for the FLLs that are commonly encountered in US. After a brief description of the bases of different CEUS techniques, contrast-enhancement patterns of different types of benign and malignant FLLs and other clinical applications are described and discussed on the basis of our experience and the literature data.
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Affiliation(s)
- Jae Young Jang
- Institute for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
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Szurowska E, Nowicki TK, Izycka-Swieszewska E, Zadrozny D, Markiet K, Studniarek M. Predictive value of apparent diffusion coefficient in evaluation of colorectal carcinoma hepatic metastases' response to radiofrequency ablation. J Magn Reson Imaging 2013; 38:1027-32. [PMID: 23526807 DOI: 10.1002/jmri.24089] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 01/30/2013] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To establish the apparent diffusion coefficient (ADC) suitability to evaluate the radiofrequency ablation (RFA) outcome in patients with chemotherapy resistant or partially responding colorectal adenocarcinoma liver metastases. MATERIALS AND METHODS A total of 56 patients with 116 metastatic foci over 10 mm in diameter were examined with 1.5 Tesla MRI scanner 1 day before percutaneous RFA treatment. Lesions were evaluated in echo-planar diffusion-weighted images with b = 0, 15 and 500 s/mm(2) . On basis of computed tomography scan at 6 weeks, 3 and 6 months after RFA and serum CEA (carcinoembryonic antigen) level lesion were recognized as responding or nonresponding lesions. ADC values for b = 0-15 and 0-500 s/mm(2) of responding and nonresponding lesions were compared. RESULTS Noncomplete ablation concerned 28 lesions. Mean pretreatment ADC values for b = 0-15 and 0-500 s/mm(2) of responding metastases were significantly lower (2.14 and 1.48 × 10(-3) mm(2) /s) than those of nonresponding tumors (2.7 and 1.74 × 10(-3) mm(2) /s). Sensitivity, specificity, and accuracy of ADC values for b = 0-15 s/mm(2) were 79 (95%CI = 59-92), 85 (95%CI = 76-92), 84%; and for b = 0-500 s/mm(2) , the efficacy parameters were, respectively, 78 (95%CI = 56-92), 78 (95%CI = 67-86), and 78%. The P value was under 0.001 for both b parameters. CONCLUSION The pretreatment ADCs values of chemotherapy resistant or partially responding colorectal adenocarcinoma liver metastatic lesion can be predictive factor of tumors response to RFA therapy.
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Affiliation(s)
- Edyta Szurowska
- 2nd Department of Radiology, Medical University of Gdansk, Gdansk, Poland
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Zou X, Liu Q, Zhou X, He G, Yu M, Han Z, Meng X, Su H. Ultrasound-guided percutaneous laser and ethanol ablation of rabbit VX2 liver tumors. Acta Radiol 2013; 54:181-7. [PMID: 23482351 DOI: 10.1258/ar.2012.110723] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Only a small percentage of patients with hepatocellular carcinoma (HCC) may benefit out of surgical resection. Thus, lots of these patients are in need of local control, such as percutaneous ethanol injection (PEI), percutaneous laser ablation (PLA), or radiofrequency thermal ablation (RF). PURPOSE To investigate the effects of ultrasound-guided PLA combined with PEI on rabbit VX2 liver tumors, using conventional gray-scale ultrasonography (US), color/power Doppler (CD/PD)US, contrast-enhanced (CE) US, and histologic examination. MATERIAL AND METHODS VX2 tumors were implanted in the livers of 80 rabbits. Fourteen days after implantation, animals were randomly separated into four groups of 20 rabbits. Treatment of the four groups was with: (i) PLA; (ii) PEI; (iii) combined therapy of PLA immediately followed by PEI; and (iv) combined therapy of PEI immediately followed by PLA. Conventional gray-scale US, CD US, PD US, and CE US were performed before and after ablation. The effects on ablated areas were assessed by histologic examination. RESULTS Conventional gray-scale US showed a clear boundary around the ablated area in groups 1, 3, and 4. An isoechoic treated region with an irregular boundary was seen in group 2. On CE US, coagulated areas demonstrated a perfusion defect. Both conventional gray-scale US and CE US showed that the ablated volume in group 4 was larger than that in groups 1, 2, and 3. CD US and PD US demonstrated residual tumor in the periphery of ablated areas in groups 1 and 2, but not in groups 3 and 4. CE US demonstrated no residual tumor in group 4, unlike in groups 1, 2, and 3. Examination of treated tumors demonstrated necrosis in the ablated zones and increasing surrounding fibrous bands in the four treatment groups. Residual viable tissue in group 4 was less than that in groups 1, 2, and 3. CONCLUSION Combined therapy of PEI immediately followed by PLA can coagulate significantly larger volumes of tumor and reduce residual tumor.
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Affiliation(s)
- Xiaojuan Zou
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Qing Liu
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Xiaodong Zhou
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Guangbin He
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Ming Yu
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Zenghui Han
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Xin Meng
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Haili Su
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
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Zheng SG, Xu HX, Lu MD, Xie XY, Xu ZF, Liu GJ, Liu LN. Role of contrast-enhanced ultrasound in follow-up assessment after ablation for hepatocellular carcinoma. World J Gastroenterol 2013; 19:855-865. [PMID: 23430451 PMCID: PMC3574882 DOI: 10.3748/wjg.v19.i6.855] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 12/03/2012] [Accepted: 12/25/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the usefulness of contrast-enhanced ultrasound (CEUS) during follow-up after percutaneous ablation therapy for hepatocellular carcinoma (HCC).
METHODS: A total of 141 patients with HCCs who received percutaneous ablation therapy were assessed by paired follow-up CEUS and contrast-enhanced computed tomography (CECT). The follow-up scheme was designed prospectively and the intervals between CEUS and CECT examinations were less than 14 d. Both images of follow-up CEUS and CECT were reviewed by radiologists. The ablated lesions were evaluated and classified as local tumor progression (LTP) and LTP-free. LTP was defined as regrowth of tumor inside or adjacent to the successfully treated nodule. The detected new intrahepatic recurrences were also evaluated and defined as presence of intrahepatic new foci. On CEUS and CECT, LTP and new intrahepatic recurrence both were displayed as typical enhancement pattern of HCC (i.e., hyper-enhancing during the arterial phase and washout in the late phase). With CECT as the reference standard, the ability of CEUS in detecting LTP or new intrahepatic recurrence during follow-up was evaluated.
RESULTS: During a follow-up period of 1-31 mo (median, 4 mo), 169 paired CEUS and CECT examinations were carried out for the 141 patients. For a total of 221 ablated lesions, 266 comparisons between CEUS and CECT findings were performed. Thirty-three LTPs were detected on CEUS whereas 40 LTPs were detected on CECT, there was significant difference (P < 0.001). In comparison with CECT, the numbers of false positive and false negative LTPs detected on CEUS were 6 and 13, respectively; the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall accuracy of CEUS in detecting LTPs were 67.5%, 97.4%, 81.8%, 94.4% and 92.3%, respectively. Meanwhile, 131 new intrahepatic recurrent foci were detected on CEUS whereas 183 were detected on CECT, there was also significant difference (P < 0.05). In comparison with CECT, the numbers of false positive and false negative intrahepatic recurrences detected on CEUS were 13 and 65, respectively; the sensitivity, specificity, PPV, NPV and overall accuracy of CEUS in detecting new intrahepatic recurrent foci were 77.7%, 92.0%, 92.4%, 76.7% and 84.0%, respectively.
CONCLUSION: The sensitivity of CEUS in detecting LTP and new intrahepatic recurrence after percutaneous ablation therapy is relatively low in comparison with CECT.
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Guibal A, Bertin C, Egels S, Savier E, Grenier PA, Lucidarme O. Contrast-enhanced ultrasound (CEUS) follow-up after radiofrequency ablation or cryoablation of focal liver lesions: treated-area patterns and their changes over time. Eur Radiol 2012; 23:1392-400. [PMID: 23138387 DOI: 10.1007/s00330-012-2702-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 09/23/2012] [Accepted: 10/12/2012] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To describe the early patterns of liver lesions successfully treated with radiofrequency ablation (RFA) or cryoablation (CA) and their changes over time. METHODS Twenty-two RFA-treated and 17 CA-treated patients underwent CEUS from week 1 to year 3 post-ablation. Patterns, margins and volumes of RF-induced and cryolesions were evaluated and compared over time. RESULTS After contrast enhancement, shortly after ablation, undefined margins with persistent enhancing small vessels penetrating >2 mm into the treated zone were significantly more frequent after CA (67 %) than RFA (22 %) (P < 0.02). During the arterial phase, a thin, enhancing marginal rim was seen during week 1 (T1) in around 28 % of RF lesions, while 75 % of cryolesions had thick enhancing rims (P < 0.02). The mean RF-induced lesion volume, maximum at T1 (44.1 ± 37.5 ml), shrank slowly over time, remaining clearly visible at 1 year (8.3 ± 7.4 ml). Cryolesions shrank faster (P = 0.009), from an average of 16.6 ± 7.1 ml at T1 to 1.7 ± 1.3 ml 1-year post-ablation. CONCLUSION RF-induced and cryolesions differ, particularly their margins and shrinkage rates. Knowing these differences allows avoidance of incomplete treatment or falsely diagnosed recurrence, especially after CA. KEY POINTS • Contrast-enhanced ultrasound (CEUS) provides new follow-up information following hepatic radiological inyervention. • CEUS provides good visualisation of vascular modifications after thermoablation. • RFA-induced lesions and cryoablated lesions differ. • Knowledge about RF and cryolesion patterns is essential for correct CEUS follow-up. • Cryolesions have thicker peripheral inflammatory reactions and shrink faster than RFA-induced lesions.
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Affiliation(s)
- Aymeric Guibal
- Radiology Department, Hôpital Pitié- Salpêtrière, AP-HP, Institut Universitaire de Cancérologie, University Pierre et Marie Curie, 47-83, Boulevard de l'Hôpital, 75651 Paris cedex 13, France
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Abstract
The administration of a contrast agent is considered an essential tool to evaluate abdominal diseases using Ultrasound. The most targeted organ is the liver, especially to characterize focal liver lesions and to assess the response to percutaneous treatment. However, the expanding abdominal indications of contrast-enhanced ultrasound make this technique an important tool in the assessment of organ perfusion including the evaluation of ischemic, traumatic, and inflammatory diseases.
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Affiliation(s)
- Carlos Nicolau
- Radiology Department, Hospital Clínic, University of Barcelona, Spain.
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Small hepatocellular carcinomas: ultrasonography guided percutaneous radiofrequency ablation. ACTA ACUST UNITED AC 2012; 38:98-111. [DOI: 10.1007/s00261-012-9883-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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40
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Jung EM, Uller W, Stroszczynski C, Clevert DA. [Contrast-enhanced sonography. Therapy control of radiofrequency ablation and transarterial chemoembolization of hepatocellular carcinoma]. Radiologe 2012; 51:462-8. [PMID: 21557022 DOI: 10.1007/s00117-010-2101-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Due to the imaging of dynamic perfusion, hepatocellular carcinoma can be detected with a sensitivity of >90% using contrast-enhanced sonography. The characterization of liver tumors with contrast-enhanced sonography is comparable to the diagnostic accuracy of contrast-enhanced computed tomography. The dynamic detection of microvascularization with contrast-enhanced sonography allows the differentiation between vascularized tumors and non-vascularized necrotic lesions before, during and after transarterial chemoembolization or percutaneous radiofrequency ablation. Image fusion with volume navigation can be useful in the followup control.
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Affiliation(s)
- E M Jung
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg,Franz-Josef-Strauss-Allee 11, 93053 Regensburg.
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Wu H, Patel RB, Zheng Y, Solorio L, Krupka TM, Ziats NP, Haaga JR, Exner AA. Differentiation of benign periablational enhancement from residual tumor following radio-frequency ablation using contrast-enhanced ultrasonography in a rat subcutaneous colon cancer model. ULTRASOUND IN MEDICINE & BIOLOGY 2012; 38:443-453. [PMID: 22266229 PMCID: PMC3280615 DOI: 10.1016/j.ultrasmedbio.2011.12.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 12/02/2011] [Accepted: 12/06/2011] [Indexed: 05/31/2023]
Abstract
Benign periablational enhancement (BPE) response to thermal injury is a barrier to early detection of residual tumor in contrast enhanced imaging after radio-frequency (RF) ablation. The objective of this study was to evaluate the role of quantitative of contrast-enhanced ultrasound (CEUS) in early differentiation of BPE from residual tumor in a BD-IX rat subcutaneous colon cancer model. A phantom study was first performed to test the validity of the perfusion parameters in predicting blood flow of two US contrast imaging modes-contrast harmonic imaging (CHI) and microflow imaging (MFI). To create a simple model of BPE, a peripheral portion of the tumor was ablated along with surrounding normal tissue, leaving part of the tumor untreated. First-pass dynamic enhancement (FPDE) and MFI scans of CEUS were performed before ablation and immediately, 1, 4 and 7 days after ablation. Time-intensity-curves in regions of BPE and residual tumor were fitted to the function y = A(1-exp[-β{t-t0}])+C, in which A, β, t0 and C represent blood volume, flow speed, time to start and baseline intensity, respectively. In the phantom study, positive linear correlations were noted between A, β, Aβ and contrast concentration, speed and flow rate, respectively, in both CHI and MFI. On CEUS images of the in vivo study, the unenhanced ablated zone was surrounded by BPE and irregular peripheral enhancement consistent with residual tumor. On days 0, 4 and 7, blood volume (A) in BPE was significantly higher than that in residual tumor in both FPDE imaging and MFI. Significantly greater blood flow (Aβ) was seen in BPE compared with residual tumor tissue in FPDE on day 7 and in MFI on day 4. The results of this study demonstrate that qualitative CEUS can be potentially used for early detection of viable tumor in post-ablation assessment.
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Affiliation(s)
- Hanping Wu
- Department of Radiology, Case Western Reserve University, Cleveland, OH 44106, USA
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Numata K, Fukuda H, Morimoto M, Kondo M, Nozaki A, Oshima T, Okada M, Takebayashi S, Maeda S, Tanaka K. Use of fusion imaging combining contrast-enhanced ultrasonography with a perflubutane-based contrast agent and contrast-enhanced computed tomography for the evaluation of percutaneous radiofrequency ablation of hypervascular hepatocellular carcinoma. Eur J Radiol 2011; 81:2746-53. [PMID: 22197088 DOI: 10.1016/j.ejrad.2011.11.052] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Revised: 11/19/2011] [Accepted: 11/19/2011] [Indexed: 12/27/2022]
Abstract
OBJECTIVE We evaluated the efficacy of fusion imaging, which fuses contrast-enhanced ultrasonography images with arterial-phase, contrast-enhanced CT images as a reference on a single screen in real time, for the evaluation of the effectiveness of radiofrequency ablation for treatment of hypervascular hepatocellular carcinoma. MATERIALS AND METHODS Eighty hepatocellular carcinoma lesions with a maximum diameter of between 1 and 3 cm that were scheduled for treatment with radiofrequency ablation were enrolled in this prospective study. After bolus injection of perflubutane-based contrast agent, fusion imaging combining contrast-enhanced ultrasonography images and arterial-phase, contrast-enhanced CT images was performed one day after radiofrequency ablation. We used two functions, which were subsets of the fusion imaging, to confirm the location of the hepatocellular carcinoma lesions in the ablated areas and to evaluate the presence or absence of an adequate safety margin. Contrast-enhanced CT was performed one month after the ablation. Two blinded observers reviewed the images obtained using both modalities to evaluate the effect of ablation. RESULTS When the one-month contrast-enhanced CT images were used as the reference standard, the sensitivity, specificity, and accuracy of the one-day fusion imaging for the diagnosis of adequate ablation were 97%, 83%, and 96%, respectively; the kappa value for the agreement between the findings obtained using the two modalities was 0.75. CONCLUSION Fusion imaging combining contrast-enhanced ultrasonography images and arterial-phase, contrast-enhanced CT images as a reference appears to be a useful method for the early evaluation of the efficacy of radiofrequency ablation for the treatment of hypervascular hepatocellular carcinoma.
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Affiliation(s)
- Kazushi Numata
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa 232-0024, Japan.
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Bruix J, Reig M, Rimola J, Forner A, Burrel M, Vilana R, Ayuso C. Clinical decision making and research in hepatocellular carcinoma: pivotal role of imaging techniques. Hepatology 2011; 54:2238-44. [PMID: 21932394 DOI: 10.1002/hep.24670] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Jordi Bruix
- Barcelona Clinic Liver Cancer group, Liver Unit, Hospital Clinic Barcelona, IDIBAPS, University of Barcelona, Spain.
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Ooi CC, Low SCA, Schneider-Kolsky M, Lombardo P, Lim SY, Abu Bakar R, Lo RHG. Diagnostic accuracy of contrast-enhanced ultrasound in differentiating benign and malignant focal liver lesions: a retrospective study. J Med Imaging Radiat Oncol 2011; 54:421-30. [PMID: 20958940 DOI: 10.1111/j.1754-9485.2010.02195.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE The purpose of this study was to assess the diagnostic accuracy of our early experience with contrast-enhanced ultrasound (CEUS) in the characterisation of focal liver lesions (FLLs) using histopathology, contrast-enhanced computed tomography (CT), magnetic resonance imaging (MRI) or other imaging follow-up as the standard of reference. MATERIALS AND METHODS Seventy-three patients with 82 FLLs who underwent liver CEUS from January 2006 to December 2008 were retrospectively reviewed. CEUS was performed with up to 4.8 mL of SonoVue® (Bracco, Milan, Italy) using a low mechanical index mode. The CEUS findings were compared with histopathology, or where histopathology was not available, clinical and imaging follow-up over at least 12 months was used as the standard of reference. RESULTS Of the 82 FLLs, 50 were malignant and 32 were benign at final diagnosis. CEUS correctly identified 43 malignant FLLs, with final diagnosis confirmed by histopathology in 13 lesions and clinico-radiological follow-up in 30 lesions. Twenty-nine lesions were correctly identified as benign on CEUS, with all these lesions confirmed on clinico-radiological follow-up. CEUS demonstrated a sensitivity of 86.0% and a specificity of 90.6% in the characterisation of liver lesions as malignant, with an overall accuracy of 87.8% (P < 0.05). CONCLUSION Our early experience has shown that CEUS can be accurate in differentiating malignant from benign FLLs and may become a useful first-line imaging tool where CT or MRI are not available or contra-indicated.
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Affiliation(s)
- Chin-Chin Ooi
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore.
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Yu NC, Chaudhari V, Raman SS, Lassman C, Tong MJ, Busuttil RW, Lu DSK. CT and MRI improve detection of hepatocellular carcinoma, compared with ultrasound alone, in patients with cirrhosis. Clin Gastroenterol Hepatol 2011; 9:161-7. [PMID: 20920597 DOI: 10.1016/j.cgh.2010.09.017] [Citation(s) in RCA: 178] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Accepted: 09/22/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS In patients with cirrhosis, hepatocellular carcinoma (HCC) is detected by ultrasound (US), computed tomography (CT), or magnetic resonance imaging (MRI); US is recommended for screening and surveillance. We performed a retrospective analysis of the abilities of these cross-sectional imaging modalities to detect HCC. METHODS We analyzed data from 638 consecutive adult patients with cirrhosis who received liver transplants within 6 months of imaging at a tertiary care institution. Imaging reports and serum alpha-fetoprotein levels were compared with results from pathology analysis of explants as the reference standard. Sensitivities of US, CT, and MRI were calculated overall and in defined size categories. False-positive imaging results and patient-based specificities were evaluated. RESULTS Of the 638 patients, 225 (35%) had HCC, confirmed by pathology analysis of liver explants. In 23 cases, the lesions were infiltrative or extensively multifocal. In the remaining 202 explants (337 numerable, discrete nodules), respective lesion-based sensitivities of US, CT, and MRI were 46%, 65%, and 72% overall and 21%, 40%, and 47% for small (<2 cm) HCC. The sensitivity of US increased with the availability of CT or MRI data (P = .049); sensitivity values were 62% and 85% for lesions 2-4 and ≥ 4 cm, respectively. Patient-based specificities of US, CT, and MRI were 96%, 96%, and 87%, respectively. CONCLUSIONS US, CT, and MRI did not detect small HCC lesions with high levels of sensitivity, although CT and MRI provide substantial improvements over unenhanced US in patients with cirrhosis who received liver transplants.
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Affiliation(s)
- Nam C Yu
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA
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Rossi S, Ravetta V, Rosa L, Ghittoni G, Viera FT, Garbagnati F, Silini EM, Dionigi P, Calliada F, Quaretti P, Tinelli C. Repeated radiofrequency ablation for management of patients with cirrhosis with small hepatocellular carcinomas: a long-term cohort study. Hepatology 2011; 53:136-47. [PMID: 20967759 DOI: 10.1002/hep.23965] [Citation(s) in RCA: 133] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Accepted: 08/31/2010] [Indexed: 12/17/2022]
Abstract
UNLABELLED In most patients with cirrhosis, successful percutaneous ablation or surgical resection of hepatocellular carcinoma (HCC) is followed by recurrence. Radiofrequency ablation (RFA) has proven effective for treating HCC nodules, but its repeatability in managing recurrences and the impact of this approach on survival has not been evaluated. To this end, we retrospectively analyzed a prospective series of 706 patients with cirrhosis (Child-Pugh class ≤ B7) who underwent RFA for 859 HCC ≤ 35 mm in diameter (1-2 per patient). The results of RFA were classified as complete responses (CRs) or treatment failures. CRs were obtained in 849 nodules (98.8%) and 696 patients (98.5%). During follow-up (median, 29 months), 465 (66.8%) of the 696 patients with CRs experienced a first recurrence at an incidence rate of 41 per 100 person-years (local recurrence 6.2; nonlocal 35). Cumulative incidences of first recurrence at 3 and 5 years were 70.8% and 81.7%, respectively. RFA was repeated in 323 (69.4%) of the 465 patients with first recurrence, restoring disease-free status in 318 (98.4%) cases. Subsequently, RFA was repeated in 147 (65.9%) of the 223 patients who developed a second recurrence after CR of the first, restoring disease-free status in 145 (98.6%) cases. Overall, there were 877 episodes of recurrence (1-8 per patient); 577 (65.8%) of these underwent RFA that achieved CRs in 557 (96.5%) cases. No procedure-related deaths occurred in 1,921 RFA sessions. Estimated 3- and 5-year overall and disease-free (after repeated RFAs) survival rates were 67.0% and 40.1% and 68.0 and 38.0%, respectively. CONCLUSION RFA is safe and effective for managing HCC in patients with cirrhosis, and its high repeatability makes it particularly valuable for controlling intrahepatic recurrences.
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Affiliation(s)
- Sandro Rossi
- VI Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
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Wong SN, Santi GE, Nurjadin H, Aguilar R, Gosalvez-Pe S. Temperature-dependent electrode repositioning for multiple overlapping radiofrequency ablation in ex vivo porcine livers. J Vasc Interv Radiol 2010; 21:1733-8. [PMID: 20884231 DOI: 10.1016/j.jvir.2010.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Revised: 06/22/2010] [Accepted: 07/15/2010] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Overlapping ablations can be used to increase radiofrequency ablation volume. Our goal was to determine, in a porcine model, the relationship of ablation size and temperature for single ablation, and to compare the extent of necrosis resulting from temperature-dependent electrode positioning versus fixed-distance dual ablation. MATERIALS AND METHODS The experiments were performed in two parts (single and dual ablations). During single ablation in ex vivo porcine livers, maximum necrotic diameter was compared with the diameters at the level at which temperatures reached 60°C, 55°C, and 50°C. Dual ablations were performed using 60°C (group 60C), 55°C (group 55C), and 50°C (group 50C), and distances of 3 cm (group 3cm) and 4.1cm (group 4.1cm) as the starting point (RFA2-start) for the second ablation. RESULTS The maximum necrotic diameter (3.3 ± 0.6 cm) and the necrotic diameters reached at 60°C (2.8 ± 0.8 cm) and 55°C (2.2 ± 0.7 cm) were significantly greater than that at 50°C (0.9 ± 0.5cm; P < .05). In dual ablations, there was no difference between RFA2-start and the maximum diameter of the preceding and subsequent ablations in all temperature-dependent dual ablations (groups 60C, 55C, and 50C) and in group 3cm. (P > .05) However, there was a significant difference between RFA2-start and maximum diameter of the preceding and subsequent ablations in Group 4.1cm (P = .038), resulting in dumbbell-shaped necrosis. CONCLUSIONS The necrotic diameter proportionally decreases with the temperature in single ablation. Withdrawing the electrode up to 50° or by 3 cm before reablating results in fusion of the two ablation zones versus withdrawal of 4.1 cm, which results in incomplete necrosis in between two ablation zones.
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Affiliation(s)
- Stephen N Wong
- Section of Gastroenterology, Endoscopy Unit, University of Santo Tomas Hospital, Espaňa Street, Manila. Philippines.
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Tratamiento percutáneo e intraarterial del carcinoma hepatocelular. RADIOLOGIA 2010; 52:399-413. [DOI: 10.1016/j.rx.2010.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Revised: 05/10/2010] [Accepted: 05/14/2010] [Indexed: 01/14/2023]
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50
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Ayuso C, Rimola J, Forner A. [Imaging techniques in hepatocellular carcinoma: diagnosis, extension and evaluation of therapeutic response]. GASTROENTEROLOGIA Y HEPATOLOGIA 2010; 33:721-6. [PMID: 20447736 DOI: 10.1016/j.gastrohep.2010.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Accepted: 01/28/2010] [Indexed: 11/26/2022]
Abstract
Hepatocellular carcinoma (HCC) has a poor prognosis when diagnosed in advanced stages. Patients with cirrhosis of any etiology are a clear risk group. Thus, to improve prognosis, these patients should be included in surveillance programs to detect HCC in the early phases. Ultrasonographic examination is recommended for this purpose. The imaging techniques currently available for characterization of focal liver lesions are dynamic ultrasound, magnetic resonance imaging (MRI) and computed tomography (CT). MRI and CT are also suitable to determine tumoral extension. This article reviews the role of imaging techniques in the diagnosis and study of extension of HCC and in assessment of tumoral response after treatment, according to tumoral stage at diagnosis and the clinical status of the patient.
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Affiliation(s)
- Carmen Ayuso
- Servicio de Radiodiagnóstico, Centro de Diagnóstico por la Imagen, Hospital Clínic, Universidad de Barcelona, IDIBAPS, CIBERehd, Barcelona, España.
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