Comparison of Contrast Enhanced Ultrasound and Contrast Enhanced CT or MRI in Monitoring Percutaneous Thermal Ablation Procedure in Patients with Hepatocellular Carcinoma: A Multi-Center Study in China

Lu, Ming-de; Yu, Xiao-ling; Li, An-hua; Jiang, Tian-an; Chen, Min-hua; Zhao, Bao-zhen; Zhou, Xiao-dong; Wang, Jin-rui

doi:10.1016/j.ultrasmedbio.2007.05.004

« Previous Next »Ultrasound in Medicine and Biology
Volume 33, Issue 11 , Pages 1736-1749, November 2007

Comparison of Contrast Enhanced Ultrasound and Contrast Enhanced CT or MRI in Monitoring Percutaneous Thermal Ablation Procedure in Patients with Hepatocellular Carcinoma: A Multi-Center Study in China

Ming-de Lu
- The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Address correspondence to: Ming-de Lu, MD, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhong Shan Road 2, Guangzhou, China.
Xiao-ling Yu
- General Hospital of PLA, Beijing, China
An-hua Li
- Sun Yat-sen University Cancer Center, Guangzhou, China
Tian-an Jiang
- The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
Min-hua Chen
- School of Oncology, Peking University, Beijing, China
Bao-zhen Zhao
- Changhai Hospital, The Second Military Medical University, Shanghai, China
Xiao-dong Zhou
- Xijing Hospital, The Fourth Military Medical University, Xi’an, China
Jin-rui Wang
- Peking University Third Hospital, Beijing, China

Received 24 January 2007; received in revised form 20 March 2007; accepted 1 May 2007. published online 16 July 2007.

Abstract

To evaluate the ability of contrast enhanced ultrasound (CEUS) in monitoring percutaneous thermal ablation procedure in patients with hepatocellular carcinoma (HCC) in comparison with contrast enhanced computed tomography (CECT) and/or magnetic resonance imaging (CEMRI). A total of 151 patients were enrolled in the study. Before the radio-frequency (RF) or microwave ablation treatment, tumor vascularity was assessed in 139 patients with three imaging modalities i.e., US (139 exams), CEUS (139 exams) and CECT (103 exams)/CEMR (36 exams). CEUS examination was performed using a sulphur hexafluoride-filled microbubble contrast agent (SonoVue^®, Bracco, Milan, Italy) and real-time contrast-specific imaging techniques. Within 30 ± 7 d after the ablation procedure, 118/139 patients were monitored to assess the tumor response to treatment. Before ablation, contrast enhancement within tumor was observed in 129/139 (92.8%) patients with CEUS and 133/139 (95.7%) patients with CECT/CEMRI. Compared with CECT/CEMRI, CEUS sensitivity and accuracy in detecting tumor vascularity were 97.0% and 94.2%, respectively. One month after treatment, no enhancement was seen in 110/118 (93.2%) both on CEUS and CECT/CEMRI. Concordance between CEUS and CECT/CEMR on the presence of residual vascularization was obtained in four patients (true positive). The specificity and accuracy of CEUS in detecting tumor vascularity were 98.2% and 96.6%, respectively. The periprocedural impact of SonoVue administration on the assessment of treatment extent was also evaluated in a subgroup of patients and CEUS showed its superiority compared with baseline US in defining treatment outcome. In conclusion, in the detection of HCC tumor vascularity and assessment of response to thermal ablation after 1 month, real time CEUS provided results comparable to those obtained with CECT/CEMRI. CEUS examination proved to be a safe and easy to access procedure, with potential for diagnostic impact in the clinical practice. (E-mail: lumd@21cn.com)

Key Words: Hepatocellular carcinoma, Percutaneous thermal ablation, Contrast-enhanced US