Download PDF
Ultraschall Med 2009; 30(3): 252-258
DOI: 10.1055/s-2008-1027727
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Is Contrast-Enhanced US Alternative to Spiral CT in the Assessment of Treatment Outcome of Radiofrequency Ablation in Hepatocellular Carcinoma?

Kontrastmittelsonografie als Alternative zum Spiral-CT bei der Beurteilung des Therapieerfolg nach Radiofrequenzablation des hepatozellulären Karzinoms?P. Ricci1 , V. Cantisani1 , F. Drudi2 , E. Pagliara2 , M. Bezzi2 , F. Meloni3 , F. Calliada4 , S. M. Erturk5 , V. D’Andrea2 , U. D’Ambrosio1 , R. Passariello1
  • 1Department of Radiology, University “La Sapienza”
  • 2Department of Radiology, Campus Biomedico, Roma
  • 3Reparto di Radiologia, Ospedale di Vimercate (Mi)
  • 4Department of Radiology, Policlinico San Matteo, Pavia
  • 5Department of Radiology, Brigham & Women’s Hospital, Harvard Medical School, Boston
Further Information

Publication History

received: 1.8.2007

accepted: 8.7.2008

Publication Date:
11 March 2009 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Ziel: Die vorliegende Studie diente dem Ziel, die Wertigkeit der Kontrastmittelsonografie mit niedrigem mechanischem Index bei der Beurteilung des Therapieerfolgs der perkutanen Radiofrequenzablation des hepatozellulären Karzinoms im Vergleich mit dem 4-zeiligen Spiral-CT zu ermitteln. Material und Methoden: 100 aufeinanderfolgend vorgestellte Patienten (65 Männer und 35 Frauen, Alter: 62 – 76 Jahre) mit hepatozellulärem Karzinom (mittlere Tumorgröße 3,7 ± 1,1 cm SD) wurden mit gekühlter Radiofrequenzablation behandelt. Das Behandlungsergebnis wurde einen Monat nach dem Eingriff mit kontrastmittelgestütztem Dreiphasen-Spiral-CT sowie der Kontrastmittelsonografie mit niedrigem mechanischem Index nach Injektion eines Bolus von 2,4 ml SonoVue (Bracco, Mailand) untersucht. 60 von 100 Patienten wurden 3 Monate später nachuntersucht. Die kontrastgestützten Sonografieaufnahmen wurden von zwei verblindeten Radiologen zusammen begutachtet. Sensitivität, Spezifität, NPV und PPV der Kontrastmittelsonografie wurden ermittelt. Ergebnisse: Nach der Behandlung stellte die Kontrastmittelsonografie eine persistierende Signalverstärkung bei 24 Patienten dar (24 %), wohingegen bei den übrigen 76 Patienten (76 %) keine Anreicherung innerhalb des Tumors festgestellt werden konnte. Im Vergleich mit dem CT als Goldstandard lagen Sensitivität, Spezifität, NPV, and PPV der Kontrastmittelsonografie bei 92,3 % (95 % CI = 75,9 – 97,9 %), 100 % (95 % CI = 95,2 – 100 %), 97,4 % (95 % CI = 91,1 – 99,3 %) und 100 % (95 % CI = 86,2 – 100 %). Schlussfolgerung: Die Kontrastmittelsonografie mit niedrigem mechanischem Index und der Anwendung von SonoVue stellt ein brauchbares Instrument für die Bewertung des Therapieerfolgs der Radiofrequenzablation beim hepatozellulären Karzinom dar mit einer Genauigkeit, die der des 4-zeiligen Spiral-CT vergleichbar ist.

Abstract

Purpose: The present study was conducted to assess the efficacy of contrast-enhanced ultrasound with low mechanical index in evaluating the response of percutaneous radiofrequency ablation treatment of hepatocellular carcinoma by comparing it with 4-row spiral computed tomography. Materials and Methods: 100 consecutive patients (65 men and 35 women; age range: 62 – 76 years) with solitary hepatocellular carcinomas (mean lesion diameter: 3.7 cm ± 1.1 cm SD) underwent internally cooled radiofrequency ablation. Therapeutic response was evaluated at one month after the treatment with triple-phasic contrast-enhanced spiral CT and low-mechanical index contrast-enhanced ultrasound following bolus injection of 2.4 ml of Sonovue (Bracco, Milan). 60 out of 100 patients were followed up for another 3 months. Contrast-enhanced sonographic studies were reviewed by two blinded radiologists in consensus. Sensitivity, specificity, NPV and PPV of contrast-enhanced ultrasound examination were determined. Results: After treatment, contrast-enhanced ultrasound identified persistent signal enhancement in 24 patients (24 %), whereas no intratumoral enhancement was detected in the remaining 76 patients (76 %). Using CT imaging as gold standard, the sensitivity, specificity, NPV, and PPV of contrast enhanced ultrasound were 92.3 % (95 % CI = 75.9 – 97.9 %), 100 % (95 % CI = 95.2 – 100 %), 97.4 % (95 % CI = 91.1 – 99.3 %), and 100 % (95 % CI = 86.2 – 100 %). Conclusion: Contrast-enhanced ultrasound with low mechanical index using Sonovue is a feasible tool in evaluating the response of hepatocellular carcinoma to radiofrequency ablation. Accuracy is comparable to 4-row spiral CT.

Key words

neoplasms - abdomen - CT - ultrasound - radiofrequency

References

  • 1 Bruix J, Sherman M, Llovet J M. et al . Clinical management of hepatocellular carcinoma: conclusions of the Barcelona-2000 EASL Conference.  Journal of Hepatology. 2001;  35 421-430
    Google Scholar
  • 2 Torzilli G, Makuuchi M, Inoue K. No-mortality liver resection for hepatocellular carcinoma in cirrhotic and non-cirrhotic patients. Is there a way? A prospective analysis of our approach.  Arch Surg. 1999;  134 984-992
    Google Scholar
  • 3 Livraghi T, Goldberg S N, Lazzaroni S. et al . Small hepatocellular carcinoma: treatment with radiofrequency ablation versus ethanol injection.  Radiology. 1999;  210 655-661
    Google Scholar
  • 4 Shibata T, Iimuro Y, Yamamoto Y. et al . Small hepatocellular carcinoma: comparison of radio-frequency ablation and percutaneous microwave coagulation therapy.  Radiology. 2002;  223 331-337
    Google Scholar
  • 5 Heisterkamp J, Hillegersberg van R, Ijzermans J N. Interstitial laser coagulation for hepatic tumours.  Br J Surg. 1999;  86 293-304
    Google Scholar
  • 6 Bilchik A J, Wood T F, Allegra D. et al . Cryosurgical ablation and radiofrequency ablation for unresectable hepatic malignant neoplasms: a proposed algorithm.  Arch Surg. 2000;  135 657-664
    Google Scholar
  • 7 Solbiati L, Goldberg S N, Ierace T. et al . Hepatic metastases: percutaneous radio-frequency ablation with cooled-tip electrodes.  Radiology. 1997;  205 367-373
    Google Scholar
  • 8 Solbiati L, Ierace T, Tonolini M. et al . Guidance and monitoring of radiofrequency liver tumor ablation with contrast-enhanced ultrasound.  Eur Journal Radiol. 2004;  51 19-23
    Google Scholar
  • 9 Vilana R, Bianchi L, Varela M. et al . Is microbuble-enhanced ultrasonography sufficient for assessment of response to percutaneous treatment in patients with early hepatocellular carcinoma?.  Eur Radiol. 2006;  16 2454-2462
    Google Scholar
  • 10 Goldberg S N, Gazelle G S, Compton C C. et al . Treatment of intrahepatic malignancy with radiofrequency ablation: radiologic-pathologic correlation.  Cancer. 2000;  88 2452-2463
    Google Scholar
  • 11 Bartolozzi C, Cioni D, Donati F. et al .Imaging evaluation of tumor response. Bartolozzi C, Lencioni R Liver malignancies. Diagnostic and interventional radiology Berlin; Springer-Verlag 1999 1st ed: 467-487
    Google Scholar
  • 12 Meloni F M, Goldberg S N, Livraghi T. et al . Hepatocellular carcinoma treated with radiofrequency ablation : comparison of pulse inversion contrast-enhanced harmonic sonography, contrast-enhanced power Doppler sonography, and helical CT.  AJR. 2001;  177 375-380
    Google Scholar
  • 13 Yamasaki S, Hasegawa S, Makuuchi M. et al . Choice of treatment for small hepatocellular carcinoma: hepatectomy, embolization or ethanol injection.  J Gastroenterol Hepatol. 1991;  6 408-413
    Google Scholar
  • 14 Ryu M, Shimamura Y, Kawano N. et al . The present condition of the treatment for HCC.  Gastroenterol Surg. 1995;  18 415-419
    Google Scholar
  • 15 Reinhold C, Hammers L, Taylor C R. et al . Characterization of focal hepatic lesions with duplex sonography: finding in 198 patients.  Am J Roentgenol. 1995;  164 1131-1135
    Google Scholar
  • 16 Rubin J M, Bude R O, Carson P L. et al . Power Doppler US: a potentially useful alternative to mean-frequency-based color Doppler US.  Radiology. 1994;  190 853-856
    Google Scholar
  • 17 Sumi S, Yamashita Y, Mitsuzaki K. et al . Power Doppler sonography assessment of tumor recurrence after chemoembolization therapy for hepatocellular carcinoma.  AJR. 1999;  172 67-71
    Google Scholar
  • 18 Hosten N, Puls R, Bechstein W O. et al . Focal liver lesions: Doppler ultrasound.  Eur Radiology. 1999;  9 428-435
    Google Scholar
  • 19 Kim A Y, Choi B I, Kim T K. et al . Hepatocellular carcinoma: power Doppler US with a contrast agent: preliminary results.  Radiology. 1998;  209 135-140
    Google Scholar
  • 20 Bartolozzi C, Lencioni R, Ricci P. et al . Hepatocellular carcinoma treatment with percutaneous ethanol injection: evaluation with contrast-enhanced color-Doppler US.  Radiology. 1998;  209 387-393
    Google Scholar
  • 21 Ding H, Kudo M, Onda H. et al . Evaluation of post-treatment response for hepatocellular carcinoma with contrast-enhanced coded phase-inversion harmonic US: comparison with dynamic CT.  Radiology. 2001;  221 721-730
    Google Scholar
  • 22 Imai Y, Okamoto N, Tateiwa N. et al . Assessment of treatment efficacy in radiofrequency ablation for hepatocellular carcinoma: comparison between multiplanar reconstruction by multi-detector CT an contrast-enhanced ultrasonography by Truagent detection mode.  Hepatology research. 2006;  35 69-75
    Google Scholar
  • 23 Kisaka Y, Hirooka M, Uehara T. et al . Usefulness of contrast-enhanced ultrasonography with abdominal virtual ultrasonography in assessing therapeutic response in hepatocellular carcinoma treated with radiofrequency ablation.  Liver International. 2006;  26 1241-1247
    Google Scholar
  • 24 Choi D, Lim H K, Lee W J. et al . Radiofrequency ablation of liver cancer: early evaluation of therapeutic response with contrast-enhanced ultrasonography.  Korean J Radiol. 2004;  5 185-196
    Google Scholar
  • 25 Wen Y L, Kudo M, Zheng R Q. et al . Radiofrequency ablation of hepatocellular carcinoma: therapeutic response using contrast-enhanced coded phase inversion harmonic sonography.  AJR. 2003;  181 57-63
    Google Scholar
  • 26 Kim H J, Kim T K, Kim P N. et al . Assessment of the therapeutic response of hepatocellular carcinoma treated with transcatheter arterial chemoembolization: comparison of contrast-enhanced sonography and 3-phase computed tomography.  J Ultrasound Med. 2006;  25 477-86
    Google Scholar
  • 27 Gazelle G S, Goldberg S N, Solbiati L. et al . Tumor ablation with radiofrequency energy.  Radiology. 2000;  217 633-646
    Google Scholar
  • 28 Kubale R, Clevert D, Krämer W. et al . Possibilities and limitations of contrast-enhanced ultrasound (CEU) in an outpatient centre.  Ultraschall in Med. DOI: 10. 1055 /s2007-989 005
    Google Scholar
  • 29 Herbay von A, Haeussinger D, Gregor M. et al . Characterization and detection of hepatocellular carcinoma (HCC): comparison of the ultrasound contrast agents SonoVue (BR 1) and Levovist (SH U 508A) Comparison of SonoVue and Levovist in HCC Charakterisierung und Detektion des Hepatozellulären Karzinoms (HCC): Vergleich der Ultraschallkontrastmittel SonoVue (BR 1) und Levovist (SH U 508A).  Ultraschall in Med. 2007;  28 168-175
    Google Scholar
  • 30 Stang A, Keles H, Seydewitz von D. et al . Percutanous and Intraoperative Ultrasound-Guided Radiofrequency Ablation of Hepatic Tumours Perkutane und intraoperative ultraschallgeführte Radiofrequenzablation hepatischer Tumoren.  Ultraschall in Med. 2007;  28 181-188
    Google Scholar
  • 31 Ichikawa T, Erturk S M, Araki T. Multiphasic contrast-enhanced multidetector-row Ct of liver: contrast-enhancement theory and practical scan protocol with a combination of fixed injection duration and patients’ body-weight-tailored dose of contrast material.  Eur J Radiol. 2006;  58 165-176
    Google Scholar
  • 32 Colagrande S, La Villa G, Vartolucci M. et al . Spiral computed tomography versus ultrasound in the follow-up of cirrhotic patients previously treated for the hepatocellular carcinoma: a prospective study.  J hepatol. 2003;  39 93-98
    Google Scholar
  • 33 Lim H K, Choi D, Lee W J. et al . Hepatocellular carcinoma treated with percutaneous radiofrequency ablation: evaluation with follow-up multiphase spiral CT.  Radiology. 2001;  221 447-454
    Google Scholar
  • 34 Sironi S, Livraghi T, Meloni F. et al . Small hepatocellular carcinoma treated with percutaneous RF ablation: MR imaging follow-up.  Am J Roentgenol. 1999;  173 1225-1229
    Google Scholar
  • 35 Goldberg S N, Gazelle G S, Mueller P R. Thermal ablation therapy for focal malignancy: a unified approach to underlying principles, and diagnostic imaging guidance.  Am J Roentgenol. 2000;  174 323-331
    Google Scholar

Ugo D’Ambrosio

Department of Radiology, University “La Sapienza”

Viale del Policlinico

00176 ROME

Italy

Phone: ++ 39/3 38/8 74 48 67 n nn

Fax: ++ 39/06/60 50 72 44 n nn

Email: compax@gmail.com

      >