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DOI: 10.1055/s-0029-1245242
© Georg Thieme Verlag KG Stuttgart · New York
Sono-Hepatic-Arteriography (Sono-HA) in the Assessment of Hepatocellular Carcinoma in Patients Undergoing Transcatheter Arterial Chemoembolization (TACE)
Evaluation der Sonoarterioportografie (Sono-AP) in der Diagnostik des hepatozellulären Karzinoms bei Patienten mit transarterieller Chemoembolisation (TACE)Publication History
received: 7.10.2008
accepted: 29.12.2009
Publication Date:
20 April 2010 (online)

Zusammenfassung
Ziel: Ziel der Studie war die Evaluation der Sonoarterioportografie in der Detektion fokaler Leberraumforderungen bei Patienten mit hepatozellulärem Karzinom, die sich einer transarteriellen Chemoembolisation unterzogen haben. Material und Methoden: Von Februar 2006 bis Mai 2008 wurden 15 Patienten mit HCC, die sich einer transarteriellen Chemoembolisation unterzogen haben, in die Studie eingeschlossen. Zunächst erfolgte bei allen Patienten eine B-Bild-Sonografie mit einem High-End-Gerät und einem Multifrequenzschallkopf (2,5 – 4 MHz). Im Anschluss daran wurde eine Kontrastmittelsonografie mit Contrast Harmonic Imaging durchgeführt. Für die Sonoarterioportografie wurde 1 ml SonoVue® als Bolus injiziert. Hierzu wurde der bereits liegende intraarterielle Katheter genutzt. Eine 16-Zeilen-Computertomografie wurde spätestens 48 Stunden vor der Chemoembolisation durchgeführt, außerdem im Rahmen der Nachsorgeuntersuchungen. Ergebnisse: Die Größe der Läsionen betrug 1 – 13 cm im größten Durchmesser (Mittelwert: 4,8 cm). In 8 Fällen diagnostizierte die i. v.-Kontrastmittelsonografie mehr Läsionen als die B-Bild-Sonografie und in 5 Fällen mehr Raumforderungen als die Computertomografie. Die Ergebnisse der Sonoarterioportografie waren in 14 Fällen (93,3 %) korrekt. Dies hatte bei 11 Patienten (73,3 %) unmittelbare Auswirkung auf das weitere Procedere. Schlussfolgerung: Wir konnten zeigen, dass die Applikation eines intraarteriellen Kontrastmittels während der Chemoembolisation dazu beiträgt neue Läsionen zu diagnostizieren und den Erfolg der transarteriellen Chemoembolisation unmittelbar beurteilen zu können. Dies kann die Ergebnisse der transarteriellen Chemoembolisation und das Outcome des Patienten verbessern.
Abstract
Purpose: The aim of our study was to evaluate sono-hepatic-arteriography in patients with hepatocellular carcinoma undergoing transcatheter arterial chemoembolization. Materials and Methods: We evaluated 15 patients with hepatocellular carcinoma undergoing TACE who presented in our institution from February 2006 to May 2008. All patients underwent a conventional B-mode ultrasound examination using a high-end machine and a multi-frequency transducer (2.5 – 4 MHz) before dynamic contrast-enhanced ultrasound examination was carried out. For the sono-hepatic-arteriography 1 ml SonoVue® was injected as a bolus using the formerly placed intraarterial catheter. Biphasic enhanced computed tomography was performed using a 16-slice CT scanner up to 48 hours before transcatheter arterial chemoembolization and during follow-up. Results: The lesion size (of the largest lesion) ranged from 1 to 13 centimeters in their largest diameter (mean: 4.8 cm). Contrast-enhanced ultrasound diagnosed more lesions than B-mode sonography in eight cases and more lesions than computed tomography in 5 patients. The findings of sono-hepatic-arteriography were correct in fourteen cases (93.3 %). Direct impact on patient management was seen in eleven patients (73.3 %). Conclusion: We were able to show that the application of an intraarterial sonographic contrast agent during embolization is able to diagnose new lesions on the one hand and to assess the embolization success on the other. This might improve transcatheter arterial chemoembolization results and patient outcome.
Key words
chemoembolization - ultrasound - tumor
References
- 1
Bosch F X, Ribes J, Diaz M. et al .
Primary liver cancer, worldwide incidence and trends.
Gastroenterology.
2004;
127
5-16
MissingFormLabel
- 2
Forner A, Hessheimer A J, Real I M. et al .
Treatment of hepatocellular carcinoma.
Critical Rev Oncol Hematol.
2006;
60
89-98
MissingFormLabel
- 3
Schmidt J, Strotzer M, Fraunhofer S. et al .
Intraoperative ultrasonography versus helical computed tomography and computed tomography
with arterioportography in diagnosing colorectal liver metastases: lesion-by-lesion
analysis.
World J Surg.
2000;
24
43-47
MissingFormLabel
- 4
Strotzer M, Gmeinwieser J, Schmidt J. et al .
Diagnosis of liver metastases from colorectal adenocarcinoma. Comparison of spiral-CTAP
combined with intravenous contrast-enhanced spiral-CT and SPIO-enhanced MR combined
with plain MR imaging.
Acta Radiol.
1997;
38
986-992
MissingFormLabel
- 5
Conlon R, Jacobs M, Dasgupta D. et al .
The value of intraoperative ultrasound during hepatic resection compared with improved
preoperative magnetic resonance imaging.
Eur J Ultrasound.
2003;
16
211-216
MissingFormLabel
- 6
Mazzaferro V, Battiston C, Perrone S. et al .
Radiofrequency ablation of small hepatocellular carcinoma in cirrhotic patients awaiting
liver transplantation: a prospective study.
Ann Surg.
2004;
240
900-909
MissingFormLabel
- 7
Rode A, Bancel B, Douek P. et al .
Small nodule detection in cirrhotic livers: evaluation with US, spiral CT, and MRI
and correlation with pathologic examination of explanted liver.
J Comput Assist Tomogr.
2001;
25
327-336
MissingFormLabel
- 8
Libbrecht L, Bielen D, Verslype C. et al .
Focal lesions in cirrhotic explant livers: pathological evaluation and accuracy of
pretransplantation imaging examinations.
Liver Transp.
2002;
8
749-761
MissingFormLabel
- 9
Ledinghen de V, Laharie D, Lecesne R. et al .
Detection of nodules in liver cirrhosis: spiral computed tomograpy or magnetic resonance
imaging? A prospective study of 88 nodules in 34 patients.
Eur J Gastroenterol Hepatol.
2002;
14
159-165
MissingFormLabel
- 10
Kim Y K, Kwak H S, Kim C S. et al .
Hepatocellular carcinoma in patients with chronic liver disease: comparison of SPIO-enhanced
MR imaging and 16-detector row CT.
Radiology.
2006;
238
531-541
MissingFormLabel
- 11
Kato H, Kanematsu M, Kondo H. et al .
Ferumoxide-enhanced MR imaging of hepatocellular carcinoma: correlation with histologic
tumor grade and tumor vascularity.
J Magn Reson Imaging.
2004;
19
76-81
MissingFormLabel
- 12
Barthia B, Ward J, Guthrie J A. et al .
Hepatocellular carcinoma in cirrhotic livers: double-contrast thin-section MR imaging
with pathologic correlation of explanted tissue.
Am J Roentgenol.
2003;
180
577-584
MissingFormLabel
- 13
Kim S R, Ando K, Mita K. et al .
Superiority of CT arterioportal angiography to contrast-enhanced CT and MRI in the
diagnosis of hepatocellular carcinoma in nodules smaller than 2 cm.
Oncology.
2007;
72
58-66
MissingFormLabel
- 14
Tsurusaki M, Sugimoto K, Fujii M. et al .
Combination of CT during arterial portography and double-phase CT hepatic arteriography
with multi-detector row helical CT for evaluation of hypervascular hepatocellular
carcinoma.
Clin Radiol.
2007;
62
1189-1197
MissingFormLabel
- 15
Larson A C, Wang D, Atassi B. et al .
Transcatheter intraarterial perfusion: MR monitoring of chemoembolization for hepatocellular
carcinoma: feasibility of initial clinical translation.
Radiology.
2008;
246
964-971
MissingFormLabel
- 16
Peterson M S, Baron R L.
Radiologic diagnosis of hepatocellular carcinoma.
Clin Liver Dis.
2001;
5
123-144
MissingFormLabel
- 17
Liu W C, Lim J H, Park C K. et al .
Poor sensitivity of sonography in detection of hepatocellular carcinoma in advanced
liver cirrhosis: accuracy of pretransplantation sonography in 118 patients.
Eur Radiol.
2003;
13
1693-1698
MissingFormLabel
- 18
Rickes S, Schulze S, Neye H. et al .
Improved diagnosing of small hepatocellular carcinomas by echo-enhanced power Doppler
sonography in patients with cirrhosis.
Eur J Gastroenterol Hepatol.
2003;
15
893-900
MissingFormLabel
- 19
Tanaka S, Ioka T, Oshikawa O. et al .
Dynamic sonography of hepatic tumors.
Am J Roentgenol.
2001;
177
799-805
MissingFormLabel
- 20
Gaiani S, Celli N, Piscaglia F. et al .
Usefulness of contrast-enhanced perfusional sonography in the assessment of hepatocellular
carcinoma hypervascular at spiral computed tomography.
J Hepatol.
2004;
41
421-426
MissingFormLabel
- 21
Quaida E, Calliada F, Bertolotto M. et al .
Characterization of focal liver lesions with contrast-specific US modes and a sulfur
hexafluoride-filled microbubble contrast agent: diagnostic performance and confidence.
Radiology.
2004;
232
420-430
MissingFormLabel
- 22
Jung E M, Clevert D A, Schreyer A G. et al .
Evaluation of quantitative contrast harmonic imaging to assess malignancy of liver
tumors: A prospective controlled two-center study.
World J Gastroenterol.
2007;
13
6356-6364
MissingFormLabel
- 23
Claudon M, Cosgrove D, Albrecht T. et al .
Guidelines and good clinical practice recommendations for contrast enhanced ultrasound
(CEUS) – update 2008.
Ultraschall in Med.
2008;
29
28-44
MissingFormLabel
- 24
Herbay von A, Haeussinger D, Gregor M. et al .
Characterization and detection of hepatocellular carcinoma (HCC): comparison of the
ultrasound contras agents SonoVue (BR 1) and Levovist (SHU 508A) – comparison of SonoVue
and Levovist in HCC.
Ultraschall in Med.
2007;
28
168-175
MissingFormLabel
- 25
Rickes S, Ocran K, Schulze S. et al .
Evaluation of Doppler sonographic criteria for the differentiation of hepatocellular
carcinomas and regenerative nodules in patients with liver cirrhosis.
Ultraschall in Med.
2002;
23
83-90
MissingFormLabel
- 26
Kumada T, Nakano S, Takeda I. et al .
Clinical utility of Lens culinaris agglutinin-reactive alpha-fetoprotein in small
hepatocellular carcinoma: special reference to imaging diagnosis.
Journal of hepatology.
1999;
30
125-130
MissingFormLabel
- 27
Bruix J, Sherman M.
AASLD Practice Guideline: Management of hepatocellular carcinoma.
Hepatology.
2005;
42
1208-1236
MissingFormLabel
- 28
Cormier J N, Thomas K T, Chari R S. et al .
Management of hepatocellular carcinoma.
J Gastrointest Surg.
2006;
10
761-780
MissingFormLabel
- 29
Llado L, Virgili J, Figueras J. et al .
A prognostic index of the survival of patients with unresectable hepatocellular carcinoma
after transcatheter arterial chemoemboliztion.
Cancer.
2000;
88
50-57
MissingFormLabel
- 30
Yamasaki T, Matsukawa T, Arakawa A. et al .
US-guided liver biopsy: predicting the effect of interventional treatment of hepatocellular
carcinoma.
Radiology.
1995;
196
799-804
MissingFormLabel
- 31
Ito K, Honjo K, Fujita T. et al .
Therapeutic efficacy of transcatheter arterial chemoembolization for hepatocellular
carcinoma: MRI and pathology.
J Comput Assist Tomogr.
1995;
19
198-203
MissingFormLabel
- 32
Zhao J G, Feng G S, Kong X Q. et al .
Assessment of hepatocellular carcinoma vascularity before and after transcatheter
arterial chemoembolization by using first pass perfusion weighted MR imaging.
World J Gastroenterol.
2004;
10
1152-1156
MissingFormLabel
- 33
Kono Y, Lucidarme O, Choi S H. et al .
Contrast-enhanced ultrasound as a predictor of treatment efficacy within 2 weeks after
transarterial chemoembolization of hepatocellular carcinoma.
J Vasc Interv Radiol.
2007;
18
57-65
MissingFormLabel
- 34
Numata K, Morimoto M, Ogura T. et al .
Ablation therapy guided by contrast-enhanced sonography with Sonazoid for hepatocellular
carcinoma lesions not detected by conventional sonography.
J Ultrasound Med.
2008;
27
395-406
MissingFormLabel
Dr. Doris Schacherer
Internal Medicine, University of Regensburg
Franz-Josef-Strauss-Allee 11
93053 Regensburg
Phone: ++ 49/9 41/94 40
Fax: ++ 49/9 41/9 44 70 02
Email: doris.schacherer@klinik.uni-regensburg.de