Sono-Hepatic-Arteriography (Sono-HA) in the Assessment of Hepatocellular Carcinoma in Patients Undergoing Transcatheter Arterial Chemoembolization (TACE)

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

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