Efficacy of intra-arterial contrast-enhanced ultrasonography during transarterial chemoembolization with drug-eluting beads for hepatocellular carcinoma

Figure 3 The patient was a 76-year-old female with hepatitis C virus cirrhosis. DEB-TACE and IAUS for HCC in S3 with a diameter of 17 mm were performed. A: Dynamic CT in the arterial phase before DEB-TACE showed a hypervascular lesion in S3 (arrow); B: CEUS in the arterial phase before DEB-TACE showed a hyperenhanced lesion in S3 (arrow) and S2 (arrow head). Radiofrequency ablation was performed for the lesion in S3 after DEB-TACE (Right image: monitor mode); C: DSA from A3 before DEB-TACE showed tumor enhancement (arrow); D: IAUS from A3 before DEB-TACE showed a hyperenhanced lesion (arrow) with a small hypoenhanced area (arrow head), which was not recognized during the procedure. This small hypoenhanced area was recognized with stored video images after DEB-TACE procedure; E: DSA from A3 after DEB-TACE (when contrast medium disappeared from the blood vessel within 5-6 heart beats) eliminated the tumor enhancement; F: The enhanced lesion was disappeared by IAUS from A3 after DEB-TACE (arrow); G: CEUS showed enhancement area in the tumor (arrow head) and extrahepatic feeding artery (arrow) three days after DEB-TACE. It was thought this artery fed the small hypoenhanced area.