Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Radiol. Aug 28, 2012; 4(8): 379-386
Published online Aug 28, 2012. doi: 10.4329/wjr.v4.i8.379
Hepatocellular carcinoma treated with transarterial chemoembolization: Evaluation with parametric contrast-enhanced ultrasonography
Hippocrates Moschouris, Katerina Malagari, Athanasios Marinis, Ioannis Kornezos, Konstantinos Stamatiou, Georgios Nikas, Marina Georgiou Papadaki, Panagiotis Gkoutzios
Hippocrates Moschouris, Ioannis Kornezos, Georgios Nikas, Marina Georgiou Papadaki, Department of Radiology, Tzaneion General Hospital, 18536 Piraeus, Greece
Katerina Malagari, Second Department of Radiology, University of Athens, Attikon Hospital, Chaidari, 12462 Athens, Greece
Athanasios Marinis, First Department of General Surgery, Tzaneion General Hospital, 18536 Piraeus, Greece
Konstantinos Stamatiou, Department of Urology, General Hospital “Tzanio”, 18536 Piraeus, Greece
Panagiotis Gkoutzios, Department of Interventional Radiology, Guy’s and St. Thomas’ Hospital, NHS Foundation Trust, SE17EH London, United Kingdom
Author contributions: Moschouris H, Malagari K, Kornezos I performed the chemoembolizations and evaluation with CEUS; Moschouris H, Marinis A and Stamatiou K drafted the manuscript and revised it according to reviewers’ comments; Moschouris H, Kornezos I and Nikas G gathered all clinical and radiological data from the patients, organized and analyzed them; Papadaki MG and Gkoutzios P critically revised the manuscript; and all authors read and approved the final and the revised form of this manuscript.
Correspondence to: Athanasios Marinis, Consultant General Surgeon, First Department of General Surgery, Tzaneion General Hospital, Zanni and Afentouli 1 str, 18536 Piraeus, Greece. drmarinis@gmail.com
Telephone: +30-21-04592493 Fax: +30-21-04592491
Received: January 30, 2012
Revised: August 20, 2012
Accepted: August 27, 2012
Published online: August 28, 2012
Abstract

AIM: To evaluate the response of hepatocellular carcinoma (HCC) to transarterial chemoembolization (TACE) using a simplified protocol of parametric contrast-enhanced ultrasound (pCEUS).

METHODS: Eighteen patients with HCC (18 target tumors, diameter: 2.8-12 cm) were evaluated before, and 20 d after TACE. The distribution and morphology of TACE-induced necrosis in these tumors precluded accurate evaluation by visual assessment or by simple measurements. For pCEUS, a 4.8 mL bolus of SonoVue (Bracco, Milan, Italy) was intravenously administered and analysis of tumor perfusion during the initial phase of enhancement (0-30 s post injection) was performed with dedicated software (Qontrast, Bracco, Milan, Italy). Time-intensity curves were plotted and three parameters were calculated: peak intensity (PI, in percentage %), time to peak (TTP in seconds, s) and area under the curve during wash-in (AUC-WI, in arbitrary units, a.u). Magnetic resonance imaging was the standard imaging modality for post-treatment evaluation. Changes in tumor size were recorded and response was assessed according to response evaluation criteria in solid tumors criteria.

RESULTS: A statistically significant decrease in PI and AUC-WI was observed in the treated tumors post TACE; PIpre: 21.5% ± 8.7% (mean ± SD), PIpost: 12.7% ± 6.7%, P < 0.001, AUC-WI pre: 17493 ± 9563 a.u, AUC-WI post: 9585 ± 5494 a.u, P < 0.001. A slight increase in TTP was noted post TACE, but this was not statistically significant; TTP pre: 13.1 ± 4.3 s, TTP post: 13.6 ± 4.2 s , P = 0.058). The changes in the aforementioned parameters were not accompanied by significant tumor shrinkage.

CONCLUSION: pCEUS, even when limited to the study of the arterial phase of tumoral enhancement, can detect and quantify early perfusional changes in HCC post TACE.

Keywords: Contrast-enhanced ultrasonography, Hepatocellular carcinoma, Parametric imaging, Transarterial chemoembolization