Field Of Vision
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World J Gastroenterol. Feb 14, 2013; 19(6): 797-801
Published online Feb 14, 2013. doi: 10.3748/wjg.v19.i6.797
Hepatocellular carcinoma after ablation: The imaging follow-up scheme
Lin-Na Liu, Hui-Xiong Xu, Yi-Feng Zhang, Jun-Mei Xu
Lin-Na Liu, Hui-Xiong Xu, Yi-Feng Zhang, Jun-Mei Xu, Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tenth People’s Hospital of Tongji University, Shanghai 200072, China
Author contributions: Liu LN collected the materials and wrote the manuscript; Zhang YF and Xu JM discussed the topic; and Xu HX supervised the publication of this commentary.
Supported by National Scientific Foundation Committee of China, No. 30970837; Key Project from Shanghai Health Bureau, No. 20114003; Shanghai Talent Development Project from Shanghai Human Resource and Social Security Bureau, No. 2012045
Correspondence to: Hui-Xiong Xu, MD, PhD, Professor, Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tenth People’s Hospital of Tongji University, No. 301 Yanchangzhong Road, Shanghai 200072, China. xuhuixiong@hotmail.com
Telephone: +86-21-66301031 Fax: +86-21-66301031
Received: November 20, 2012
Revised: January 9, 2013
Accepted: January 18, 2013
Published online: February 14, 2013
Processing time: 90 Days and 0.2 Hours
Abstract

Percutaneous ablation using thermal or chemical methods has been widely used in the treatment of hepatocellular carcinoma (HCC). Nowadays, contrast-enhanced imaging modalities such as computed tomography (CT), magnetic resonance imaging (MRI), and contrast-enhanced ultrasound (CEUS) are widely used to evaluate local treatment response after ablation therapies. CEUS is gaining increasing attention due to its characteristics including real-time scanning, easy performance, lack of radiation, wide availability, and lack of allergy reactions. Several studies have documented that CEUS is comparable to CT or MRI in evaluating local treatment efficacy within 1 mo of treatment. However, little information is available regarding the role of CEUS in the follow-up assessment after first successful ablation treatment. Zheng et al found that in comparison with contrast-enhanced computed tomography (CECT), the sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of CEUS in detecting local tumor progression (LTP) were 67.5%, 97.4%, 81.8%, 94.4% and 92.3%, respectively, and were 77.7%, 92.0%, 92.4%, 76.7% and 84.0%, respectively for the detection of new intrahepatic recurrence. They concluded that the sensitivity of CEUS in detecting LTP and new intrahepatic recurrence after ablation is relatively low in comparison with CECT, and CEUS cannot replace CECT in the follow-up assessment after percutaneous ablation for HCC. These results are meaningful and instructive, and indicated that in the follow-up period, the use of CEUS alone is not sufficient. In this commentary, we discuss the discordance between CT and CEUS, as well as the underlying mechanisms involved. We propose the combined use of CT and CEUS which will reduce false positive and negative results in both modalities. We also discuss future issues, such as an evidence-based ideal imaging follow-up scheme, and a cost-effectiveness analysis of this imaging follow-up scheme.

Keywords: Hepatocellular carcinoma, Radiofrequency ablation, Ethanol ablation, Contrast-enhanced ultrasound, Follow-up, Treatment response, Computed tomography