Original Article
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Radiol. Jun 28, 2013; 5(6): 229-240
Published online Jun 28, 2013. doi: 10.4329/wjr.v5.i6.229
Contrast ultrasound in hepatocellular carcinoma at a tertiary liver center: First Indian experience
Shalini Thapar Laroia, Simranjeet Singh Bawa, Deepak Jain, Amar Mukund, Shiv Sarin
Shalini Thapar Laroia, Simranjeet Singh Bawa, Department of Radiodiagnosis, Institute of Liver and Biliary Sciences, New Delhi 110070, India
Deepak Jain, Amar Mukund, Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi 110070, India
Shiv Sarin, Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi 110070, India
Author contributions: Laroia ST managed all the cases, formed the design and concept of the study, did data analysis, reviewed the literature and wrote the manuscript; Bawa SS assisted in performing the research and data analysis; Jain D and Mukund A performed the interventions and managed cases with trans-arterial chemo-embolization and radiofrequency ablation; Sarin S gave the guidance for design, concept and data analysis, supervised the entire study and revised the manuscript before submission.
Correspondence to: Shalini Thapar Laroia, Associate Professor, Department of Radiodiagnosis, Institute of Liver and Biliary Sciences, Sector D-1 Vasant Kunj, New Delhi 110070, India. thaparshalini@gmail.com
Telephone: +91-981-757973 Fax: +91-11-26806356
Received: August 30, 2012
Revised: April 24, 2013
Accepted: May 18, 2013
Published online: June 28, 2013
Processing time: 306 Days and 18.4 Hours
Abstract

AIM: To assess the role of contrast enhanced ultrasonography in evaluation of hepatocellular carcinoma (HCC) at the first Indian tertiary liver center.

METHODS: Retrospective analysis of contrast enhanced ultrasound (CEUS) examinations over 24 mo for diagnosis, surveillance, characterization and follow up of 50 patients in the context of HCC was performed. The source and indication of referrals, change in referral rate, accuracy and usefulness of CEUS in a tertiary liver center equipped with a 64 slice dual energy computer tomography (CT) and 3 tesla magnetic resonance imaging (MRI) were studied. Sonovue (BR1, Bracco, Italy, a second generation contrast agent) was used for contrast US studies. Contrast enhanced CT/MRI or both were performed in all patients. The findings were taken as a baseline reference and correlation was done with respect to contrast US. Contrast enhanced MRI was performed using hepatocyte specific gadobenate dimeglumine (Gd-BOPTA). Iomeron (400 mg; w/v) was used for dynamic CT examinations.

RESULTS: About 20 (40%) of the examinations were referred from clinicians for characterization of a mass from previous imaging. About 15 (30%) were performed for surveillance in chronic liver disease; 5 (10%) examinations were performed for monitoring lesions after radiofrequency ablation (RFA); 3 (6%) were post trans-arterial chemo-embolization (TACE) assessments and 3 (6%) were patients with h/o iodinated contrast allergy. About 2 (4%) were performed on hemodynamically unstable patients in the intensive care with raised alpha fetoprotein and 2 (4%) patients were claustrophobic. The number of patients referred from clinicians steadily increased from 12 in the first 12 mo of the study to 38 in the last 12 mo. CEUS was able to diagnose 88% of positive cases of HCC as per reference standards. In the surveillance group, specificity was 53.3% vs 100% by CT/MRI. Post RFA and TACE specificity of lesion characterization by CEUS was 100% in single/large mass assessment, similar to CT/MRI. For non HCC lesions such as regenerative and dysplastic nodules, the specificity was 50% vs 90% by CT/MRI. The positive role of CEUS in imaging spectrum of HCC included a provisional urgent diagnosis of an incidentally detected mass. It further led to a decrease in time for further management. A confident diagnosis on CEUS was possible in cases of characterization of an indeterminate mass, in situations where the patient was unfit for CT/MRI, was allergic to iodinated contrast or had claustrophobia, etc. CEUS was also cost effective, radiation free and an easy modality for monitoring post RFA or TACE lesions.

CONCLUSION: CEUS is a valuable augmentation to the practice of ultrasonography, and an irreplaceable modality for confounding cases and interpretation of indeterminate lesions in imaging of HCC.

Keywords: Hepatocellular carcinoma; Contrast ultrasound; Tertiary liver care; Triple phase contrast-enhanced computed tomography; Dynamic contrast enhanced magnetic resonance imaging