Contrast-Enhanced Ultrasound for Monitoring Treatment Response in Different Stages of Hepatocellular Carcinoma

Faccia, Mariella; Garcovich, Matteo; Ainora, Maria Elena; Riccardi, Laura; Pompili, Maurizio; Gasbarrini, Antonio; Zocco, Maria Assunta

doi:10.3390/cancers14030481

Cited by 25 publications

(20 citation statements)

References 50 publications

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“…During CEUS, microbubble-specific software on the sonographic console weakens all background signal intensity so that the operator can clearly see the signal intensity produced by the contrast agent passing under the sonographic probe, while the nonvascularized (unenhanced) tissue remains invisible [ 17 ]. CEUS has been used to evaluate the ablation effect in many studies [ 18 , 19 ]. However, due to the presence of vaporization mass after ablation and the hyperemia reaction around the ablation zone, it is difficult to accurately determine the extent of the lesion and evaluate the ablation effect in the short-term after ablation using contrast-enhanced ultrasound.…”

Section: Discussionmentioning

confidence: 99%

Real-Time Elastography versus Shear Wave Elastography on Evaluating the Timely Radiofrequency Ablation Effect of Rabbit Liver: A Preliminary Experimental Study

Shi

Liao

et al. 2023

Diagnostics

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Purpose: to evaluate and monitor the timely thermal ablation changes of rabbit liver by using two elastographic methods—real-time elastography (RTE) and shear wave elastography (SWE)—as compared to contrast-enhanced ultrasound (CEUS) and physical specimens. Materials and Methods: 20 ablation zones were created in the livers of 20 rabbits using radiofrequency ablation (RFA). After the ablation, RTE and SWE were used to measure the elastic properties of the twenty ablation zones. The consistency of efficacy evaluation for RTE and SWE measurements was analyzed using the Bland–Altman test. The areas of the thermal ablation zones were also measured and compared according to the images provided by RTE, SWE, CEUS, and gross physical specimen measurement. Results: RTE and SWE could clearly display the shape of RFA ablation zones within one hour after the ablation. The average elasticity ratio for the ablation zone measured by RTE was 3.41 ± 0.67 (2.23–4.76); the average elasticity value measured by SWE was 50.7 ± 11.3 kPa (33.2–70.4 kPa). The mean areas of the ablation zones measured with RTE, SWE, gross specimen, and CEUS were 1.089 ± 0.199 cm2, 1.059 ± 0.201 cm2, 1.081 ± 0.201 cm2, and 3.091 ± 0.591 cm2, respectively. The Bland–Altman test showed that RTE and SWE have great consistency. Area measurements by CEUS were significantly larger than those of the other three methods (p < 0.05). Conclusion: RTE and SWE are both able to accurately confirm the range of ablation zones shortly after the ablation for rabbit livers.

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Section: Discussionmentioning

confidence: 99%

Real-Time Elastography versus Shear Wave Elastography on Evaluating the Timely Radiofrequency Ablation Effect of Rabbit Liver: A Preliminary Experimental Study

Shi

Liao

et al. 2023

Diagnostics

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“…Ultrasound assessment, also with the employment of contrast medium (CEUS), is a relatively new tool, utilized for problem solving during treatment phases and surveillance [ 122 , 123 , 124 , 125 , 126 , 127 , 128 , 129 , 130 , 131 , 132 ], although the critical point of interest is due to the possibility of real time procedure efficacy assessment. In fact, CEUS allows to detect perfusion change during the procedure, and bearing in mind the higher temporal resolution and the possibility of repeating this diagnostic exam several times in a short period, it is a secure and cost-effective tool for treatment outcome assessment [ 130 , 131 , 132 ].…”

Section: Non Anatomic Liver Resectionmentioning

confidence: 99%

Imaging Features of Main Hepatic Resections: The Radiologist Challenging

Cutolo

Fusco

Simonetti

et al. 2023

JPM

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Liver resection is still the most effective treatment of primary liver malignancies, including hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA), and of metastatic disease, such as colorectal liver metastases. The type of liver resection (anatomic versus non anatomic resection) depends on different features, mainly on the type of malignancy (primary liver neoplasm versus metastatic lesion), size of tumor, its relation with blood and biliary vessels, and the volume of future liver remnant (FLT). Imaging plays a critical role in postoperative assessment, offering the possibility to recognize normal postoperative findings and potential complications. Ultrasonography (US) is the first-line diagnostic tool to use in post-surgical phase. However, computed tomography (CT), due to its comprehensive assessment, allows for a more accurate evaluation and more normal findings than the possible postoperative complications. Magnetic resonance imaging (MRI) with cholangiopancreatography (MRCP) and/or hepatospecific contrast agents remains the best tool for bile duct injuries diagnosis and for ischemic cholangitis evaluation. Consequently, radiologists should be familiar with the surgical approaches for a better comprehension of normal postoperative findings and of postoperative complications.

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“…Computed tomography (CT) and magnetic resonance imaging (MRI) represent the traditional imaging tools employed during the pre-treatment phase in order to identify and assess the target area [ 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 ], and in surveillance of the patient to evaluate treatment efficacy and post-procedural complications [ 87 , 88 , 89 , 90 , 91 , 92 , 93 ]. Ultrasound examination (US), without or with contrast medium (CEUS), is an innovative tool, utilized for problem solving during pre- and post-treatment phases [ 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 ], although the main use of interest is the possibility of assessing immediate effects during the procedure [ 60 , 61 ]. Given the ability of CEUS to detect real-time perfusion during the treatment, and considering the advantages of higher temporal resolution and the possibility of repeating an examination several times in a short period, it represents a secure and cost-effective tool for procedure outcome evaluation [ 96 ].…”

Section: Imaging and Ablation Treatmentmentioning

confidence: 99%

“…Ultrasound examination (US), without or with contrast medium (CEUS), is an innovative tool, utilized for problem solving during pre- and post-treatment phases [ 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 ], although the main use of interest is the possibility of assessing immediate effects during the procedure [ 60 , 61 ]. Given the ability of CEUS to detect real-time perfusion during the treatment, and considering the advantages of higher temporal resolution and the possibility of repeating an examination several times in a short period, it represents a secure and cost-effective tool for procedure outcome evaluation [ 96 ].…”

Section: Imaging and Ablation Treatmentmentioning

confidence: 99%

Complications Risk Assessment and Imaging Findings of Thermal Ablation Treatment in Liver Cancers: What the Radiologist Should Expect

Granata

Fusco

Muzio

et al. 2022

JCM

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One of the major fields of application of ablation treatment is liver tumors. With respect to HCC, ablation treatments are considered as upfront treatments in patients with early-stage disease, while in colorectal liver metastases (CLM), they can be employed as an upfront treatment or in association with surgical resection. The main prognostic feature of ablation is the tumor size, since the goal of the treatment is the necrosis of all viable tumor tissue with an adequate tumor-free margin. Radiofrequency ablation (RFA) and microwave ablation (MWA) are the most employed ablation techniques. Ablation therapies in HCC and liver metastases have presented a challenge to radiologists, who need to assess response to determine complication-related treatment. Complications, defined as any unexpected variation from a procedural course, and adverse events, defined as any actual or potential injury related to the treatment, could occur either during the procedure or afterwards. To date, RFA and MWA have shown no statistically significant differences in mortality rates or major or minor complications. To reduce the rate of major complications, patient selection and risk assessment are essential. To determine the right cost-benefit ratio for the ablation method to be used, it is necessary to identify patients at high risk of infections, coagulation disorders and previous abdominal surgery interventions. Based on risk assessment, during the procedure as part of surveillance, the radiologists should pay attention to several complications, such as vascular, biliary, mechanical and infectious. Multiphase CT is an imaging tool chosen in emergency settings. The radiologist should report technical success, treatment efficacy, and complications. The complications should be assessed according to well-defined classification systems, and these complications should be categorized consistently according to severity and time of occurrence.

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Contrast-Enhanced Ultrasound for Monitoring Treatment Response in Different Stages of Hepatocellular Carcinoma

Cited by 25 publications

References 50 publications

Real-Time Elastography versus Shear Wave Elastography on Evaluating the Timely Radiofrequency Ablation Effect of Rabbit Liver: A Preliminary Experimental Study

Real-Time Elastography versus Shear Wave Elastography on Evaluating the Timely Radiofrequency Ablation Effect of Rabbit Liver: A Preliminary Experimental Study

Imaging Features of Main Hepatic Resections: The Radiologist Challenging

Complications Risk Assessment and Imaging Findings of Thermal Ablation Treatment in Liver Cancers: What the Radiologist Should Expect

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