Contrast Harmonic Sonography-Guided Radiofrequency Ablation Therapy Versus B-Mode Sonography in Hepatocellular Carcinoma: Prospective Randomized Controlled Trial

Minami, Yasunori; Kudo, Masatoshi; Chung, Hobyung; Kawasaki, Toshihiko; Yagyu, Yukinobu; Shimono, Taro; Shiozaki, Hitoshi

doi:10.2214/ajr.05.1286

Cited by 90 publications

(71 citation statements)

References 28 publications

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“…Among these problems, Levovist-enhanced US has made a certain contribution to differential diagnosis [5,6,7], evaluation of malignancy grade [8], evaluation of therapeutic response to transcatheter arterial chemoembolization (TACE) [9,10,11], and needle insertion guidance [12, 13]; however, there are still remarkable limitations in the evaluation of the therapeutic response to radiofrequency ablation [14], screening or staging.…”

Section: Newly Introduced Diagnostic Techniquesmentioning

confidence: 99%

Hepatocellular Carcinoma 2009 and Beyond: from the Surveillance to Molecular Targeted Therapy

Kudo

2008

Oncology

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Hepatocellular carcinoma (HCC) is a malignant tumor which is becoming more prevalent worldwide. Patients at high risk of developing HCC, namely hepatitis B- and C-related liver cirrhosis patients, should be entered into surveillance programs, which should be performed using both ultrasonography and 3 tumor markers (AFP, PIVKA-II, AFP-L3). The surveillance interval needs to be shortened for patients at higher risk of HCC. Therefore, super-high-risk patients should be screened at 3- to 4-month intervals based on their risk of developing HCC. Sonazoid-enhanced US is extremely useful to characterize hepatic tumors when compared with multidetector-row computed tomography (MDCT). Moreover, Sonazoid-enhanced US with defect reperfusion imaging is a breakthrough approach in the treatment of HCC. This technique will markedly change the therapeutic strategy for liver cancer. Furthermore, diagnostic capability using the new imaging technique Gd-EOB-DTPA MRI is promising. A reduced uptake (low intensity) in the hepatobiliary phase of Gd-EOB-DTPA MRI strongly suggests HCC (including early-stage HCC) or a high-grade dysplastic nodule with high malignant potential. Empirically, intrahepatic arterial infusion chemotherapy using implanted reservoir port is known to be effective for advanced HCC with vascular invasion; however, no randomized study exists to prove its efficacy. Further controlled study is necessary to establish this treatment option as a standard of care in a treatment algorithm for HCC. In contrast, sorafenib was established as the first choice of treatment as a standard of care in advanced HCC patients with preserved liver function and vascular invasion/extrahepatic spread. Furthermore, global clinical trials are now ongoing using sorafenib as an adjuvant setting after resection, ablation or TACE. Efficacy of combined use of sorafenib with TACE or intra-arterial infusion chemotherapy is not clear. In order to clarify this issue a randomized clinical trial for intermediate and advanced HCC comparing sorafenib alone versus sorafenib combined with maintenance TACE/intra-arterial infusion chemotherapy and/or intra-arterial infusion chemotherapy is scheduled to be initiated in Japan in 2009. If positive results are obtained by these trials, its impact on treatment strategy for HCC will be drastically changed.

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Section: Newly Introduced Diagnostic Techniquesmentioning

confidence: 99%

Hepatocellular Carcinoma 2009 and Beyond: from the Surveillance to Molecular Targeted Therapy

Kudo

2008

Oncology

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“…Sonography-guided percutaneous radiofrequency (RF) ablation in treating unresectable hepatic tumors is an operator-dependent procedure and requires considerable experience to obtain good therapeutic results [1,2,3,4,5,6,7]. In our experience, a mismatch resulting from different scanning planes between sonographic and computed tomography (CT) images in terms of anatomical location of the tumor has made it difficult to accurately place the RF electrode in the desired site.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous Radiofrequency Ablation of Sonographically Unidentifiable Liver Tumors

Minami

Kudo²,

Chung³

et al. 2007

Oncology

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Objective: The purpose of this study was to evaluate the safety and feasibility of a real-time integrated system with computed tomography (CT) and sonographic images for radiofrequency (RF) ablation of hepatic malignancies poorly defined on B-mode sonography, and to clarify the suitable phase of CT images for using this virtual sonography. Methods: Between September 2004 and December 2004, 12 patients with 16 hepatocellular carcinomas and two metastatic lesions arising from colorectal adenocarcinoma (n = 1) and rectal carcinoid (n = 1) were treated. The maximum diameter of nodules ranged from 1.0 to 2.5 cm (mean ± SD; 1.5 ± 0.6 cm) on CT images. Results: Complete tumor necrosis was achieved in a single session in 19 lesions (90%), while a second session was required for the remaining two lesions (10%). Portal phase multi-planar reconstruction images were displayed under a suitable position corresponding to the ultrasound images in 9 patients (HCC = 7, metastasis = 2), and arterial phase multi-planar reconstruction images were displayed in the 3 remaining patients with hepatocellular carcinoma. Conclusion: Percutaneous RF ablation guidance using virtual sonography is an effective treatment for patients with hepatic malignancies. The portal phase of CT images may be the most suitable to indicate the 3-dimensional relationship between the liver vasculature and tumors on virtual sonography.

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“…Because this modality can distinguish viable from necrotic portions of hepatocellular carcinoma lesions, it has also been used to guide additional treatments, such as percutaneous ethanol and radio frequency ablation therapy (RFA). [2][3][4][5] A second-generation sonographic contrast agent, Sonazoid (GE Healthcare, Oslo, Norway), a lipid-stabilized suspension of perfluorobutane gas microbubbles, has been used clinically in patients with liver tumors and for phase inversion harmonic gray scale sonography in Japan since January 2007. On the basis of the results obtained in rabbit liver tumor models, the contrast agent is retained within the reticuloendothelial cells in the liver 10 to 30 minutes after injection and enhances the liver parenchyma in the late phase of contrast-enhanced phase inversion harmonic gray scale imaging at a low (0.4) 6 or moderate (0.6) 7 mechanical index setting.…”

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Ablation Therapy Guided by Contrast-Enhanced Sonography with Sonazoid for Hepatocellular Carcinoma Lesions Not Detected by Conventional Sonography

Numata¹,

Morimoto²,

Ogura³

et al. 2008

Journal of Ultrasound in Medicine

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AbbreviationsCHA, coded harmonic angio; CPI, coded phase inversion; CT, computed tomography; RFA, radio frequency ablation ecurrences of small new hepatocellular carcinoma lesions not identified by conventional sonography increase because of a heterogeneous echo signal as a result of the progression of cirrhosis R ArticleObjective. We evaluated the usefulness of contrast-enhanced harmonic gray scale sonography with a newly developed sonographic contrast medium as a means of guidance for percutaneous ablation therapy of hepatocellular carcinoma lesions not detected by conventional sonography. Methods. We examined 85 patients with 108 hepatocellular carcinoma lesions that were identified as hypervascular by multidetector-row computed tomography by using contrast-enhanced harmonic gray scale sonography after injection of Sonazoid (GE Healthcare, Oslo, Norway), a lipid-stabilized suspension of a perfluorobutane gas microbubble contrast agent. We scanned the whole liver by this modality at a low mechanical index in the late phase to detect lesions not detected by conventional sonography and then scanned the lesions again by this modality at a high mechanical index to visualize tumor vessels and enhancement. We also performed percutaneous ablation therapy guided by this modality to treat viable hepatocellular carcinoma lesions that could not be detected by conventional sonography. Results. Conventional sonography identified 90 (83%) of 108 hepatocellular carcinoma lesions; 15 (14%) additional viable lesions not detected by conventional sonography were detected in the late phase of contrast-enhanced harmonic gray scale sonography at a low mechanical index, and tumor vessels and enhancement were observed in the late phase at a high mechanical index. Contrast-enhanced harmonic gray scale sonography diagnosed 105 (97%) of the 108 viable hepatocellular carcinoma lesions, and 14 (93%) of the 15 lesions not detected by conventional sonography were successfully treated by percutaneous ablation therapy guided by this modality. Conclusions. Contrast-enhanced harmonic gray scale sonography is useful for guidance of percutaneous ablation therapy of hepatocellular carcinoma lesions not detected by conventional sonography.

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Contrast Harmonic Sonography-Guided Radiofrequency Ablation Therapy Versus B-Mode Sonography in Hepatocellular Carcinoma: Prospective Randomized Controlled Trial

Abstract: Contrast harmonic sonography-guided radiofrequency ablation is an efficient technique for guiding further ablation of local tumor progression not clearly demarcated with B-mode sonography.

Cited by 90 publications

References 28 publications

Hepatocellular Carcinoma 2009 and Beyond: from the Surveillance to Molecular Targeted Therapy

Hepatocellular Carcinoma 2009 and Beyond: from the Surveillance to Molecular Targeted Therapy

Percutaneous Radiofrequency Ablation of Sonographically Unidentifiable Liver Tumors

Ablation Therapy Guided by Contrast-Enhanced Sonography with Sonazoid for Hepatocellular Carcinoma Lesions Not Detected by Conventional Sonography

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