Efficacy of intra-arterial contrast-enhanced ultrasonography during transarterial chemoembolization with drug-eluting beads for hepatocellular carcinoma

Abstract

AIMTo assess the usefulness of intra-arterial contrast-enhanced ultrasonography (IAUS) during transarterial chemoembolization (TACE) with drug-eluting beads (DEB) for hepatocellular carcinoma (HCC).METHODSThirty two patients with 39 HCC underwent DEB-TACE guided with IAUS, and examined by contrast-enhanced ultrasonography (CEUS) or dynamic CT after DEB-TACE were enrolled in this study. CEUS findings before DEB-TACE and IAUS findings were compared. Treatments judged to be complete and incomplete for lesions were appropriate and insufficient, respectively. Findings on CEUS and/or dynamic CT performed 1, 3 and 6 mo after DEB-TACE were evaluated using mRECIST (CR/PR/SD/PD).RESULTSThe treatments were complete and incomplete in 26 and 13 lesions, respectively. On imaging evaluation using CEUS and/or dynamic CT one month after treatment, 25 and 1 lesions were judged to be CR and PR, respectively, and at 6 mo after treatment, the results were CR, PR, SD and PD for 24, 1, 0 and 1 of these lesions, respectively, in the 26 completely treated lesions. Of the 13 lesions in which treatment was incomplete, the results on imaging at one month after treatment were CR, PR, SD and PD for 0, 6, 4 and 3 lesions, respectively. The overall CR rate at 6 mo after treatment was 61.5% (24/39).CONCLUSIONA combination of DEB-TACE with IAUS can improve the therapeutic effects in patients with HCC.

Utility of Contrast‐Enhanced Ultrasound for Early Therapeutic Evaluation of Hepatocellular Carcinoma After Transcatheter Arterial Chemoembolization

“…The utility of intra-arterial CEUS has recently been reported in TACE using drug-eluting beads. [26][27][28] However, intra-arterial administration of Sonazoid is contraindicated, and in the case of TACE using iodized oil and gelatin sponge particles, as artifacts appear due to air mixed in during the procedure and the entire tumor may be observed as a strongly hyperechoic lesion with acoustic shadow on US images immediately after TACE, it becomes difficult to judge the detailed treatment effect. Therefore, we performed CEUS examinations 1 to 2 days after TACE in this study.…”

Contrast-enhanced US for the Interventional Radiologist: Current and Emerging Applications

“…In a series of 12 patients who underwent TACE, Moschouris et al (58) found that intraarterial CEUS increased the accuracy of chemoembolization when the vascular supply could not be clearly delineated with angiography. Intra-arterial CEUS could potentially be used in conjunction with preprocedure intravenous CEUS, where mismatches in lesion enhancement between the two could indicate inadequate or incomplete treatment targets, prompting a search for alternative feeding vessels (59). Intra-arterial CEUS during TACE could also potentially decrease the amount of iodinated contrast material required during the procedure, an important consideration in patients with renal impairment (60).…”

Predicting Therapeutic Efficacy of Transarterial Chemoembolization with Drug-Eluting Beads for Hepatocellular Carcinoma Using Contrast-Enhanced Ultrasound

“…However, it is difficult to assess the therapeutic efficacy of DEB-TACE by CT based on Lipiodol ® (Laboratoire Guerbet, Aulnay-Sous-Bois, France) (Lip) accumulation, unlike after Lip-TACE. Previously, we showed that DEB-TACE for HCC achieved a high CR rate [ 16 ]. Therefore, in order to accurately detect the feeding blood vessels, we performed TACE using IAUS—not only DEB-TACE but also conventional TACE.…”

“…Sonazoid ® (0.5 mL diluted with 49.5 mL of distilled water) was used as the contrast medium in IAUS. The diluted Sonazoid ® was introduced into the feeding artery by intermittent injection of 0.3–0.5 mL through a microcatheter placed in the artery and flushing with saline at the same flow rate [ 16 ].…”