Percutaneous Treatment of Malignant Liver Lesions: Evaluation of Success Using Contrast- Enhanced Ultrasound (CEUS) and Perfusion Software

Abstract

A combination of CEUS with perfusion imaging enables critical assessment of successful treatment after percutaneous interventional procedures for a malignant liver lesion.

Joint Consensus Statement of the Indian National Association for Study of the Liver and Indian Radiological and Imaging Association for the Diagnosis and Imaging of Hepatocellular Carcinoma Incorporating Liver Imaging Reporting and Data System

“…Furthermore, even though a residual viable tumor is detected on CECT, it is sometimes difficult to visualize and target the residual viable tumor on conventional grayscale US, particularly immediately after RFA. 153 Because CEUS can overcome these disadvantages, it can be used in the evaluation of the post-RFA response. For hypervascular lesions such as HCC, if the intratumoral vascularity, which was noted before treatment, disappears on postprocedural CECT or CEUS, complete ablation of the tumor can be confirmed.…”

“…According to previous studies, the diagnostic accuracy of CEUS (93.8%-100%) for the evaluation of the RFA treatment response with either SonoVue or Sonazoid was comparable with CECT or CEMR. 152,153 The optimal time to assess the treatment response to RFA is 3 h after the procedure because the treated tumor margin is the most clearly perceived at this time. Uniform rim enhancement can be seen up to 30 days after RFA, and this rim enhancement should not be misdiagnosed as marginal tumor recurrence.…”

“…Efforts have also been made to evaluate the treatment response after TACE with CEUS. Although CEUS could detect residual intratumoral vascularity after TACE in previous studies, it is not feasible to use it as an evaluation tool after TACE because of the difficulty in evaluating multiple lesions, deeply located lesions, and poorly enhancing, or diffusely growing lesions [152][153][154] STRUCTURED REPORTING TEMPLATE AND MINIMUM DATA SET (TABLE 7) Literature Review…”

Contrast-Enhanced Ultrasound in Hepatobiliary Interventions

“…In the postinterventional follow-up, it is a safe and efficient method for diagnostic imaging, especially if combined with preinterventional imaging studies using image fusion. 26,27 Conclusion CEUS and image fusion are real-time imaging techniques that merge the benefits of conventional ultrasound with the dynamic information of microvascularization and other imaging modalities for an extensive assessment and monitoring of abdominal interventions. This technique has the potential to be extensively integrated into clinical routine for best patient care.…”

Use of intra-procedural fusion imaging combining contrast-enhanced ultrasound using a perflubutane-based contrast agent and auto sweep three-dimensional ultrasound for guiding radiofrequency ablation and evaluating its efficacy in patients with hepatocellular carcinoma

“…However, neither of these imaging techniques can be performed during the RFA procedure to evaluate its therapeutic efficacy. The recent European Federation of Societies for Ultrasound in Medicine and Biology guidelines have highlighted the role of contrastenhanced ultrasound (CEUS) as a cost-effective technique with a good safety profile, not only for characterization and detection of focal liver lesions, but also for monitoring tumor response after curative, locoregional or systemic treatment for HCC [5][6][7]. However, the ablation margin can be hard to determine by CEUS because of the difficulty in identifying the edge between the ablated HCC and the ablated adjacent liver parenchyma using this imaging modality alone [8,9].…”