Prognostic value of enhancement rate by enhanced ultrasound in hepatitis B virus‐positive hepatocellular carcinoma undergoing radiofrequency ablation

Abstract

Aim:To assess the prognostic significance of enhancement rate (ER) measured by contrastenhanced ultrasonography (CEUS) in patients with hepatocellular carcinoma (HCC) undergoing radiofrequency ablation (RFA). Materials and methods:A total of 253 patients with single primary HCC undergoing preoperative CEUS and RFA were enrolled in this study. The ER were evaluated though pretreatment CEUS.After a mean follow-up of 36.8 ± 10.2 months, the correlation of ER measured by CEUS and survival after RFA was analyzed by univariate and multivariate analysis. The optimal cutoff ER value to predict survival was determined using receiver-operating characteristic analysis.Results: Mean follow-up period for all 253 patients was 36.8 ± 10.2 months, 31.2% of patients had died at endpoint. The optimal cutoff ER value predicting survival was 2.2 dB/s. Univariate analysis demonstrated that patients with a high ER level had poorer OS (62.8 months vs 48.8 months, P = 0.02) and recurrence-free survival (RFS = 60.2 months vs 47.4 months, P = 0.03) than patients with a low ER level. ER measured by CEUS also been confirmed as independent risk factor for overall survival (hazard ratio [HR], 1.87; 95% confidence interval [95% CI], 1.21-7.25; P < 0.01) and RFS (HR, 1.67; 95% CI, 1.08-6.21; P < 0.01) in multivariate analysis enrolling gender, BMI, tumor size, antiviral therapy, HBV DNA, histological differentiation, Child-Pugh score and tumor node metastasis (TNM) stage.Conclusions: ER measured by CEUS was a significant predictive factor for survival after RFA for HCC. K E Y W O R D Shepatocellular carcinoma, perfusion, prognosis, radiofrequency ablation is an important factor influencing the energy distribution of thermal ablation. 14,15 Therefore, pretreatment accurate quantification 238

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

“…In a prospective study, Maruyama et al (44) showed that HCC lesions with early arterial phase intensity difference less than 10 dB had a significantly higher rate of recurrence after radiofrequency ablation than those with intensity difference greater than 10 dB. However, Zhou et al (45) recently showed that lesions with higher pretreatment enhancement rate in terms of decibels per second had lower overall survival and recurrencefree survival than those with lower enhancement rate. Although there is an overall paucity of data on pretreatment lesion enhancement characteristics for predicting response to liver-directed therapy, future increased clinical use of CEUS for pretreatment evaluation of liver lesions could provide the necessary data to answer these questions.…”

The Perfusion Features of Recurrent Hepatocellular Carcinoma After Radiofrequency Ablation Using Contrast-Enhanced Ultrasound and Pathological Stemness Evaluation: Compared to Initial Tumors

“…The mechanisms of malignant behaviors from recurrent HCC after RFA have been increasingly reported (22). Early detection and diagnosis of local recurrence in HCC patients' follow-up have become important issues (5,9,(23)(24)(25)(26). A previous study (27) indicated that isoenhancement in all vascular phase patterns on CEUS was found in >50% of recurrent lesions, indicating a high risk of HCC.…”