The value of intra-procedural transcatheter intraarterial contrast-enhanced ultrasonography (IA-CEUS) in predicting the short-term efficacy of conventional transarterial chemoembolization (cTACE)

Abstract

Background This study aimed to evaluate whether corona enhancement and intratumor perfusion features of intra-procedural transcatheter intraarterial contrast-enhanced ultrasonography (IA-CEUS) predict short-term tumor response on follow-up contrast-enhanced magnetic resonance imaging (CE-MRI) in patients with hepatocellular carcinoma (HCC) treated with conventional transarterial chemoembolization (cTACE). Methods This trial included 39 patients with 51 HCC target lesions who underwent cTACE with IA-CEUS. The maximum cross-sectional area ratio of intratumor perfusion between pre- and post-procedure, as well as the peak value and sickness of corona enhancement immediately post-cTACE were measured respectively. Tumor response at MRI was assessed according to modified Response Evaluation Criteria in Solid Tumors (mRECIST) guidelines. Nonparametric Spearman rank-order correlation was used to correlate the maximum cross-sectional area ratio of intratumor perfusion, the peak value, and sickness of corona enhancement of IA-CEUS immediately after cTACE with tumor response. Results The results showed that 39 patients with 51 target lesions were assessed for tumor response. Complete remission (CR), partial remission (PR), stable disease (SD), and progressive disease (PD) were 22 (43.1%), 14 (27.5%), 10 (19.6%), and 5 (9.8%), respectively. The maximum cross-sectional area ratio of intratumor perfusion moderately correlated with tumor response on CE-MRI (Spearman rho =0.513, P<0.001). Furthermore, the peak value and sickness of corona enhancement showed a good correlation with tumor response on CE-MRI respectively (Spearman rho =0.671, P<0.001, rho =0.704, P<0.001). Conclusions Intra-procedural transcatheter IA-CEUS may predict short-term tumor response in cTACE of HCC. The feature of corona enhancement immediately post-cTACE also showed a more accurate prediction when compared with the feature of intratumor infusion (rho =0.671).

The feasibility of early response evaluation using superb microvascular imaging one day after transcatheter arterial chemoembolization for hepatocellular carcinoma

“…28 When evaluating the tumor response of the TACE in HCC, CEUS can dynamically observe the real-time change in the microcirculation of the entire tumor after TACE, the intratumoral perfusion, and also changes in the local drainage area around the tumor. 29 There are several limitations of our study that should be addressed in a future study. First, CDI, PDI, and SMI were performed in a sequential manner in each patient, thus, there is potential for recall bias.…”

“…CEUS could be performed immediately after TACE 28 . When evaluating the tumor response of the TACE in HCC, CEUS can dynamically observe the real‐time change in the microcirculation of the entire tumor after TACE, the intratumoral perfusion, and also changes in the local drainage area around the tumor 29 …”

Intraarterial contrast-enhanced ultrasound to predict the short-term tumour response of hepatocellular carcinoma to Transarterial chemoembolization with Lipiodol

“…Even if this phenomenon is demonstrated by CBCT in this case, the consistency of CBCT and CEUS in the display of drainage areas needs further study. In our previous study, we found that the consistency between the drainage area and short-term TR, as evaluated by MRI, was good [ 28 ]. In addition, a decrease in drainage area can be explained by a decrease in blood supply within the tumour.…”