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

Abstract

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.

Clinical translation in the treatment of hepatocellular carcinoma following the introduction of contrast-enhanced ultrasonography with Sonazoid

“…However, the combination of ceUs with another agent besides sonazoid does not reveal the Kupffer phase continuously, because imaging during that phase is performed by bursting microbubbles that accumulate in Kupffer cells by sound waves (24). continuous imaging in the Kupffer phase with sonazoid occurs because the images are obtained with vibration rather than bursting microbubbles by sound waves, making it easy to observe abnormal areas continuously (9). Although rFA guided by ceUs with sonazoid has been reported (9), there are no known reports of changes in therapies at any institution prior to and following the introduciton of this procedure.…”

“…the primary characteristic of this agent is the ability to repeatedly obtain a continuous enhanced view in the Kupffer phase. numata et al also noted that repeated and continuous scanning in the Kupffer phase using ceUs with sonazoid allowed for the easy detection of target lesions during rFA procedures (9). thus, this contrast enhancement agent is considered to have a positive effect on therapeutic strategy.…”

Assessment of hepatocellular carcinoma by contrast-enhanced ultrasound with perfluorobutane microbubbles: comparison with dynamic CT

“…Sonazoid-enhanced ultrasound is therefore useful to differentiate HCCs from these benign nodules. Recent studies have reported that HCC nodules not detected by baseline B-mode ultrasound could be detected at the vascular phase and/or at the post-vascular phase of CEUS with Sonazoid [32]. Furthermore, Sonazoidenhanced ultrasound has been shown to be a sensitive and accurate modality for evaluating the response of HCCs following arterial embolisation [33].…”

Percutaneous Radiofrequency Ablation Guided by Contrast-enhanced Ultrasound in Treatment of Metastatic Hepatocellular Carcinoma after Liver Transplantation

“…Only a few cases have been reported (Numata et al, 2008;Minami et al, 2010) in which RFA, guided by CEUS technology, was performed to treat liver metastases after liver transplantation to find inchoate focal liver masses and treat them promptly. Certain therapeutic effects have been achieved through tentative application; a preliminary summary and evaluation are in progress.…”