Application of percutaneous ultrasound-guided treatment for ultrasonically invisible hypervascular hepatocellular carcinoma using microbubble contrast agent

Maruyama, Hitoshi; Kobayashi, Satoshi; Yoshizumi, Hiroaki; Okugawa, Hidehiro; Akiike, Taro; Yukisawa, Seigo; Fukuda, Hiroyuki; Matsutani, Shoichi; Ebara, Masaaki; Saisho, Hiromitsu

doi:10.1016/j.crad.2006.11.025

Cited by 16 publications

(15 citation statements)

References 58 publications

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“…Because this modality can distinguish viable from necrotic portions of hepatocellular carcinoma lesions, it has also been used to guide additional treatments, such as percutaneous ethanol and radio frequency ablation therapy (RFA). [2][3][4][5] A second-generation sonographic contrast agent, Sonazoid (GE Healthcare, Oslo, Norway), a lipid-stabilized suspension of perfluorobutane gas microbubbles, has been used clinically in patients with liver tumors and for phase inversion harmonic gray scale sonography in Japan since January 2007. On the basis of the results obtained in rabbit liver tumor models, the contrast agent is retained within the reticuloendothelial cells in the liver 10 to 30 minutes after injection and enhances the liver parenchyma in the late phase of contrast-enhanced phase inversion harmonic gray scale imaging at a low (0.4) 6 or moderate (0.6) 7 mechanical index setting.…”

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confidence: 99%

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

Numata¹,

Morimoto²,

Ogura³

et al. 2008

Journal of Ultrasound in Medicine

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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.

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confidence: 99%

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

Numata¹,

Morimoto²,

Ogura³

et al. 2008

Journal of Ultrasound in Medicine

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“…whether the tumour was ablated completely and whether sufficient safety margins were achieved (26). CEUS facilitates the application of percutaneous US-guided treatment by improving the localization of HCCs invisible to conventional ultrasound (27). Of the 32 CT-detected HCCs, CEUS localized 75% of the lesions with a mean diameter (15.1 AE 4.9 mm), being significantly larger than that of the remaining 25% of the non-detected lesions (10.5 AE 2.1 mm).…”

Section: Role Of Ultrasound In Hepatocellular Carcinomamentioning

confidence: 99%

“…Contrast enhancement at the liver-specific phase is crucial for the differential diagnosis of liver tumours. Maruyama et al (27) inspected the microbubble disappearance-time (MD-T). Their study suggests that the 5 min interval after the injection of microbubbles, commonly used for the healthy liver-specific phase, does not always correlate with the cirrhotic liverspecific phase, and inappropriately timed sonograms may affect the diagnostic result for the characterization of hepatic nodules and cellular differentiation of HCC.…”

Section: Role Of Ultrasound In Hepatocellular Carcinomamentioning

confidence: 99%

Radiological diagnosis of hepatocellular carcinoma

Saar

Kellner-Weldon

2008

Liver International

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Treatment of hepatocellular carcinomas (HCC) is often complicated by the fact that early HCCs are mostly asymptomatic and the carcinoma is often discovered at an advanced stage. The aim of diagnostic imaging is to detect HCC at an early stage, when curative options are available. In recent years, there have been many efforts to improve early detection of small HCC. The purpose of this article is to describe the pertinent findings of HCCs in non-invasive, diagnostic imaging, including ultrasound, computed tomography, as well as modern magnetic resonance imaging techniques. Special emphasis is given to the frequently addressed difficulties of differentiation of precancerous lesions and small HCCs. A non-invasive diagnostic approach is considered with a review of the literature.

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“…To date, five prospective studies [20,21,22,23,24], two retrospective analyses [25,26] and one prospective randomized trial [27] have been published on this theme. Four studies report on the use of Levovist [20,21,26,27], three on Sonazoid [22,23,24] and only one on SonVue [25]. The latter study included patients with liver metastases as well [25].…”

Section: Targeting Hccmentioning

confidence: 99%

“…Harmonic gray-scale CEUS targeting emerges from the published literature as a highly sensitive and effective image-guiding tool, proving a consistent detection rate of 75–100% [20,21,22,23,24,26,27] (table 2). The detection rate is lower than 93% in only two studies [21,26].…”

Section: Targeting Hccmentioning

confidence: 99%

Contrast-Enhanced Ultrasound Techniques for Guiding and Assessing Response to Locoregional Treatments for Hepatocellular Carcinoma

Andreana

Kudo²,

Hatanaka³

et al. 2010

Oncology

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Most hepatocellular carcinomas (HCC) are diagnosed in patients with cirrhosis and/or when tumor burden is too advanced for surgical treatment. In many of these cases the only suitable therapy is locoregional, percutaneous and/or intraarterial treatment. Moreover, the best way to guide and assess response to locoregional HCC treatment are two issues under discussion today. First-generation and subsequent second-generation microbubble contrast agents, together with contrast-enhanced ultrasound (US) imaging, have expanded the role of US techniques in HCC treatments. In this review our purpose is to illustrate the advantages, limits and potential of contrast-enhanced US application for locoregional HCC treatment.

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Application of percutaneous ultrasound-guided treatment for ultrasonically invisible hypervascular hepatocellular carcinoma using microbubble contrast agent

Cited by 16 publications

References 58 publications

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

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

Radiological diagnosis of hepatocellular carcinoma

Contrast-Enhanced Ultrasound Techniques for Guiding and Assessing Response to Locoregional Treatments for Hepatocellular Carcinoma

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