Contrast-enhanced ultrasonography used for post-treatment responses evaluation of radiofrequency ablations for hepatocellular carcinoma: a meta-analysis

Abstract

Weixiang Shi and Ying He should both be regarded as first authors.Objective: This meta-analysis aims to analyze the usefulness of contrast-enhanced ultrasonography (CEUS) for posttreatment responses evaluation of radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) management. Methods: Literature retrieval in three databases PubMed, Embase and Cochrane Library was conducted up to September 2015, with pre-defined criteria. The technical success rate, local tumour recurrence and local tumour progression were the measurement indexes. Cochran's Q test and I 2 were used for heterogeneity detection. Subgroup analyses were performed for complete ablation rate stratified by study designs, contrast agents and post-operative testing time points. Statistical analyses were conducted using Stata® 12.0 software (Stata Corporation, College Station, TX). Results: 12 studies consisting of 772 patients were included in this study. The CEUS-evaluated success rate of RFA for HCCs was 91%. The proportion of ablative margin ,5 mm was 53%. The local tumour recurrence rate and local tumour progression rate were 4% and 8%, respectively. Subgroup analysis indicated that the CEUS-assessed technical success rate with Sonazoid™ (Daiichi-Sankyo, Tokyo, Japan) as the contrast agent was higher (95%) than those with other agents [SH U 508A (Schering AG, Berlin, Germany) 86%; SonoVue (Bracco SpA, Milan, Italy) 87%]. The success rate assessed within 24 h (94%) after treatment was higher than longer time (1-3 days 86%; 1 month 91%). Conclusion:The meta-analysis showed that the CEUSevaluated success rate of RFA for HCCs was 91%. The local tumour recurrence rate and local tumour progression rate were 4% and 8%, respectively. Advances in knowledge: Using meta-analysis, the study provided more reliable assessment of usefulness of CEUS, which could provide guidelines for HCC treatment.

Laparoscopic Contrast-Enhanced Ultrasonography for Real Time Monitoring of Laparoscopic Radiofrequency Ablation for Hepatocellular Carcinoma: an Observational Pilot Study

“…At one-month follow-up, contrast-enhanced CT represents the standard of care. High accuracy (91%) in the assessment of the residual tumor after ablative techniques was also demonstrated for CEUS in a meta-analysis [32].…”

AIUM Practice Parameter for the Performance of Contrast‐Enhanced Ultrasound Examinations

“…Contrast‐enhanced ultrasound is safe for patients with contraindications to computed tomography (CT) or magnetic resonance imaging (MRI), such as pacemakers, allergies to gadolinium‐based or iodinated contrast material, claustrophobia, immobility, or metal implants. Because of its lack of ionizing radiation and ease of performance without sedation, CEUS should be considered as a useful problem‐solving tool and as an indicated first‐line imaging modality in select settings as indicated below. Liver Characterization of focal liver lesions in the noncirrhotic liver. Further characterize incidentally found liver lesions on US examinations. Evaluate incompletely characterized lesions on noncontrast or contrast‐enhanced CT or MRI. Characterization of focal liver lesions in the cirrhotic liver. Assess nodules detected on surveillance US. Assess a Liver Imaging Reporting and Data System (LIRADS) category LR‐2, LR‐3, LR‐4, or LR‐M observation on prior contrast‐enhanced CT or MRI. Detect arterial‐phase hyperenhancement when mistiming is suspected as the reason for its absence on prior CT or MRI. Assess biopsied lesions with inconclusive histologic results. Detection of metastases. Vascular. Determine hepatic artery, portal vein, and hepatic vein patency. Assess transjugular intrahepatic portosystemic shunt patency. Distinguish a bland thrombus versus a tumor in a vein. Response to therapy (ablation or transarterial chemoembolization for hepatic malignancy) for assessment of residual viable disease Help select appropriate sites for biopsy. Assess for residual tumor after ablation. Kidney and bladder Antegrade nephrostogram for evaluation of ureteral patency in the setting of an indwelling nephrostomy tube …”

Recent Advances in Microbubble-Augmented Cancer Therapy

“…A 2016 meta-analysis studied the results from 12 studies (772 patients with 933 lesions) on CEUS assessment of therapeutic response of RFA in HCC. The study reported 91% success rate of CEUS in evaluating the RFA response, which is comparable to CT-based methods [20]. A later meta-analysis reported that CEUS has sensitivity of 90% and specificity of 100% in A recent study examined the potential of MRI, CT, and ultrasound in predicting the response to antiangiogenic agent Sunitinib in patients with metastatic renal cell carcinoma (mRCC) [8].…”