Contrast-enhanced US in Local Ablative Therapy and Secondary Surveillance for Hepatocellular Carcinoma

Abstract

Hepatocellular carcinoma (HCC) has a high incidence of recurrence following therapy. Therefore, secondary surveillance (scheduled follow-up imaging after treatment) is an important part of disease management. The recent approval in the United States for use of a microbubble-based contrast agent for US liver imaging promotes the increased use of contrast-enhanced US (CEUS) in patients with HCC. Although the criteria for the diagnosis of HCC at CEUS are well described, there is a paucity of published literature describing the role of CEUS in ablative therapy and secondary surveillance. In the setting of ablative therapy, CEUS can have vital roles, including patient selection, intraprocedural guidance, and immediate postprocedural assessment. Although CEUS is not widely used, the authors found that it can be used to accurately detect residual or recurrent tumor, characterize the geographic pattern of recurrence (intrazonal, extrazonal, segmental, or remote), and assess for tumor in vein. In addition, similar to primary surveillance, secondary surveillance includes assessment of the entire liver for evaluation of new nodules. Arterial phase hyperenhancement is the reference standard characteristic of disease recurrence at secondary surveillance with CEUS.

Challenges Facing Percutaneous Ablation in the Treatment of Hepatocellular Carcinoma: Extension of Ablation Criteria

“…41,42 Contrast-enhanced ultrasound (CEUS) can also be applied to help identify lesions. [125][126][127][128] Improving the visibility of target tumor in image guidance techniques is the key to improving the effect of tumor ablation, 129 because a higher complete ablation rate is associated with a better prognosis. 130,131 Therefore, it is necessary to optimize image guidance techniques and make full use of image information to guide treatment.…”

Alteration of contrast enhanced ultrasound (CEUS) of hepatocellular carcinoma in patients with cirrhosis and transjugular intrahepatic portosystemic shunt (TIPS)

“…To date, routine HCC screening is done by B-mode ultrasound. Though CEUS has been successfully described in the context of surveillance after HCC treatment [28][29][30][31] , data regarding the use of CEUS for routine HCC screening is at best scarce 32,33 . Currently, CEUS is recommended as a good diagnostic tool for the work up of focal liver lesions found in routine HCC screening via B-mode.…”

Invited Commentary on “Contrast-enhanced US in Local Ablative Therapy and Secondary Surveillance for Hepatocellular Carcinoma,” with Author Response

“…From: Shuchi K. Rodgers, MD Department of Radiology, Einstein Medical Center Philadelphia, Pennsylvania CEUS can play a crucial role in patients with HCC who undergo ablation. Bansal et al (1) have written a clear and compelling article describing their use of CEUS for preprocedural planning and postablation imaging. In their algorithm, focal regions of APHE diagnosed at postablation CEUS are re-treated during the same session, leading to decreased tumor recurrence rates.…”

“…In their algorithm, focal regions of APHE diagnosed at postablation CEUS are re-treated during the same session, leading to decreased tumor recurrence rates. Considering that recurrence rates after ablation can be as high as 70% within 5 years (2,3), the approach outlined by Bansal et al (1) offers the potential for a significant reduction in these rates. While their approach adds time to the initial procedure, the overall reduction in time, costs, and number of repeat ablation procedures undoubtedly improves patient care.…”

“…In summary, the challenges encountered in imaging and treating HCC necessitate the use of all available diagnostic and therapeutic tools to provide the best outcomes for patients. In their article, Bansal et al (1) describe methods that are undeniably beneficial for patients. In their hands, CEUS after ablation and for surveillance has presumably reduced rates of residual and recurrent tumor and ultimately decreased costs, time, and number of procedures.…”