Contrast-enhanced US with Perfluorobutane for Hepatocellular Carcinoma Surveillance: A Multicenter Diagnostic Trial (SCAN)

Abstract

S with or without a-fetoprotein has served as a standard surveillance tool for hepatocellular carcinoma (HCC). Attempts have been made to overcome the suboptimal detection rates and false referral rates of US. The Japan Society of Hepatology suggests use of contrast material-enhanced CT or MRI as another optional strategy (1). A recent study reported that screening using MRI with liver-specific contrast material resulted in a higher HCC detection rate and a lower false-positive rate when compared with those attained with US screening (2). Still, questions remain regarding the availability, accessibility, and cost-effectiveness of such advanced imaging modalities that should be underlined in the surveillance setting (3-5). Use of a US contrast agent can be a viable option, as it can be simply added to the pre-established surveillance program using B-mode US. The pure blood pool US contrast agents have not been recommended in the surveillance setting because they can be used only for vascular phase (arterial and portal venous phases) imaging, the duration of which might not be sufficient to examine the

The AFSUMB Consensus Statements and Recommendations for the Clinical Practice of Contrast-Enhanced Ultrasound using Sonazoid

“…However, the specificity of Sonazoid CEUS was significantly higher than that of B-mode US, 0.982 (272/277) and 0.978 (271/277) versus 0.892 (247/277) and 0.949 (263/277). Similar trends were observed in prospectively collected data from five tertiary centers in Korea [77,78]. The detection rate of early-stage HCC of Sonazoid CEUS was 1.0% (95% confidence interval [CI], 0.3% to 2.2%; 5 of 524 patients) and that of B-mode US was 0.6% (95% CI, 0.1% to 1.7%; 3 of 524 patients), without a statistically significant difference (P=0.16).…”

“…However, the false referral rate with Sonazoid CEUS was 1.3% (95% CI, 0.5% to 2.7%; 7 of 524 patients) and that with B-mode US was 4.6% (95% CI, 3.0% to 6.7%; 24 of 524 patients), which was statistically significant (P<0.001). Sonazoid CEUS did not improve the detection rate of early-stage HCC but did reduce the false referral rate for HCC in patients under HCC surveillance [78].…”

“…A recent diagnostic trial in Korea evaluated adverse events in 524 patients [78]. The adverse event rate was 5.7% (30/524; 95% CI, 3.9% to 8.1%).…”

Can contrast-enhanced ultrasound with perfluorobutane add value in detection of hepatocellular carcinoma in cirrhosis during surveillance?

“…The study of Park and colleagues recently appeared on Radiology addresses this issue (15). On the basis of abovementioned characteristics of Sonazoid, these authors "hypothesized that the detection rate of early-stage HCC (BCLC stage 0 or A) could be improved with fewer false referrals by adding perfluorobutane enhanced US to conventional US" (15).…”

“…CEUS allows the study of the different phases (arterial, portal and late phase) of blood supply of focal liver lesions and especially of HCC lesions that can be easily characterized (12)(13)(14). There are two main US contrast agents on the market: the sulphur-hexafluoride (SonoVue, Bracco Imaging Italia, Milan, Italy) and perfluorobutane (Sonazoid, Daiichi-Sankyo, Tokyo, Japan; GE Healthcare, Milwaukee, WI, USA) (12)(13)(14)(15). SonoVue is a pure bloodstream agent; it is widely distributed in Western and Asian countries and has also recently been approved by FDA in USA (16).…”