Intra-arterial contrast-enhanced ultrasound (IA CEUS) for localization of hepatocellular carcinoma (HCC) supply during transarterial chemoembolization (TACE): a case series

Abstract

Transarterial chemoembolization (TACE) is a proven catheter-based locoregional therapy for treatment of hepatocellular carcinoma (HCC). Drug-eluting bead TACE involves delivering micrometer-sized particles preloaded with doxorubicin directly to the tumor via its arterial blood supply and results in vascular embolization with intra-tumoral drug release. Effective therapy requires mapping of the tumor arterial supply, which in some cases cannot be accomplished with conventional angiographic techniques alone. Contrast-enhanced ultrasound (CEUS) is an imaging technique which utilizes microbubble contrast agents to demonstrate blood flow and tissue perfusion, enabling tumor visualization in real time. CEUS with intravenous contrast administration is well established for evaluation of HCC. Intra-arterial (IA) CEUS, on the other hand, is an emerging technique that allows more selective evaluation of the arterial supply to the tumor. The three cases in this report illustrate the utility of intra-procedural IA CEUS during TACE. Specifically, IA CEUS aided TACE in cases where the HCC showed poor arterial enhancement, an extrahepatic arterial supply, and a portal venous supply, respectively.

Analysis of B-ultrasound and contrast-enhanced ultrasound characteristics of different hepatic neuroendocrine neoplasm

“…Centripetal enhancement at the arterial phase appears first, and then uniform high enhancement appears[15]. The characteristics of HCC B-mode ultrasound are hypoechoic or mixed echo masses with clear boundaries[16]. The CEUS characteristics are “fast forward and fast out” as well.…”

Efficacy of intra-arterial contrast-enhanced ultrasonography during transarterial chemoembolization with drug-eluting beads for hepatocellular carcinoma

“…IAUS has previously been shown to be safe and effective in facilitation of TACE to treat malignant liver tumors such as HCC[ 12 - 16 , 23 ]. Use of IAUS during TACE allows accurate identification of feeding blood vessels, which is difficult with DSA alone, and the frequency of DSA during treatment can be decreased, which reduces the risk of embolization of non-target regions[ 14 ].…”

“…Use of IAUS during TACE allows accurate identification of feeding blood vessels, which is difficult with DSA alone, and the frequency of DSA during treatment can be decreased, which reduces the risk of embolization of non-target regions[ 14 ]. In addition, IAUS can identify tumors that are not stained through an artery and are fed by a branch of the portal vein, which may provide information comparable to that from CT angiography (CTA)[ 16 ].…”

“…Transcatheter (intra-arterial) CEUS (IAUS) has recently been used in DEB-TACE for HCC and metastatic hepatic tumors, and its safety and efficacy in identifying the feeding artery have been evaluated[ 12 - 16 ]. However, the therapeutic effect using IAUS as support for DEB-TACE in HCC has not been examined.…”

Physiologic and Functional Imaging for Tumor Response Assessment Following Transarterial Chemoembolization of Hepatic Malignancy: Imaging Biomarkers Should Reflect the Therapeutic Mechanism of Action

“…Intra-arterial (IA) CEUS was then introduced in which the microbubble contrast agent is injected directly into the artery during catheter-based arteriography, allowing more selective evaluation of arterial supply to the tumor [38]. Lekht also demonstrated the utility of intra-procedural intra-arterial CEUS to help visualize the tumor and its arterial supply without additional iodinated contrast or angiography related x ray exposure [39]. Uller also showed time intensity curves (TIC), generated with Intra-arterial and intravenous CEUS during DEB TACE could be used to measure a reduction of vascularization which correlated with subsequent tumor response [40].…”