Unenhanced and Contrast-Enhanced Ultrasonography During Hepatic Transarterial Embolization and Chemoembolization With Drug-Eluting Beads

Abstract

The purpose of this study was to describe and evaluate the findings of unenhanced ultrasonography (US) and contrast-enhanced ultrasonography (CEUS) when these modalities are applied during transarterial embolization (TAE) or transarterial chemoembolization (TACE) of liver tumors. Sixteen tumors (9 hepatocellular carcinomas, 5 metastases from colorectal cancer, and 2 hemangiomas) were treated with TAE with microspheres and/or TACE with drug-eluting beads. All of these lesions were studied with intraprocedural unenhanced US and 12 were studied with intraprocedural CEUS. For the latter, a second-generation echo-enhancer (SonoVue; Bracco, Milan, Italy) and a low mechanical index technique were used. Intraprocedural findings were classified according to an arbitrary scale and were compared with pretreatment imaging (CEUS and computed tomography or CEUS and magnetic resonance imaging), with postembolization angiography, and with follow-up results. On unenhanced intraprocedural US, 13 of 16 tumors demonstrated intralesional high-level echoes of varying extent. These feature correlated poorly (r = 0.33, p = 0.097) with and generally underestimated the actual extent of necrosis. Exceptionally, high-level echoes that occupied the largest part of the treated lesions were associated with >50% tumor necrosis. Intraprocedural CEUS clearly depicted immediate partial or complete disappearance of tumor enhancement as a result of TAE/TACE. Three of 6 tumors with complete devascularization on postembolization angiogram showed residual enhancement on intraprocedural CEUS. Intraprocedural CEUS findings correlated closely (r = 0.91, p = 0.002) with follow-up findings. Intraprocedural sonography, particularly with echo-enhancers, could be used for intraprocedural monitoring in selected cases of liver tumors that undergo TAE or TACE.

Intraprocedure contrast enhanced ultrasound: The value in assessing the effect of ultrasound-guided high intensity focused ultrasound ablation for uterine fibroids

“…CEUS has been used as a means of follow-up after RFA and TAE/ TACE [17,18]. Kennedy et al have used CEUS to evaluate the extent of ablation after HIFU treatment of liver tumor [8].…”

Contrast enhanced ultrasonography in assessing the treatment response to transarterial chemoembolization in patients with hepatocellular carcinoma.

“…Unfortunately, there are no studies comparing CECT with CEUS after DEB based TACE. Considering the half-life of doxorubicin in drug-eluting beads, a very early assessment may not be appropriate in the case of TACE with DC beads because the degree of necrosis could be underestimated [23]. However, all CEUS performed 1 to 2 weeks after DEB based TACE (a total of 14 tumors) resulted in 100% sensitivity, specificity, positive predicted value, negative predictive value, and accuracy when compared to contrast enhanced MRI/CT at 1 month [24].…”

Effect of alginate‐chitosan sustained release microcapsules for transhepatic arterial embolization in VX2 rabbit liver cancer model

“…However, its mortality rate is second only to gastric cancer and esophagus cancer in China. Thus, several new techniques have been discovered for liver cancer therapy, such as vascular minimally invasive treatment [transarterial hepatic embolization, transarterial hepatic infusion, and transarterial hepatic chemoembolization (TACE)] and non‐vascular minimally invasive treatment (percutaneous ethanol injection and radiofrequency ablation) . TACE is the most commonly used therapy for unresectable liver cancer, which uses minimal invasive surgery and has the characteristics of accurate positioning, easy operation, and generalization.…”

“…Thus, several new techniques have been discovered for liver cancer therapy, such as vascular minimally invasive treatment [transarterial hepatic embolization, transarterial hepatic infusion, and transarterial hepatic chemoembolization (TACE)] and non-vascular minimally invasive treatment (percutaneous ethanol injection and radiofrequency ablation). [1][2][3][4][5] TACE is the most commonly used therapy for unresectable liver cancer, which uses minimal invasive surgery and has the characteristics of accurate positioning, easy operation, and generalization. TACE has recently been shown to provide substantial survival benefit in a subset of patients with unresectable hepatocellular carcinoma because of distinct double hepatic blood supply.…”