Usefulness of contrast-enhanced ultrasonography with dynamic flow imaging to evaluate therapeutic effects for hepatocellular carcinoma.
OBJECTIVE
To examine the usefulness of dynamic flow imaging in identifying the therapeutic effects for hepatocellular carcinoma, we performed contrast-enhanced ultrasonography with Levovist.


METHODS
Tumor vascularity of 48 hepatocellular carcinoma nodules in 27 patients infected with hepatitis C virus was assessed before and after radiofrequency ablation therapy by dynamic flow imaging with a wide-band power Doppler technology.


RESULTS
All patients showed hypervascular enhancement of hepatocellular carcinoma on contrast-enhanced ultrasonography and/or dynamic computed tomography. The dynamic flow was obtained as vascular and perfusion images of hepatic tumors. The diameters of tumors were 1.1-2.0 cm in 12 nodules, 2.1-3.0 cm in 28, and 3.1-5.0 cm in 8, respectively. We were able to assess the tumor vascularities in 45 of 48 nodules before radiofrequency ablation by the dynamic flow. Three nodules showed insufficient dynamic flow which was located approximately 9 cm in depth from the body surface. The dynamic flow study for the therapeutic efficacy indicated that the tumor vessels disappeared in 43 of the 45 visible nodules. The tumor vascularities were noted in the remaining 2 nodules, and they were successfully retreated by radiofrequency ablation. The frequencies detecting positive enhancement in pretreatment and post-treatment were almost equivalent between vascular phase of dynamic flow on ultrasonography and early phase on helical dynamic computed tomography, although 5 nodules gave different findings; 2 were positive only on ultrasonography, and 3 were positive only on computed tomography. A major complication of radiofrequency ablation procedure was noted in only one case associated with intestinal edema, but it was cured by medical treatment.


CONCLUSIONS
The results indicated that contrast-enhanced dynamic flow imaging on ultrasonography is a reliable tool to evaluate intratumoral vascularity both before and after radiofrequency ablation treatment in patients with hepatocellular carcinoma.
Hotta
Naoki
N
Department of Internal Medicine, Division of Gastroenterology, Research Center for Infectious Disease, Aichi Medical University School of Medicine, 21 Karimata Yazako, Nagakute-cho, Aichi-gun, Aichi-ken 480-1195, Japan.
Tagaya
Tsuneaki
T
Maeno
Tadashi
T
Ishikawa
Tetsuya
T
Okumura
Akihiko
A
Fukuzawa
Yoshitaka
Y
Kakumu
Shinichi
S
D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity / Q000502:physiology; D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000628:therapy*; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000000981:diagnostic imaging*; D006801:Humans; D006979:Hyperthermia, Induced; D007089:Image Enhancement; D007091:Image Processing, Computer-Assisted; D008113:Liver Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011134:Polysaccharides; D012039:Regional Blood Flow / Q000502:physiology; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex
D003287:Contrast Media; D011134:Polysaccharides; C059891:SHU 508