title: Contrast-enhanced gray-scale harmonic ultrasound in the efficacy assessment of ablation treatments for hepatocellular carcinoma.
abstract: BACKGROUND
  The aim of this study was to compare contrast-enhanced gray-scale harmonic ultrasound with multiphasic spiral computed tomography in the assessment of treatment efficacy of non-surgically treated HCC.
  
  
  METHODS
  We studied 56 HCCs treated by percutaneous ethanol injection (31 cases), radiofrequency ablation (three cases), trans-arterial chemoembolization (12 cases), and combined treatment (10 cases). The efficacy of therapies was blindly assessed by multiphasic computed tomography and gray-scale harmonic ultrasound with a second-generation contrast agent (sulfur hexafluoride).
  
  
  RESULTS
  On computed tomography 30 tumors (53.6%) showed complete necrosis, while 26 lesions (45.4%) were still viable. On contrast-enhanced ultrasound examination 33/56 nodules (58.9%) had no contrast enhancement in the arterial phase, while 23/56 lesions (41.1%) were still vascularized. All the nodules assessed as completely necrotic on computed tomography did not show arterial enhancement on contrast-enhanced ultrasound and diagnostic agreement was found in 53/56 cases (94.6%) (P<0.001). Contrast-enhanced ultrasound demonstrated relative sensitivity and specificity of 87.0% and 98.4%.
  
  
  CONCLUSIONS
  Contrast-enhanced harmonic ultrasound is promising in the efficacy evaluation of ablation treatments for HCC. Nodules vascularized in the arterial phase on contrast harmonic ultrasound should be considered still viable and addressed to additional treatment without further evaluation.
authors.affiliation: Istituto di Medicina Interna e Geriatria, Universita Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168 Rome, Italy. mpompili@rm.unicatt.it
authors.forename: Maurizio
authors.initials: M
authors.lastname: Pompili
authors.forename: Laura
authors.initials: L
authors.lastname: Riccardi
authors.forename: Marcello
authors.initials: M
authors.lastname: Covino
authors.forename: Brunella
authors.initials: B
authors.lastname: Barbaro
authors.forename: Carmine
authors.initials: C
authors.lastname: Di Stasi
authors.forename: Ruggero
authors.initials: R
authors.lastname: Orefice
authors.forename: Giovanni
authors.initials: G
authors.lastname: Gasbarrini
authors.forename: Gian Ludovico
authors.initials: GL
authors.lastname: Rapaccini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000628:therapy; D017115:Catheter Ablation; D016461:Chemoembolization, Therapeutic; D003287:Contrast Media; D000431:Ethanol / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D036542:Tomography, Spiral Computed; D014463:Ultrasonography
chemical_list: D003287:Contrast Media; D000431:Ethanol