title: Flash-echo contrast sonography in the evaluation of response of small hepatocellular carcinoma to percutaneous ablation.
abstract: OBJECTIVE
  To evaluate the use of flash-echo contrast sonography (FECS) in subtraction mode in assessing small hepatocellular carcinoma (HCC) after percutaneous local ablation therapy.
  
  
  METHODS
  Between March 2000 and February 2002, we prospectively assessed small HCCs after percutaneous local ablation therapy using FECS in subtraction mode. Thirty-three patients (22 men, 11 women) with 35 tumors ranging in size from 1.1 to 3.0 cm (mean +/- SD, 2.0 +/- 0.5) were enrolled. Twenty-one tumors received percutaneous ethanol injection only, 13 tumors received percutaneous microwave ablation therapy only, and the remaining tumor received both treatments. CT, hepatic angiography, and follow-up were used as gold standards in analyzing the accuracy of FECS in detecting residual tumors.
  
  
  RESULTS
  The agreements between FECS and CT, FECS and hepatic angiography, and all 3 imaging modalities were 80% (28/35), 85.7% (30/35), and 77.1% (27/35), respectively. Twenty-one patients with 23 completely ablated tumors were followed up for 5 to 39 months (mean +/- SD, 20.2 +/- 11.2). Recurrent disease was detected in 11 (52.4%) patients; local tumor recurrence occurred in 4 (17.4%) patients. The sensitivity, specificity, accuracy, and positive and negative predictive value of FECS in detecting viable tumors were 53.8% (7/13), 90.9% (20/22), 77.1% (27/35), 77.8% (7/9), and 76.9% (20/26), respectively.
  
  
  CONCLUSIONS
  FECS in subtraction mode shows good agreement with hepatic angiography and CT in the assessment of small HCC after percutaneous local ablation therapy. The sensitivity of FECS in detecting residual tumors is suboptimal.
authors.affiliation: Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, 123 Ta-Pei Rd, Niaosung 833, Kaohsiung, Taiwan.
authors.forename: Jing-Houng
authors.initials: JH
authors.lastname: Wang
authors.forename: Sheng-Nan
authors.initials: SN
authors.lastname: Lu
authors.forename: Hung-Da
authors.initials: HD
authors.lastname: Tung
authors.forename: Chi-Sin
authors.initials: CS
authors.lastname: Changchien
authors.forename: Chao-Hung
authors.initials: CH
authors.lastname: Hung
authors.forename: Chien-Hung
authors.initials: CH
authors.lastname: Chen
authors.forename: Chuan-Mo
authors.initials: CM
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D017115:Catheter Ablation; D003287:Contrast Media; D000431:Ethanol / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging*; D018365:Neoplasm, Residual / Q000000981:diagnostic imaging*; D016609:Neoplasms, Second Primary / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011859:Radiography; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color / Q000379:methods
chemical_list: D003287:Contrast Media; D000431:Ethanol