title: Ablation therapy guided by contrast-enhanced sonography with Sonazoid for hepatocellular carcinoma lesions not detected by conventional sonography.
abstract: OBJECTIVE
  We evaluated the usefulness of contrast-enhanced harmonic gray scale sonography with a newly developed sonographic contrast medium as a means of guidance for percutaneous ablation therapy of hepatocellular carcinoma lesions not detected by conventional sonography.
  
  
  METHODS
  We examined 85 patients with 108 hepatocellular carcinoma lesions that were identified as hypervascular by multidetector-row computed tomography by using contrast-enhanced harmonic gray scale sonography after injection of Sonazoid (GE Healthcare, Oslo, Norway), a lipid-stabilized suspension of a perfluorobutane gas microbubble contrast agent. We scanned the whole liver by this modality at a low mechanical index in the late phase to detect lesions not detected by conventional sonography and then scanned the lesions again by this modality at a high mechanical index to visualize tumor vessels and enhancement. We also performed percutaneous ablation therapy guided by this modality to treat viable hepatocellular carcinoma lesions that could not be detected by conventional sonography.
  
  
  RESULTS
  Conventional sonography identified 90 (83%) of 108 hepatocellular carcinoma lesions; 15 (14%) additional viable lesions not detected by conventional sonography were detected in the late phase of contrast-enhanced harmonic gray scale sonography at a low mechanical index, and tumor vessels and enhancement were observed in the late phase at a high mechanical index. Contrast-enhanced harmonic gray scale sonography diagnosed 105 (97%) of the 108 viable hepatocellular carcinoma lesions, and 14 (93%) of the 15 lesions not detected by conventional sonography were successfully treated by percutaneous ablation therapy guided by this modality.
  
  
  CONCLUSIONS
  Contrast-enhanced harmonic gray scale sonography is useful for guidance of percutaneous ablation therapy of hepatocellular carcinoma lesions not detected by conventional sonography.
authors.affiliation: Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Kanagawa 232-0024, Japan. kz-numa@zero.ad.jp
authors.forename: Kazushi
authors.initials: K
authors.lastname: Numata
authors.forename: Manabu
authors.initials: M
authors.lastname: Morimoto
authors.forename: Takashi
authors.initials: T
authors.lastname: Ogura
authors.forename: Kazuya
authors.initials: K
authors.lastname: Sugimori
authors.forename: Shigeo
authors.initials: S
authors.lastname: Takebayashi
authors.forename: Masahiro
authors.initials: M
authors.lastname: Okada
authors.forename: Katsuaki
authors.initials: K
authors.lastname: Tanaka
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001706:Biopsy; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000601:surgery*; D017115:Catheter Ablation; D016009:Chi-Square Distribution; D003287:Contrast Media; D005260:Female; D005290:Ferric Compounds; D006801:Humans; D007501:Iron; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010087:Oxides; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D003287:Contrast Media; D005290:Ferric Compounds; D010087:Oxides; C069727:Sonazoid; D007501:Iron