title: Contrast-enhanced ultrasonography (CEUS) immediately after percutaneous ablation of hepatocellular carcinoma.
abstract: OBJECTIVE
  This study evaluated the effectiveness of contrast-enhanced ultrasound (CEUS), performed immediately after percutaneous ethanol injection (PEI) or radiofrequency thermal ablation (RFTA), by comparing results with the computed tomography (CT) follow-up.
  
  
  METHODS
  Sixty-nine consecutive patients with a diagnosis of hepatocellular carcinoma (HCC) were included in this prospective study. All patients underwent PEI or RFTA. After treatment, three CEUS enhancement patterns were observed: isovascular, hypovascular and avascular, which were compared with the CT findings. Sensitivity of the avascular pattern at CEUS and effectiveness of the ablative procedures were evaluated and compared with the chi-square test.
  
  
  RESULTS
  Ninety hypervascular HCCs, with a mean diameter of 2.6 cm (0.5-4.9 cm), underwent PEI (n=54) and RFTA (n=36). In the first group, CT identified complete necrosis in 28/54 (52%) lesions, 21 (75%) of which had avascular, one (4%) isovascular and six (21%) hypovascular patterns at CEUS. In the second group, CT showed complete necrosis in 31/36 (86%) lesions, all (100%) of which had a corresponding avascular pattern at CEUS. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the avascular pattern at CEUS compared with CT findings were 75%, 69%, 72%, 72% and 72% for PEI and 100%, 20%, 89%, 100% and 89%, for RFTA, respectively. A statistically significant difference (p<0.05) between the sensitivity of CEUS after PEI and after RFTA and between the necrosis obtained by RFTA and PEI were observed.
  
  
  CONCLUSIONS
  CEUS performed immediately after percutaneous ablation of hepatocellular carcinoma to evaluate treatment efficacy is compulsory in the case of RFTA but not for PEI.
authors.affiliation: Istituto di Radiologia, Policlinico G.B. Rossi, Università di Verona, Verona, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Gallotti
authors.forename: M
authors.initials: M
authors.lastname: D'Onofrio
authors.forename: A
authors.initials: A
authors.lastname: Ruzzenente
authors.forename: E
authors.initials: E
authors.lastname: Martone
authors.forename: R
authors.initials: R
authors.lastname: De Robertis
authors.forename: A
authors.initials: A
authors.lastname: Guglielmi
authors.forename: R
authors.initials: R
authors.lastname: Pozzi Mucelli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D017115:Catheter Ablation / Q000379:methods*; D003287:Contrast Media; D000431:Ethanol / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015552:Injections, Intralesional; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods
chemical_list: D003287:Contrast Media; D000431:Ethanol