Evaluation of the therapeutic efficacy of high-intensity focused ultrasound ablation of hepatocellular carcinoma by three-dimensional sonography with a perflubutane-based contrast agent.
OBJECTIVE
We performed contrast-enhanced three-dimensional sonography (CE 3D US) with a perflubutane-based contrast agent to immediately evaluate the completeness of ablation of small hepatocellular carcinoma (HCC) lesions by extracorporeal high-intensity focused ultrasound (HIFU).


METHODS
Twenty-one HCC lesions were treated by a single ultrasound-guided HIFU ablation session, and CE 3D US was performed before, immediately after, and 1 week, and 1 month after HIFU, and contrast-enhanced CT (CE CT) or contrast-enhanced MRI (CE MRI) was performed before HIFU, 1 week and 1 month after HIFU, and during the follow-up period.


RESULTS
Immediately and 1 month after HIFU, 17 lesions were evaluated as adequately ablated by CE 3D US, and the other 4 lesions as residual tumors. One month after HIFU, 18 were evaluated as adequately ablated by CE CT or CE MRI, and the other 3 as residual tumors. The evaluation by CE 3D US immediately after HIFU and by CE CT or CE MRI 1 month after HIFU was concordant with 20 lesions. The kappa value for agreement between the findings of CE 3D US and other modalities by two blinded observers was 0.83. When the 1-month CE CT or CE MRI findings were used as the reference standard, the sensitivity, specificity, and accuracy of CE 3D US immediately after HIFU for the diagnosis of the adequate ablation were 100%, 75%, and 95%, respectively.


CONCLUSIONS
CE 3D US appears to be a useful method for immediate evaluation of therapeutic efficacy of HIFU ablation of HCC lesions.
Numata
Kazushi
K
Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa 232-0024, Japan. kz-numa@urahp.yokohama-cu.ac.jp
Fukuda
Hiroyuki
H
Ohto
Masao
M
Itou
Ryu
R
Nozaki
Akito
A
Kondou
Masaaki
M
Morimoto
Manabu
M
Karasawa
Eii
E
Tanaka
Katsuaki
K
D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000628:therapy*; D003287:Contrast Media; D005260:Female; D005290:Ferric Compounds; D005466:Fluorocarbons; D057086:High-Intensity Focused Ultrasound Ablation; D006801:Humans; D021621:Imaging, Three-Dimensional; D007501:Iron; D008113:Liver Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D010087:Oxides; D014057:Tomography, X-Ray Computed; D018084:Ultrasonography, Interventional
D003287:Contrast Media; D005290:Ferric Compounds; D005466:Fluorocarbons; D010087:Oxides; C069727:Sonazoid; D007501:Iron; C108042:perfluorobutane