title: Unenhanced and contrast-enhanced ultrasonography during hepatic transarterial embolization and chemoembolization with drug-eluting beads.
abstract: The purpose of this study was to describe and evaluate the findings of unenhanced ultrasonography (US) and contrast-enhanced ultrasonography (CEUS) when these modalities are applied during transarterial embolization (TAE) or transarterial chemoembolization (TACE) of liver tumors. Sixteen tumors (9 hepatocellular carcinomas, 5 metastases from colorectal cancer, and 2 hemangiomas) were treated with TAE with microspheres and/or TACE with drug-eluting beads. All of these lesions were studied with intraprocedural unenhanced US and 12 were studied with intraprocedural CEUS. For the latter, a second-generation echo-enhancer (SonoVue; Bracco, Milan, Italy) and a low mechanical index technique were used. Intraprocedural findings were classified according to an arbitrary scale and were compared with pretreatment imaging (CEUS and computed tomography or CEUS and magnetic resonance imaging), with postembolization angiography, and with follow-up results. On unenhanced intraprocedural US, 13 of 16 tumors demonstrated intralesional high-level echoes of varying extent. These feature correlated poorly (r = 0.33, p = 0.097) with and generally underestimated the actual extent of necrosis. Exceptionally, high-level echoes that occupied the largest part of the treated lesions were associated with >50% tumor necrosis. Intraprocedural CEUS clearly depicted immediate partial or complete disappearance of tumor enhancement as a result of TAE/TACE. Three of 6 tumors with complete devascularization on postembolization angiogram showed residual enhancement on intraprocedural CEUS. Intraprocedural CEUS findings correlated closely (r = 0.91, p = 0.002) with follow-up findings. Intraprocedural sonography, particularly with echo-enhancers, could be used for intraprocedural monitoring in selected cases of liver tumors that undergo TAE or TACE.
authors.affiliation: Department of Radiology, General Hospital Tzanio, Zanni and Afentouli 1 str, 18536 Piraeus, Greece. hipmosch@gmail.com
authors.forename: Hippocrates
authors.initials: H
authors.lastname: Moschouris
authors.forename: Katerina
authors.initials: K
authors.lastname: Malagari
authors.forename: Ioannis
authors.initials: I
authors.lastname: Kornezos
authors.forename: Marina Georgiou
authors.initials: MG
authors.lastname: Papadaki
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Gkoutzios
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Matsaidonis
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography; D000970:Antineoplastic Agents / Q000008:administration & dosage; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D003287:Contrast Media / Q000008:administration & dosage; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D010743:Phospholipids / Q000008:administration & dosage; D013459:Sulfur Hexafluoride / Q000008:administration & dosage; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*
chemical_list: D000970:Antineoplastic Agents; D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride