title: Evaluation of sorafenib for hepatocellular carcinoma by contrast-enhanced ultrasonography: a pilot study.
abstract: OBJECTIVE
  To determine the usefulness of arrival time parametric imaging (AtPI) using contrast-enhanced ultrasonography (CEUS) with Sonazoid in evaluating early response to sorafenib for hepatocellular carcinoma (HCC).
  
  
  METHODS
  Fourteen advanced HCC patients who received sorafenib 400/800 mg/d for at least 4 wk and were followed up by CEUS were enrolled in this study. CEUS was performed before treatment and 2 and 4 wk after treatment, and images of the target lesion in the arterial phase were recorded for each patient. The images were analyzed by AtPI. Color mapping (CM) images obtained by AtPI were compared before and after the treatment. In these CM images, the mean arrival time of the contrast agent in the region of interest from the starting point [mean time (MT)] was calculated. In each patient, differences between MT before and MT 2 and 4 wk after the treatment were compared with responses evaluated 4-8 wk after the treatment by dynamic computed tomography (CT), and statistical analysis was performed. Modified response evaluation criteria in solid tumors was used for the response evaluation.
  
  
  RESULTS
  In CM images both 2 and 4 wk after the treatment, delays in the arrival time of the contrast agent were noted in 8 of the 14 patients. In the other 6 patients, no color changes were observed in the tumor, or red and/or yellow increase, suggesting a decrease in blood flow velocity between images 2 and 4 wk after the treatment and those before the treatment. Dynamic CT could be performed 4-8 wk after the treatment in 13 of the 14 patients. Median differences in the MT were 1.13 s and 1.015 s, 2 and 4 wk after the treatment, respectively, in the 8 patients who showed stable disease (SD)/partial response (PR) on dynamic CT. Median differences in the MT were -0.39 s and -0.95 s, 2 and 4 wk after the treatment, respectively, in the 5 patients who showed progressive disease (PD). Differences in the median MT between SD/PR and PD groups were significant 2 and 4 wk after the treatment with P = 0.019 and P = 0.028, respectively.
  
  
  CONCLUSIONS
  AtPI by CEUS using Sonazoid is suggested to be useful for evaluating early responses to sorafenib.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Medical Center, Omori Hospital, Tokyo 143-8541, Japan.
authors.forename: Kazue
authors.initials: K
authors.lastname: Shiozawa
authors.forename: Manabu
authors.initials: M
authors.lastname: Watanabe
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Kikuchi
authors.forename: Takahide
authors.initials: T
authors.lastname: Kudo
authors.forename: Kenichi
authors.initials: K
authors.lastname: Maruyama
authors.forename: Yasukiyo
authors.initials: Y
authors.lastname: Sumino
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000201:enzymology; D003287:Contrast Media; D018450:Disease Progression; D005290:Ferric Compounds; D006801:Humans; D007501:Iron; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000201:enzymology; D008297:Male; D008875:Middle Aged; D009536:Niacinamide / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010087:Oxides; D010671:Phenylurea Compounds / Q000627:therapeutic use*; D010865:Pilot Projects; D011237:Predictive Value of Tests; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use*; D000077157:Sorafenib; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D000970:Antineoplastic Agents; D003287:Contrast Media; D005290:Ferric Compounds; D010087:Oxides; D010671:Phenylurea Compounds; D047428:Protein Kinase Inhibitors; C069727:Sonazoid; D009536:Niacinamide; D000077157:Sorafenib; D007501:Iron