title: Comparison of volume perfusion computed tomography and contrast-enhanced ultrasound for assessment of therapeutic effect of transarterial chemoembolization in patients with hepatocellular carcinoma: a preliminary report.
abstract: BACKGROUND
  Evaluation of transarterial chemoembolization (TACE) by using contrast-enhanced ultrasound (CEUS) and volume perfusion computed tomography (VPCT) as methods that display tumor vascularization.
  
  
  OBJECTIVE
  To assess early results of TACE in patients with hepatocellular carcinoma (HCC) using CEUS and VPCT.
  
  
  METHODS
  Twenty patients with HCC underwent CEUS and VPCT in the pre- and post-TACE setting (1 day). Hepatic perfusion index (HPI), arterial liver perfusion (ALP), blood flow (BF), and blood volume (BV) were measured with VPCT. Peak intensity (PI), time-to-peak (TTP), and regional blood flow (RBF) were measured with CEUS. Sensitivity, specificity, negative and positive predictive values, and cutoff values for these parameters were calculated. Immediate tumor response after TACE was classified as responder or non-responder. Results were compared with those at follow-up after 2 and 4 months (FU2mo/FU4mo) following modified RECIST.
  
  
  RESULTS
  CEUS and VPCT showed comparable immediate post-TACE results in 20/20 cases. Complete response was confirmed in 10/20 patients at FU2mo and in 9/20 at FU4mo. For responders, reduction in HPI, ALP, BV, and BF at day 1 post TACE proved significant (P < 0.001). For non-responders, the course of all VPCT parameters proved non-significant. A cutoff of 40% reduction in HPI and a reduction in ALP of >29.6%, in BV of >41.4%, or in BF of >53.1% was indicative of response according to FU2mo. For responders only, changes in PI (P < 0.001), TTP (P < 0.01), and BF (P < 0.01) proved significant whereas for non-responders, all CEUS parameters proved non-significant.
  
  
  CONCLUSIONS
  CEUS performs equally to VPCT for assessment of early response to TACE in HCC by a lesion-by-lesion assessment and showed prognostic value at mid-term.
authors.affiliation: Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany sascha.kaufmann@med.uni-tuebingen.de.
authors.forename: Sascha
authors.initials: S
authors.lastname: Kaufmann
authors.affiliation: Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Schulze
authors.affiliation: Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Spira
authors.affiliation: Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany.
authors.forename: Marius
authors.initials: M
authors.lastname: Horger
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001810:Blood Volume; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D054893:Cone-Beam Computed Tomography / Q000379:methods*; D003287:Contrast Media; D005260:Female; D006801:Humans; D007472:Iohexol / Q000031:analogs & derivatives; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D012039:Regional Blood Flow; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D003287:Contrast Media; D007472:Iohexol; C038192:iopromide
keywords: Transarterial chemoembolization (TACE); contrast-enhanced ultrasound (CEUS); hepatocellular carcinoma (HCC); volume perfusion computed tomography (VPCT)