Contrast-enhanced ultrasound evaluation of residual blood flow to hepatocellular carcinoma after treatment with transarterial chemoembolization using drug-eluting beads: a prospective study.
OBJECTIVE
To evaluate the accuracy and change over time of contrast-enhanced ultrasound (US) imaging for assessing residual blood flow after transarterial chemoembolization of hepatocellular carcinoma with drug-eluting beads at 2 different follow-up intervals.


METHODS
Data from 16 tumors treated by transarterial chemoembolization with drug-eluting beads were successfully obtained. As part of the study, patients provided consent to undergo contrast-enhanced US examinations the morning before embolization, 1 to 2 weeks after embolization, and the morning before follow-up contrast-enhanced magnetic resonance imaging (MRI) or computed tomography (CT) (1 month after embolization). Blinded review of contrast-enhanced US and MRI/CT studies were performed by 2 radiologists who evaluated residual flow as no change, partial change, or no residual flow. Inter- and intra-reader variability rates were calculated before discordant individual reads were settled by consensus.


RESULTS
The only adverse event reported during the contrast-enhanced US examinations was a single episode of transient back pain. Contrast-enhanced US at 1 to 2 weeks after embolization (n = 14) resulted in 100% sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. Contrast-enhanced US 1 month after embolization (n = 15) resulted in 75% sensitivity, 100% specificity, 100% positive predictive value, 92% negative predictive value, and 93% accuracy. Inter-reader agreement was 86% for contrast-enhanced US at 1 to 2 weeks, 93% for contrast-enhanced US at 1 month, and 100% for contrast-enhanced MRI/CT at 1 month, whereas intra-reader agreement was 71% for contrast-enhanced US at 1 to 2 weeks, 87% for contrast-enhanced US at 1 month, and 91% for MRI/CT.


CONCLUSIONS
Contrast-enhanced US imaging at 1 to 2 weeks after the procedure may be a viable alternative to MRI/CT for evaluating residual blood flow after transarterial chemoembolization with drug-eluting beads, albeit with a higher degree of reader variability.
Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania USA.
Colette M
CM
Shaw
Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania USA john.eisenbrey@jefferson.edu.
John R
JR
Eisenbrey
Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania USA.
Andrej
A
Lyshchik
Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania USA.
Patrick L
PL
O'Kane
Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania USA.
Daniel A
DA
Merton
Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania USA.
Priscilla
P
Machado
Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania USA.
Laura
L
Pino
Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania USA.
Daniel B
DB
Brown
Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania USA.
Flemming
F
Forsberg
D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D003287:Contrast Media; D003692:Delayed-Action Preparations / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D054855:Drug-Eluting Stents; D005260:Female; D006490:Hemostatics / Q000008:administration & dosage; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging* / Q000188:drug therapy; D015588:Observer Variation; D055420:Perfusion Imaging / Q000379:methods; D011379:Prognosis; D011446:Prospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography / Q000379:methods
D000970:Antineoplastic Agents; D003287:Contrast Media; D003692:Delayed-Action Preparations; D006490:Hemostatics; D004317:Doxorubicin
contrast-enhanced ultrasound; drug-eluting beads; hepatocellular carcinoma; transarterial chemoembolization