title: Radiofrequency ablation for hepatocellular carcinoma: utility of conventional ultrasound and contrast-enhanced ultrasound in guiding and assessing early therapeutic response and short-term follow-up results.
abstract: The purpose of this study was to assess the efficacy of conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS) in guiding and assessing early therapeutic response to radiofrequency (RF) ablation for hepatocellular carcinomas (HCCs; up to 3 lesions, each ≤3 cm in diameter) and to report the short-term follow-up results. Between September 2011 and January 2013, 63 patients with 78 HCCs (≤3 cm) underwent conventional US- and CEUS-guided percutaneous RF ablation. CEUS was repeated after 20-30 min to assess therapeutic response, and local efficacy was further confirmed by contrast-enhanced magnetic resonance imaging (MRI) 1 mo after tumor ablation. Patients were followed periodically to look for local tumor or disease progression. Survival probability was estimated with the Kaplan-Meier method. Complete ablation was achieved for 76 (97.4%) of 78 HCCs in one (n = 73) or two (n = 3) sessions. No major complications were observed in any patient. The overall concordance in assessment of therapeutic efficacy of RF ablation between CEUS and MRI was 97.4% (76/78 tumors). The concordance test gave a value of κ = 0.74 (p < 0.001), indicating that CEUS had a high diagnostic agreement with MRI. During a mean follow-up of 20 mo, the local tumor progression rate was 5.3% (4/76 tumors). The 1-, 1.5- and 2-y cumulative survival rates were 98.4%, 96.1% and 92.6%, respectively. Although CEUS has some intrinsic limitations, the combined use of conventional US and CEUS provides a safe and efficient tool to guide RF ablation for HCCs 3 cm or smaller, with encouraging results in terms of survival rate and minimal complications. Moreover, the immediate post-procedural CEUS can be a reliable alternative to contrast-enhanced MRI for assessing the early therapeutic response to RF ablation.
authors.affiliation: Department of Ultrasound, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Du
authors.affiliation: Department of Ultrasound, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
authors.forename: Hong-Li
authors.initials: HL
authors.lastname: Li
authors.affiliation: Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. Electronic address: renjizhaibo@163.com.
authors.forename: Bo
authors.initials: B
authors.lastname: Zhai
authors.affiliation: Department of Radiology, University of Colorado Hospital, University of Colorado School of Medicine, Aurora, Colorado, USA.
authors.forename: Samuel
authors.initials: S
authors.lastname: Chang
authors.affiliation: Department of Ultrasound, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. Electronic address: fenghua-li@163.com.
authors.forename: Feng-Hua
authors.initials: FH
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D003287:Contrast Media; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome; D014463:Ultrasonography / Q000379:methods
chemical_list: D003287:Contrast Media
keywords: Contrast-enhanced ultrasound; Hepatocellular carcinoma; Liver; Radiofrequency ablation; Therapeutic response