Evaluation of tumor response to intra-arterial chemoembolization of hepatocellular carcinoma: Comparison of contrast-enhanced ultrasound with multiphase computed tomography.
OBJECTIVE
To compare the diagnostic accuracy of contrast-enhanced ultrasound (CEUS) with that of multiphase computed tomography (CT) in the evaluation of tumor response to transarterial chemoembolization (TACE) of hepatocellular carcinoma (HCC).


METHODS
Fifty patients (41 men, 9 women; mean age, 53 years±12.5 [SD]) with a total of 70 HCCs (mean size, 5cm±3 [SD]) were evaluated. Post-TACE therapeutic assessment of HCC was done at 4 weeks. Patients with TACE done earlier and reporting with suspicion for recurrence were also included. Patients with hepatic masses seen on ultrasound were enrolled and subjected to CEUS, multiphase CT and magnetic resonance imaging (MRI). Hyperenhancing area at the tumor site on arterial phase of CEUS/multiphase CT/MRI was termed as residual disease (RD), the patterns of which were described on CEUS. Diagnostic accuracies of CEUS and MPCT were compared to that of MRI that was used as the reference standard.


RESULTS
CEUS detected RD in 43/70 HCCs (61%). RD had a heterogeneous pattern in 22/43 HCCs (51%). Sensitivities of CEUS and multiphase CT were 94% (34/36; 95% CI: 81-99%) and 50% (18/36; 95% CI: 33-67%) respectively. Significant difference in sensitivity was found between CEUS and multiphase CT (P=0.0001). CEUS and multiphase CT had 100% specificity (95% CI: 83-100%).


CONCLUSIONS
CEUS is a useful technique for detecting RD in HCC after TACE. For long term surveillance, CEUS should be complemented with multiphase CT/MRI for a comprehensive evaluation.
Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India. Electronic address: shashi.aiims@gmail.com.
S B
SB
Paul
Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India.
E
E
Dhamija
Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India.
S R
SR
Gamanagatti
Department of Biostatistics, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India.
V
V
Sreenivas
Department of Gastroenterology, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India.
D P
DP
Yadav
Department of Gastroenterology, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India.
S
S
Jain
Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India.
Shalimar
Department of Gastroenterology, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India.
S K
SK
Acharya
D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D003287:Contrast Media; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
D003287:Contrast Media
Comparative studies; Contrast-enhanced ultrasound; Hepatocellular carcinoma; Multiphase computed tomography (CT); Trans-arterial chemoembolization