Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tenth People's Hospital of Tongji University, Shanghai 200072, China.
World J Gastroenterol. 2013 Feb 14;19(6):797-801. doi: 10.3748/wjg.v19.i6.797.
Percutaneous ablation using thermal or chemical methods has been widely used in the treatment of hepatocellular carcinoma (HCC). Nowadays, contrast-enhanced imaging modalities such as computed tomography (CT), magnetic resonance imaging (MRI), and contrast-enhanced ultrasound (CEUS) are widely used to evaluate local treatment response after ablation therapies. CEUS is gaining increasing attention due to its characteristics including real-time scanning, easy performance, lack of radiation, wide availability, and lack of allergy reactions. Several studies have documented that CEUS is comparable to CT or MRI in evaluating local treatment efficacy within 1 mo of treatment. However, little information is available regarding the role of CEUS in the follow-up assessment after first successful ablation treatment. Zheng et al found that in comparison with contrast-enhanced computed tomography (CECT), the sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of CEUS in detecting local tumor progression (LTP) were 67.5%, 97.4%, 81.8%, 94.4% and 92.3%, respectively, and were 77.7%, 92.0%, 92.4%, 76.7% and 84.0%, respectively for the detection of new intrahepatic recurrence. They concluded that the sensitivity of CEUS in detecting LTP and new intrahepatic recurrence after ablation is relatively low in comparison with CECT, and CEUS cannot replace CECT in the follow-up assessment after percutaneous ablation for HCC. These results are meaningful and instructive, and indicated that in the follow-up period, the use of CEUS alone is not sufficient. In this commentary, we discuss the discordance between CT and CEUS, as well as the underlying mechanisms involved. We propose the combined use of CT and CEUS which will reduce false positive and negative results in both modalities. We also discuss future issues, such as an evidence-based ideal imaging follow-up scheme, and a cost-effectiveness analysis of this imaging follow-up scheme.
经皮消融治疗（使用热或化学方法）已广泛应用于肝细胞癌（HCC）的治疗。目前，广泛应用于评估消融治疗后局部治疗反应的对比增强成像方式包括计算机断层扫描（CT）、磁共振成像（MRI）和对比增强超声（CEUS）。CEUS 由于具有实时扫描、易于操作、无辐射、可用性广、无过敏反应等特点，越来越受到关注。几项研究表明，CEUS 在治疗后 1 个月内评估局部治疗效果与 CT 或 MRI 相当。然而，关于 CEUS 在首次成功消融治疗后的随访评估中的作用，信息有限。Zheng 等人发现，与增强 CT（CECT）相比，CEUS 检测局部肿瘤进展（LTP）的灵敏度、特异性、阳性预测值、阴性预测值和总准确率分别为 67.5%、97.4%、81.8%、94.4%和 92.3%，检测新的肝内复发的灵敏度、特异性、阳性预测值、阴性预测值和总准确率分别为 77.7%、92.0%、92.4%、76.7%和 84.0%。他们得出结论，CEUS 检测消融后 LTP 和新的肝内复发的灵敏度与 CECT 相比相对较低，CEUS 不能在 HCC 经皮消融治疗后的随访评估中替代 CECT。这些结果具有重要意义和指导作用，表明在随访期间，单独使用 CEUS 是不够的。在本评论中，我们讨论了 CT 与 CEUS 之间的差异以及涉及的潜在机制。我们提出了联合使用 CT 和 CEUS，这将减少两种方式的假阳性和假阴性结果。我们还讨论了未来的问题，如基于证据的理想成像随访方案，以及这种成像随访方案的成本效益分析。
