Moschouris Hippocrates, Kalokairinou-Motogna Mariana, Vrakas Spyros, Papadatou Aggeliki, Karagiannis Eyaggelos, Kiltenis Michail, Kladis-Kalentzis Konstantinos, Marmaridou Kyriaki, Papadogeorgopoulos Nikolaos, Malagari Katerina
Department of Radiology, Tzaneion General Hospital, Piraeus 18536, Greece.
Radiologist, Private Practice,15341, Athens, Greece.
Med Ultrason. 2017 Apr 22;19(2):134-142. doi: 10.11152/mu-891.
To assess the diagnostic efficacy of contrast-enhanced ultrasonography (CEUS) in the context of intrahepatic progression (IHP) of hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE).
Sixty HCC patients were prospectively included in the study. They were treated with transarterial chemoembolization (TACE)with doxorubicin-eluting microspheres (231 sessions). Imaging follow-up was performed 1 month after each session and at 3-6 month intervals after the last session of TACE and included CEUS and contrast-enhanced magnetic resonance (MR) imaging (reference modality). The diagnosis of IHP was based on mRECIST criteria and the respective findings of MR and CEUS were recorded, categorized and correlated.
A total of 441 CEUS studies were compared with the corresponding MR studies. During a follow-up period of 5-82 months (mean: 22 months), MR diagnosed 51 cases of IHP in 34/60 (56.6%) patients. CEUS correctly diagnosed 12/14 (85.7%) cases of IHP of target tumors, 2/5 (40%) cases of IHP of non-target tumors, 13/18 (72.2%) cases of distal and 6/9 (66.6%) cases of proximal new lesions, and 5/5 (100%) cases of major vessel involvement. On a per-lesion basis, CEUS was significantly inferior to MR in the detection of new lesions (p=0.002). No false positive CEUS diagnoses of IHP were observed. 54% of the diagnostic failures of CEUS were considered clinically significant.
In the long term evaluation of HCC post TACE, CEUS appears to have limitations in the detection of IHP, which are more prominent in the case of new lesions and of progressive non-target tumors.
评估超声造影（CEUS）在经动脉化疗栓塞术（TACE）后肝细胞癌（HCC）肝内进展（IHP）情况下的诊断效能。
前瞻性纳入60例HCC患者。他们接受了载阿霉素微球经动脉化疗栓塞术（TACE）（231个疗程）。每次疗程后1个月以及最后一次TACE疗程后每隔3 - 6个月进行影像学随访，包括CEUS和对比增强磁共振（MR）成像（参考模式）。IHP的诊断基于mRECIST标准，并记录、分类和关联MR和CEUS的各自发现。
共对441项CEUS研究与相应的MR研究进行了比较。在5 - 82个月（平均：22个月）的随访期内，MR诊断出34/60（56.6%）例患者中有51例IHP。CEUS正确诊断出14例靶肿瘤IHP中的12例（85.7%）、5例非靶肿瘤IHP中的2例（40%）、18例远处新病灶中的13例（72.2%）、9例近端新病灶中的6例（66.6%）以及5例大血管受累中的5例（100%）。在每个病灶基础上，CEUS在检测新病灶方面明显不如MR（p = 0.002）。未观察到CEUS对IHP的假阳性诊断。CEUS诊断失败的54%被认为具有临床意义。
在TACE后HCC的长期评估中，CEUS在检测IHP方面似乎存在局限性，在新病灶和进展性非靶肿瘤的情况下更为突出。
