Department of Radiology, Thomas Jefferson University.
Department of Medical Imaging and Radiation Sciences, Jefferson College of Health Professions Jefferson University.
Ultrasound Q. 2020 Sep;36(3):218-223. doi: 10.1097/RUQ.0000000000000513.
Transarterial chemoembolization (TACE) of hepatocellular carcinoma (HCC) often requires retreatment and identification of feeding vessels supplying the residual/recurrent tumor is an important step in treatment planning. The objective of this study was to determine if contrast-enhanced ultrasound (CEUS) could correctly identify the vessel supplying the residual tumor. To date, 69 patients have undergone CEUS follow-up of HCC TACE therapy at our institution as part of an ongoing institutional review board approved trial (NCT02764801). The CEUS examinations were performed before HCC TACE as well as 1 to 2 weeks and 1 month after treatment using a Logiq E9 scanner with a C1-6 curved array transducer (GE Healthcare, Waukesha, WI). The CEUS images obtained 2 weeks after initial TACE treatment were reviewed, and any feeding vessels supplying the residual HCC were identified. Digital subtraction angiograms during the retreatment TACE were used as reference standard for feeding vessel identification. Thirteen patients with viable HCC post-TACE were included in this study. In these cases, the sonographer correctly identified 85% (11 of 13) of the feeding vessels later confirmed by angiography. Importantly, one of the false-negative cases involved a segment 8 tumor with parasitic blood supply from the medial left hepatic artery. In this case, CEUS identified a largely treated tumor with some residual internal flow, but was unable to visualize any major hepatic vascularity supplying the tumor. In conclusion, CEUS appears to be a valuable tool for planning retreatment of residual HCC post-TACE.
经动脉化疗栓塞术（TACE）治疗肝细胞癌（HCC）常需多次治疗，明确为肿瘤残留/复发提供营养的供血血管是治疗计划的重要步骤。本研究旨在明确超声造影（CEUS）是否可正确识别供应残留肿瘤的血管。目前，本机构有 69 例 HCC TACE 治疗患者接受了 CEUS 随访，这是一项正在进行的机构审查委员会批准的试验的一部分（NCT02764801）。CEUS 检查在 HCC TACE 治疗前、治疗后 1 至 2 周和 1 个月进行，使用配备 C1-6 凸阵探头的 Logiq E9 扫描仪（GE Healthcare，Waukesha，WI）。回顾初始 TACE 治疗后 2 周的 CEUS 图像，并识别任何供应残留 HCC 的供血血管。将再次 TACE 治疗期间的数字减影血管造影作为供血血管识别的参考标准。本研究纳入了 13 例 TACE 后仍有存活 HCC 的患者。在这些病例中，超声医师正确识别了造影后血管造影证实的 85%（13 例中的 11 例）供血血管。重要的是，1 例假阴性病例涉及来源于左内叶动脉的寄生性供血的 8 段肿瘤。在这种情况下，CEUS 识别出大部分已治疗的肿瘤，内部仍有一些残留血流，但无法显示任何为肿瘤供血的主要肝血管。总之，CEUS 似乎是 TACE 后计划治疗残留 HCC 的有价值的工具。
