Samuel Anna S, Qiao Andee, Merrill Christina D, Ball Chad G, Burrowes David, Wilson Stephanie R
University of Calgary, Calgary, Canada.
University of Toronto, Toronto, Canada.
Abdom Radiol (NY). 2025 Jun 4. doi: 10.1007/s00261-025-05046-z.
To appraise the inclusion of CEUS resection site evaluation in LI-RADS CEUS Nonradiation Treatment Response Assessment (TRA) v2024, currently applied for ablative therapy. We highlight the specific benefits afforded by CEUS in this effort.
Retrospective chart review was performed for 102 patients following surgical resection of HCC and ICC with post-operative CEUS at our center. Demographic data, surgical history, CT/MR findings, and resection site appearances on greyscale and CEUS were documented. The resection site where the tumor was originally positioned was designated as the treatment site and the resection margin as the perilesional tissue to establish equal assessment to TRA for ablative therapy. The morphology of the resection site was assigned one of three appearances, using novel descriptors: EDGE, VOID, or SURFACE DIVOT. Resection sites were evaluated for benign appearances, post-surgical changes, and tumor recurrence, and then categorized with a CEUS LI-RADS TRA score.
102 patients had 120 resection sites following 115 operations for 94 HCC and 8 ICC. On CEUS, 59 (49%) were characterized as EDGE, 46 (38%) as VOID, and 15 (13%) as SURFACE DIVOT, n = 120. 23 (19%) of resection sites were LR-TR VIABLE for recurrence, 91 (76%) LR-TR NONVIABLE, and 6 (5%) EQUIVOCAL, n = 120. Benign post-surgical changes developed in 23 (19%) resection sites, n = 120. 63/115 surgeries (55%) had post-operative recurrence, 40 De Novo, 17 Perilesional, and 6 Intralesional.
Our conclusions are in two categories: the first assessing the success of CEUS in the assessment of post-surgical treatment sites following liver resections. CEUS can successfully distinguish between unique post-operative appearances such as benign tissue migration, resection VOIDs resembling an intrinsic mass, and true recurrence. CEUS is thus strongly recommended for secondary surveillance following HCC and ICC resection. The second conclusion evaluates the inclusion of resection sites into the CEUS LI-RADS TRA algorithm for ablative therapies. In this regard, we believe that our study was highly successful, improving the perspective of all our staff as to what is important in the assessment of the post-surgical liver on CEUS and the method whereby this information is communicated to our referring clinicians.
评估在LI-RADS超声造影非辐射治疗反应评估（TRA）v2024中纳入超声造影对切除部位的评估，该版本目前用于消融治疗。我们强调了超声造影在此过程中的特定优势。
对我院102例接受肝癌（HCC）和肝内胆管癌（ICC）手术切除并术后行超声造影检查的患者进行回顾性病历审查。记录人口统计学数据、手术史、CT/MR检查结果以及灰度图像和超声造影下切除部位的表现。将肿瘤最初所在的切除部位指定为治疗部位，将切缘指定为病变周围组织，以便与消融治疗的TRA评估建立同等评估。使用新的描述符将切除部位的形态分为三种表现之一：边缘（EDGE）、空洞（VOID）或表面凹陷（SURFACE DIVOT）。对切除部位进行良性表现、术后改变和肿瘤复发评估，然后用超声造影LI-RADS TRA评分进行分类。
102例患者接受了115次手术，共120个切除部位，其中94例为HCC，8例为ICC。在超声造影下，120个切除部位中，59个（49%）表现为边缘（EDGE），46个（38%）表现为空洞（VOID），15个（13%）表现为表面凹陷（SURFACE DIVOT）。120个切除部位中，23个（19%）为LR-TR可复发，91个（76%）为LR-TR不可复发，6个（5%）为不确定。120个切除部位中有23个（19%）出现良性术后改变。115例手术中有63例（55%）术后复发，40例为新发，17例为病变周围复发，6例为病变内复发。
我们的结论分为两类：第一类评估超声造影在评估肝切除术后治疗部位方面的成功性。超声造影能够成功区分独特的术后表现，如良性组织移位、类似内在肿块的切除空洞以及真正的复发。因此，强烈推荐在HCC和ICC切除术后进行超声造影二次监测。第二类结论评估将切除部位纳入超声造影LI-RADS TRA消融治疗算法的情况。在这方面，我们认为我们的研究非常成功，提高了我们所有工作人员对超声造影评估术后肝脏时重要因素的认识，以及将这些信息传达给我们的转诊临床医生的方法。
