Galasso Linda, Iaccarino Jacopo, Esposto Giorgio, Giansanti Gabriele, Mignini Irene, Borriello Raffaele, Vidili Gianpaolo, Gasbarrini Antonio, Ainora Maria Elena, Zocco Maria Assunta
CEMAD Digestive Disease Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University of Rome, 00168 Rome, Italy.
Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy.
Diagnostics (Basel). 2025 May 29;15(11):1380. doi: 10.3390/diagnostics15111380.
Transarterial chemoembolization (TACE) is a well-established treatment for intermediate-stage hepatocellular carcinoma (HCC), shown through randomized trials to improve survival compared to supportive care in patients with large, unresectable tumors who are not candidates for liver transplantation or local ablation. As the most commonly used transarterial intervention, TACE is also employed to downstage advanced HCC, allowing certain patients to become eligible for orthotopic liver transplantation under the Milan criteria. Despite its widespread use, variability in therapeutic outcomes highlights the need for improved procedural guidance. Recent advancements in intra-arterial contrast-enhanced ultrasound (IA CEUS) offer new opportunities to enhance TACE precision with real-time imaging that provides superior visualization of tumor vasculature and chemoembolic agent distribution. This review explores the role of IA CEUS in refining TACE for HCC, emphasizing its potential to increase intraprocedural accuracy and reduce the risk of incomplete tumor embolization. The enhanced spatial resolution of IA CEUS enables real-time tracking of embolic agent dispersion within tumor vessels, which could improve therapeutic efficacy by ensuring complete tumor targeting and minimizing non-target embolization. Additionally, IA CEUS may decrease procedural complications by allowing dynamic adjustment of embolic delivery based on real-time imaging feedback. By reviewing existing evidence on IA CEUS applications in TACE, this article highlights the modality's potential to transform treatment protocols, improve outcomes, and expand the patient population eligible for TACE.
经动脉化疗栓塞术（TACE）是治疗中期肝细胞癌（HCC）的一种成熟疗法，随机试验表明，对于无法切除的大肿瘤患者，若不符合肝移植或局部消融条件，与支持性治疗相比，TACE可提高生存率。作为最常用的经动脉介入治疗方法，TACE还用于降低晚期HCC的分期，使某些患者符合米兰标准下的原位肝移植条件。尽管TACE应用广泛，但治疗效果的差异凸显了改进操作指导的必要性。动脉内对比增强超声（IA CEUS）的最新进展提供了新的机会，可通过实时成像提高TACE的精准度，这种成像能更好地显示肿瘤血管系统和化疗栓塞剂的分布。本综述探讨了IA CEUS在优化HCC的TACE治疗中的作用，强调其提高术中准确性和降低肿瘤栓塞不完全风险的潜力。IA CEUS更高的空间分辨率能够实时追踪栓塞剂在肿瘤血管内的扩散情况，通过确保完全靶向肿瘤并将非靶向栓塞降至最低，从而提高治疗效果。此外，IA CEUS可根据实时成像反馈动态调整栓塞剂的输送，从而减少手术并发症。通过回顾IA CEUS在TACE中应用的现有证据，本文强调了这种技术在改变治疗方案、改善治疗效果以及扩大适合TACE治疗的患者群体方面的潜力。
