Gori Giulia, Mazza Stefano, Ciccioli Carlo, Bartolotta Erica, Alfieri Daniele, Torello Viera Francesca, Mauro Aurelio, Scalvini Davide, Veronese Letizia, Barteselli Chiara, Sgarlata Carmelo, Bardone Marco, Rovedatti Laura, Agazzi Simona, Strada Elena, Pozzi Lodovica, Vanoli Alessandro, Bortolotto Chandra, Facciorusso Antonio, Di Sabatino Antonio, Ravetta Valentina, Anderloni Andrea
Department of Internal Medicine and Medical Therapeutics, University of Pavia, 27100 Pavia, Italy.
Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy.
Cancers (Basel). 2025 Aug 28;17(17):2808. doi: 10.3390/cancers17172808.
Contrast-enhanced computed tomography (CECT) is considered the gold standard for assessing therapeutic response in hepatocellular carcinoma (HCC) following locoregional treatments. More recently, contrast-enhanced ultrasound (CEUS) has emerged as a promising, cost-effective alternative, although evidence supporting its use in this context remains limited. This study aimed to evaluate the diagnostic performance of CEUS compared to CECT in assessing local response of HCC nodules treated with radiofrequency ablation (RFA).
We retrospectively analyzed a consecutively enrolled cohort of patients undergoing RFA for HCC at IRCCS San Matteo Hospital, Pavia, between January 2017 and January 2022. Follow-up imaging included both CEUS and CECT at predefined time points. Imaging follow-up, MRI, and/or histological results were used as the reference standard to compare CEUS and CECT.
A total of 55 patients (mean age 74 years, 64% male) with 79 HCC nodules were included. Complete response was observed in 57 nodules (72%), all correctly identified by CEUS, whereas 4 cases were misclassified by CECT. Among the 22 nodules (28%) with residual disease, CEUS correctly identified 15 cases, while 17 were detected by CECT; notably, CEUS identified 4 lesions missed by CECT, which identified 6 missed at CEUS. Combined, the two modalities detected 21 (96%) out of 22 residual tumors. CEUS showed a sensitivity of 68.1%, specificity of 100%, and diagnostic accuracy of 91.1%, compared to 68.0%, 98.1%, and 88.6%, respectively, for CECT, with no significant differences.
CEUS is a reliable, non-inferior, and complementary modality to CECT for evaluating treatment response of HCC following RFA. Larger prospective studies are warranted to further define its role in clinical practice.
对比增强计算机断层扫描（CECT）被认为是评估肝细胞癌（HCC）局部区域治疗后治疗反应的金标准。最近，对比增强超声（CEUS）已成为一种有前景、性价比高的替代方法，尽管支持其在此背景下使用的证据仍然有限。本研究旨在评估CEUS与CECT相比在评估经射频消融（RFA）治疗的HCC结节局部反应中的诊断性能。
我们回顾性分析了2017年1月至2022年1月期间在帕维亚圣马泰奥医院IRCCS接受HCC射频消融治疗的连续入组患者队列。随访成像包括在预定时间点进行的CEUS和CECT。成像随访、MRI和/或组织学结果用作比较CEUS和CECT的参考标准。
共纳入55例患者（平均年龄74岁，64%为男性），有79个HCC结节。57个结节（72%）观察到完全缓解，所有这些结节均被CEUS正确识别，而4例被CECT误分类。在22个（28%）有残留疾病的结节中，CEUS正确识别出15例，而CECT检测到17例；值得注意的是，CEUS识别出4个CECT漏诊的病变，而CECT识别出6个CEUS漏诊的病变。两种方法联合检测出22个残留肿瘤中的21个（96%）。CEUS的敏感性为68.1%，特异性为100%，诊断准确性为91.1%，而CECT的敏感性、特异性和诊断准确性分别为68.0%、98.1%和88.6%，差异无统计学意义。
CEUS是评估RFA后HCC治疗反应的一种可靠、非劣效且互补的方法。需要开展更大规模的前瞻性研究以进一步明确其在临床实践中的作用。
