Using Contrast-Enhanced Sonography to Assess the Effectiveness of Transcatheter Arterial Embolization for Hepatocellular Carcinoma

Abstract

OBJECTIVE. We evaluated the usefulness of contrast-enhanced wideband harmonic gray-scale sonography in assessing the therapeutic effects of transcatheter arterial embolization for patients with hepatocellular carcinoma and compared the findings of this imaging modality with those of helical CT. SUBJECTS AND METHODS. Twenty-nine patients with 39 hepatocellular carcinoma lesions were examined. We scanned lesions before and after therapy using contrast-enhanced wideband harmonic gray-scale sonography after injection of a galactose—palmitic acid contrast agent. All patients held their breath for 20-50 sec after injection while the vascularity of the tumor was observed. We then monitored tumor enhancement between 60 and 180 sec after injection with patients breath-holding for a few seconds. Lesions were considered to exhibit viable tumor residue if hypervascular enhancement was observed in the tumor. We compared this enhancement with helical CT findings. RESULTS. After therapy, 36 of the 39 lesions showed viable tumor residue on contrast-enhanced wideband harmonic gray-scale sonography, with no artifacts from iodized oil. Helical CT revealed a high-attenuation area in 12 of the 36 lesions, whereas 24 of the 36 lesions could not be evaluated for tumor residue as a result of artifacts from iodized oil accumulation in the tumor. The remaining three lesions showed complete deposition of iodized oil and complete necrosis on contrast-enhanced wideband harmonic gray-scale sonography. CONCLUSION. Contrast-enhanced wideband harmonic gray-scale sonography is useful in evaluating the therapeutic effects of transcatheter arterial embolization for hepatocellular carcinoma.