Contrast-enhanced ultrasound evaluation of residual blood flow to hepatocellular carcinoma after treatment with transarterial chemoembolization using drug-eluting beads: a prospective study

• Published in: Journal of ultrasound in medicine Vol. 34; no. 5; pp. 859 - 867
• Main Authors: Shaw, Colette M, Eisenbrey, John R, Lyshchik, Andrej, O'Kane, Patrick L, Merton, Daniel A, Machado, Priscilla, Pino, Laura, Brown, Daniel B, Forsberg, Flemming
• Format: Journal Article
• Language: English
• Published: England 01.05.2015
• Subjects: Aged; Antineoplastic Agents - administration & dosage; Carcinoma, Hepatocellular - diagnostic imaging; Carcinoma, Hepatocellular - drug therapy; Chemoembolization, Therapeutic - methods; Contrast Media; Delayed-Action Preparations - administration & dosage; Doxorubicin - administration & dosage; Drug-Eluting Stents; Female; Hemostatics - administration & dosage; Humans; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - drug therapy; Male; Middle Aged; Neovascularization, Pathologic - diagnostic imaging; Neovascularization, Pathologic - drug therapy; Observer Variation; Perfusion Imaging - methods; Prognosis; Prospective Studies; Treatment Outcome; Ultrasonography - methods; drug-eluting beads; transarterial chemoembolization; contrast-enhanced ultrasound; hepatocellular carcinoma
• ISSN: 0278-4297; 1550-9613
• DOI: 10.7863/ultra.34.5.859

To evaluate the accuracy and change over time of contrast-enhanced ultrasound (US) imaging for assessing residual blood flow after transarterial chemoembolization of hepatocellular carcinoma with drug-eluting beads at 2 different follow-up intervals. Data from 16 tumors treated by transarterial chemoembolization with drug-eluting beads were successfully obtained. As part of the study, patients provided consent to undergo contrast-enhanced US examinations the morning before embolization, 1 to 2 weeks after embolization, and the morning before follow-up contrast-enhanced magnetic resonance imaging (MRI) or computed tomography (CT) (1 month after embolization). Blinded review of contrast-enhanced US and MRI/CT studies were performed by 2 radiologists who evaluated residual flow as no change, partial change, or no residual flow. Inter- and intra-reader variability rates were calculated before discordant individual reads were settled by consensus. The only adverse event reported during the contrast-enhanced US examinations was a single episode of transient back pain. Contrast-enhanced US at 1 to 2 weeks after embolization (n = 14) resulted in 100% sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. Contrast-enhanced US 1 month after embolization (n = 15) resulted in 75% sensitivity, 100% specificity, 100% positive predictive value, 92% negative predictive value, and 93% accuracy. Inter-reader agreement was 86% for contrast-enhanced US at 1 to 2 weeks, 93% for contrast-enhanced US at 1 month, and 100% for contrast-enhanced MRI/CT at 1 month, whereas intra-reader agreement was 71% for contrast-enhanced US at 1 to 2 weeks, 87% for contrast-enhanced US at 1 month, and 91% for MRI/CT. Contrast-enhanced US imaging at 1 to 2 weeks after the procedure may be a viable alternative to MRI/CT for evaluating residual blood flow after transarterial chemoembolization with drug-eluting beads, albeit with a higher degree of reader variability.